1、IHEIntegrating the Healthcare EnterpriseGeneral Overview (again once)Scheduled Workflow Patient Information Reconciliation Consistent Presentation of Images Key Image NotesHow to deal with IHE-itemsProf. Berthold B. WeinUser co-chair IHE-EuropeIHEIntegrating the HealthcareIHE: short overview and sch

2、eduled workflow and patient information reconciliationProf. Berthold B. Wein, MDUser co-chair IHE-EuropePraxisgemeinschaft KapuzinerkarreeUniversity Hospital Aachen GermanyIHE: short overview and scheHealthcare IT Main ObstaclesLack of financial funding :IT : 2.3% of hospital budget (in other indust

3、ries : 2.8%) GartnerLack of national/regional guidelines & incentivesLack of access to IT infrastructureLack of solutions that meet clinical needsLack of adequate healthcare IT standards and interoperabilityIntegration cost : 20% of hospital IT budgetIHE scopeHealthcare IT Main ObstaclesIHE MissionI

4、mprove the quality and cost of healthcare by removing the interoperability barriersContinuity & Integrity of Patient InformationClinical Workflow OptimizationProvide an open interoperability framework, based on existing standardsEnable cross-vendor environmentMake life more easy for the users and ve

5、ndorsIHE = Integrating the Healthcare EnterpriseIHE MissionImprove the qualityseamless information flowfrom system to systemwithin and across departmentswithin and across hospital bordersaccess to all vital clinical data at the right time and at the right placeworkflow optimisationelimination of red

6、undancies in data entryfoster openess of productsless problems in interoperability and understandingBenefits of IHEseamless information flowBenefIHE is based onTechnical frameworkThe bible for interoperability, the hope for us/vndrsConnect-a-thonThe real-life test of systems, the hell for productsDe

7、monstrationThe show to others, how it worksIntegration statementsThe advertising to users, enabling understandingSucessThe teaching by othersIHE is based onTechnical frameIHE MembersUsersClinicians, Medical Staff, Administrators, CIOs, Vendors Information Systems & Imaging Equipment (80 vendors)Soci

8、eties Representing Healthcare SegmentsEAR, ECR, ESC, Other Professional SocietiesGovernmental agencies e.g. GMSIHActive liaison with Standards Development Organizations (SDOs)HL7, DICOM, ASTM, others IHE MembersUsersYear nDemosIHE TF Development ProcessYear nConnectathonYear nTrial ImplementationYea

9、r N Technical FrameworkStandardsAssessmentYear nGoalsYear n-1Year nIHE TF Development ProceIHE - Connect-a-thonEuropeanApplication rather than protocol testing real lifeParis, Aachen, Padua, Nordwijkerhout200120022003200420052001, Paris, F: 13 vendors 20 sys2002, Paris, F: 33 vendors 60 sys2003, Aac

10、hen, D:47 vendors 85 sys2004, Padova, I: 49 vendors 80 sysIHE - Connect-a-thonEuropeanApIHE - DemonstrationsF D I UK EURFirst experiences with IHE-compliant systemsduring hands-on trials on user congressesIHE - DemonstrationsF D I UIHE Integration StatementVendorProduct Name VersionDateHuge Imaging

11、Medical SystemsIntegrateRAD V2.312 Oct 2002Integration Profiles ImplementedActors ImplementedOptions ImplementedScheduled WorkflowImage Manager/ArchiveenoneImage DisplayPerformed Procedure StepOrder FillerPPS Exception ManagementSimple Image and Numeric ReportReport CreatornoneLink to vendor IHE pag

12、ewww.HImedicalsystems.fake/iheLinks to Standards Conformance Statements of the ImplementationHL7www.HImedicalsystems.fake/hl7 DICOMwww.HImedicalsystems.fake/dicom/integrateRAD.pdfIHE Integration StatementIHE Integration StatementVendoIHE EuropaNational initiativesWell establishedF, D, I, NL, GBIn or

13、ganisationDK, N, EbeginningSIHE EuropaNational initiativesTechnical FrameworkIntegration ProfilesPractical solutions for daily-work integration problemsPrecise definitions of actors and transactionsExact requirements for open standardsConversion tablesDefining correspondant fieldsDescribing characte

14、ristics of the fieldsUse casesDepicting daily scenarios for easy understandingTechnical FrameworkIntegrationTF and IHE DomainsRadiologyLaboratory MedicineInformation Technology InfrastructureCardiologyGeneral practicionersPathologyDermatologyTF and IHE DomainsRadiologyIntegration ProfilesSolving dai

15、ly life problems by standardsExactly defining solutions and parts for succeeding in interoperabilityReduce the problem to actors transactionstherefore making it independent from real world limitations and offering a global strategy for solutionIntegration ProfilesSolving daLaboratory Medicine 2004-2

16、005Laboratory Scheduled Workflow (LSWF) done in 2003Tests performed by a laboratory for an identified inpatient or outpatientLaboratory Patient Information Reconciliation (LPIR) year 2004Tests performed on an unidentified or misidentified patientLaboratory Code Set Distribution (LCSD) year 2004Shari

17、ng the batteries and tests code sets throughout the enterpriseLaboratory Device Automation (LDA) year 2004Pre-analytic process, analysis and post-analytical treatmentLaboratory Point Of Care Testing (LPOCT) year 2004Tests performed on point of care or patients bedsideLaboratory Medicine 2004-2005LIH

18、E IT Infrastructure 2004-2005Enterprise User AuthenticationProvide users a single nameand centralized authentication processacross all systemsRetrieve Information for DisplayAccess a patients clinical information and documents in a format ready to be presentedto the requesting userRetrieve Informati

