Introduction to IHE ACCA IHE Workshop 2007 Jon

Introduction to IHE ACCA IHE Workshop 2007 Jon Elion MD, FACC Associate Professor of Medicine, Brown University Co-Chair, IHE-Cardiology Planning Committee

Overview of Today’s Workshop Introduction to IHE Review of Profiles Part 1: Ø Ø Cardiology Workflows: Cath, Echo Stress Content Display Requirements: Stress Echo, Stress Break Review of Profiles Part 2: Ø Ø Ø ECG for Display Nuclear Cardiology Implantable Device Cardiac Observations Displayable reports (status updates) XDS and related profiles IHE’s Relationship to government initiatives. Interactive RFP Session 2

Why Standards Are Important Bernstein Thomson-Houston (arc current) Heisler Municipal Edison Thomson-Houston (alternating current) Municipal Bernstein 3

IHE • … is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information • … promotes the coordinated use of established standards such as DICOM and HL 7 to address specific clinical needs • … leads to systems that communicate better, are easier to implement, and enable care providers to use information more effectively 4

Goals of IHE • • • Speed up the rate and quality of integration in healthcare environments Foster communication among vendors and care providers Improve the efficiency and effectiveness of clinical practice Improve interoperability among care domains and build foundation for the EHR Integration solutions within the healthcare enterprise and across healthcare enterprises 5

Who is IHE? IHE is a joint initiative among: Ø American College of Cardiology (ACC), Echocardiography (ASE) Ø American College of Physicians Ø Radiological Society of North America (RSNA) Ø Healthcare Information Management Systems Society (HIMSS) Ø GMSIH, HPRIM, JAHIS (laboratory) Ø American Society of Ophthalmology Ø And many more…. Began in 1997 in Radiology (RSNA) and IT (HIMSS) International effort: IHE- Europe and IHE-Japan Additional sponsors for Cardiology including ASE, ESC, ASNC, SCA&I, HRS and more 6

IHE Participants • Societies Representing Healthcare Segments: RSNA, HIMSS, ACC, ASE, ACP… • Users: Clinicians, Medical Staff, Administrators, CIOs, … • Consultants • Imaging and Information Systems Vendors • Standards Development Organizations: DICOM, HL 7, ASTM, … 7

IHE Deliverables • Venue for communication (committees) • Integration Profiles (what needs to be done) • Technical Framework (how to do it) • Connect-a-thon (actually do it!) • Public Demonstrations (example: ACC ’ 07 for Cardiology) • Tools for Acquiring Conformant Products (RFP’s) 8

Standards-Based Integration Professional Societies Sponsorship Healthcare Providers & Vendors Healthcare IT Standards General IT Standards HL 7, DICOM, etc. Internet, ISO, etc. IHE Process Interoperable Healthcare IT Solution Specifications Healthcare IT Interoperable IHE Integration Profile Specifications Healthcare IT Solution Interoperable IHE Integration Profile Specifications Solution IHE Integration Profile 9

IHE Organizational Structure IHE (International) Strategic Development Committee Sponsor Co-Chairs supervises reports Global IHE North America IHE Domain-related Planning and Technical Committees IHE Europe IHE Asia/Oceania Regional & National Deployment Delegates contribute Participants Global Development: Radiology, Interoperability IT Infrastructure, Cardiology, Laboratory, Eye Care, Patient Care Coordination Patient Care Devices 10

Standards Adoption Process Product IHE Integration Statement IHE Connect-a-thon Results IHE Technical Framework Standards IHE Integration Profiles Product With IHE Connect-a-thon IHE Integration Profiles at the heart of IHE : Ø Ø Ø IHE Demonstration Easy to Integrate Products User Site RFP Detailed selection of standards and options each solving a specific integration problem A growing set of effective provider/vendor agreed solutions Vendors can implement with ROI Providers can deploy with stability Process started in 1998; continuously improved 11

What is IHE NOT • IHE is not a standard You conform to a standard ü You comply with IHE Technical Framework • IHE is not a standards development organization ü • IHE is not a certifying authority • IHE is not simply a demonstration project Demos are only one means to the end: Adoption ü Backed up by documentation, tools, testing, and publication of information • IHE is not just for radiology any more! ü 12

IHE Annual Cycle 1. Clinicians identify clinical problems to be addressed -“Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL 7) 3. Vendors implement the technical specification and participate in the “Connectathon” 4. Demonstrations at trade shows (ACC, HIMSS, etc. ) 5. Vendors publish IHE Integration Statements 6. Customers reference IHE profiles in RFP’s 13

Cardiology Example (Year 1) The Planning Committee identified three initial clinical problems to be addressed: 1. ► 2. ► 3. ► The ability to view an ECG from many locations - quickly and easily “Retrieve ECG for Display” Lab systems integration of patient, order, and procedure information in an Echo Lab, including mobile echo “Echocardiography Workflow” Lab systems integration of patient, order, and procedure information in a Cath Lab, including angio, hemo, and IVUS “Cardiac Catheterization Workflow” 14

IHE Annual Cycle 1. Clinicians identify clinical problems to be addressed -“Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL 7) 3. Vendors implement the technical specification and participate in the “Connectathon” 4. Demonstrations at trade shows (ACC, HIMSS, etc. ) 5. Vendors publish IHE Integration Statements 6. Customers reference IHE profiles in RFP’s 15

IHE Technical Frameworks Detailed standards implementation guides: ØCardiology ØIT Infrastructure ØLab ØRadiology ØEye Care ØPatient Care Coordination ØPatient Care Devices 16

Organization of Frameworks Volume 1: Integration Profiles Ø Describes clinical need and use cases Ø Identifies the actors and transactions Volume 2+ of Technical Framework Ø Provides implementation specification for each transaction by specific reference to Standards 17

Transactions & Actors: Example Report Creator Encapsulated Report or Dept Scheduler / Order Filler Report Completion Notify Report Manager Report Reference Enterprise Report Repository Encapsulated Report Storage Commitment Patient Identity Feed Patient Demographics Source Patient Demographics Consumer Report Repository Information Source Retrieve Document for Display Web Display Encapsulated Report Query Encapsulated Report Retrieve [CARD-11] Report Reader 18

IHE Annual Cycle 1. Clinicians identify clinical problems to be addressed -“Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL 7) 3. Vendors implement the technical specification and participate in the “Connectathon” 4. Demonstrations at trade shows (ACC, HIMSS, etc. ) 5. Vendors publish IHE Integration Statements 6. Customers reference IHE profiles in RFP’s 19

IHE Connectathon • Open invitation to vendor community • Advance testing tools (MESA) • Testing organized and supervised by project management team • Thousands of cross-vendor tests performed • Results recorded and published 20

IHE Connectathon, January 2007 165 systems from 79 vendors, 3500 monitored test cases Workflow: Cath (22) and Echo (20) Evidence Documents (measurement interchange): 13 Nuclear Cardiology: 12 Stress Testing Workflow: 15 Retrieve ECG for Display: 5 Cross Enterprise Document Sharing (XDS): 45 21

IHE Connectathon 22

Ohmagawd – we’re next! Egad! They’ve totally misunderstood the Technical Framework! Looks like it’s working just fine! 23

IHE Annual Cycle 1. Clinicians identify clinical problems to be addressed -“Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL 7) 3. Vendors implement the technical specification and participate in the “Connectathon” 4. Demonstrations at trade shows (ACC, HIMSS, etc. ) 5. Vendors publish IHE Integration Statements 6. Customers reference IHE profiles in RFP’s 24

Total ACC attendance is typically over 28, 000. 25

2005: Over 1, 000 visitors from 47 countries attended the IHE presentations and demonstrations. 26

IHE Annual Cycle 1. Clinicians identify clinical problems to be addressed -“Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL 7) 3. Vendors implement the technical specification and participate in the “Connectathon” 4. Demonstrations at trade shows (ACC, HIMSS, etc. ) 5. Vendors publish IHE Integration Statements 6. Customers reference IHE profiles in RFP’s 27

IHE Integration Statement 28

IHE Annual Cycle 1. Clinicians identify clinical problems to be addressed -“Integration Profiles” 2. Engineers from vendors collaborate to define technical specification (using existing standards such as DICOM and HL 7) 3. Vendors implement the technical specification and participate in the “Connectathon” 4. Demonstrations at trade shows (ACC, HIMSS, etc. ) 5. Vendors publish IHE Integration Statements 6. Customers reference IHE profiles in RFP’s 29

RFPs & IHE Integration • Be Brief: “The system must support DICOM” • Be Effective: ü “The system must support the following DICOM services (see following 100 pages of specs)” • Be Both: ü “The system must support IHE Scheduled Workflow as an Acquisition Modality” • IHE Integration Statements: ü ü “Version 2. 1 of the Acme Road. Runner Trap supports IHE Scheduled Workflow as an Acquisition Modality” 30

Request for Proposals (RFPs) Incorporate IHE framework into RFP documents & product selection Much easier to specify an IHE Integration Profile !! than detailed technical specs ten f ud Lo O & Ø “Device must support IHE Echo Integration Profile, and vendor must supply an IHE tion Integration Statement. ” gra nte to evaluate your current Use IHE framework EI workflow, even if not buying now r IH fo sk A Vendors build product functions that are requested by customers 31

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