19、on for DisplayAccess a patients clinical information and documents in a format ready to be presentedto the requesting userPatient Identifier Cross-referencing for MPIMap patient identifiers across independent identification domainsPatient Identifier Cross-referencing for MPIMap patient identifiers a

20、cross independent identification domainsSynchronize multiple applications on a desktop to the same patientPatient Synchronized ApplicationsConsistent TimeCoordinate time across networked systemsAudit Trail & Node AuthenticationCentralized privacy audit trail and node to node authentication to create

21、 a secured domain.Patient Demographics QueryPersonnel White PageAccess to workforcecontact informationCross-Enterprise Document SharingRegistration, distribution and access across health enterprises of clinical documents forming a patient electronic health record IHE IT Infrastructure 2004-200Radiol

22、ogy 2000-2005Access to Radiology InformationPatient Information Reconciliation Consistent Presentation of ImagesBasic SecurityEvidence DocumentKey Image NotesSimple Image and Numeric ReportPresentation of Grouped ProceduresPost-Processing WorkflowReporting WorkflowCharge PostingScheduled WorkflowRad

23、iology 2000-2005Access to RRadiology 2000-2005Access to Radiology InformationPatient Information Reconciliation Consistent Presentation of ImagesBasic SecurityEvidence DocumentKey Image NotesSimple Image and Numeric ReportPresentation of Grouped ProceduresPost-Processing WorkflowReporting WorkflowCh

24、arge PostingScheduled WorkflowRadiology 2000-2005Access to RRadiology 2000-2005Access to Radiology InformationPatient Information Reconciliation Consistent Presentation of ImagesBasic SecurityEvidence DocumentKey Image NotesSimple Image and Numeric ReportPresentation of Grouped ProceduresPost-Proces

25、sing WorkflowReporting WorkflowCharge PostingScheduled WorkflowRadiology 2000-2005Access to RProblemsIt is very hard to get the ball teed-up for the technologist on the modality.Paper based workflow with data re-entryRisk of errorInefficient Stale informationChanges between time of print and time of

26、 data entryCancel ordersGeneric Order / Order ChangesAfter the tech wacks the ball, how do I let all systems know where it went.When are things ready to be read (PACS)When can things be deleted (Modality)How do I know what to bill (RIS)When do I wake up the referring physicianProblemsIt is very hard

27、 to getKey IHE ConceptsGeneralized Systems= ActorsInteractions between Actors= TransactionsProblem/Solution Scenarios= Integration Profiles For each Integration Profile:the context is described (which real-world problem)the actors are defined (what systems are involved)the transactions are defined (

28、what must they do)Key IHE ConceptsGeneralized SyThe Product World.Poduct XYZfrom Vendor TADTMPIHISThe Product World.Poduct XYZThe IHE World.IHE ActorActorActorActorIHETransactionIHETransactionIHETransactionIHE ActorThe IHE World.IHE ActorActorHISMPIADTMapping IHE to ProductsPoduct XYZfrom Vendor TIH

29、E ActorActorActorActorIHETransactionIHETransactionIHETransactionIHE ActorHISMPIADTMapping IHE to ProducIntegration ProfilesEasy to understand practical solutions for IT integration problems in daily life.Fostering the under-standing between users and vendors24: Report SubmissionStructured Report Exp

30、ort: 28 25: Report IssuingReport Creator26: Query Reports27: Retrieve ReportsReport RepositoryReport ReaderExternal Report Repository AccessReport ManagerEnterprise Report RepositoryIntegration Profiles24: ReporIntegration Profiles24: Report SubmissionStructured Report Export: 28 25: Report IssuingR

31、eport Creator26: Query Reports27: Retrieve ReportsReport RepositoryReport ReaderExternal Report Repository AccessReport ManagerEnterprise Report Repository24: Report SubmissionStructured Report Export: 28 25: Report IssuingReport Creator26: Query Reports27: Retrieve ReportsReport RepositoryReport Re

32、aderExternal Report Repository AccessReport ManagerEnterprise Report Repository24: Report SubmissionStructured Report Export: 28 25: Report IssuingReport Creator26: Query Reports27: Retrieve ReportsReport RepositoryReport ReaderExternal Report Repository AccessReport ManagerEnterprise Report Reposit

33、oryIntegration Profiles24: ReporWorkflow involves several IHE ActorsADT PatientRegistrationOrderPlacerDeptSchedulerImageManager/ArchiveModalityPatient Registration (HIS):ADT Focal Point for Patient Registration InformationDepartment Scheduler (RIS):Focal Point for Requested Procedure ManagementBreak

34、s Order into Requested ProceduresSchedules Steps for Each Requested ProcedureAcquisition Modality:Focal Point for Performed Procedure StepsA PPS Tracks One or More Series of ImagesImage Manager/Archive (PACS)Focal Point for Imaging Study. Manages ImagesTriggers Reading when All Expected PPS Are Comp

35、letedOrder Placer (HIS):Focal Point for Order ManagementWorkflow involves several IHE Scheduled WorkflowADTPatient RegistrationImage ArchiveImage ManagerImage DisplayImage CreatorAcquisitionModalityDepartmentSystem Scheduler Order Filler Order PlacerPerformedProcedure StepManagerModality WorklistPat

36、ient RegistrationProcedure ScheduledImages Availability QueryProcedure UpdateImagesStoredStorageCommitQ /R KeyImage NoteQ /RPresentationSatesStorageCommitImagesStoredPPSIn-Progress/ CompletedPPSIn-Progress/ CompletedPPSIn-Progress/ CompletedFiller OrderManagementPlacer Order ManagementPresent.StateStoredQ /RImagesKey Image NoteStoredPresent.StateStoredKey Image NoteStoredScheduled WorkflowADTImage ArcStore ImagesStorage CommitmentStorageCommitmentList of I