IHE Update Chris Lindop, IHE Radiology Planning Co-chair

Without standards, complex custom integrations… in the best of cases … Don’t even ask about the worst cases

IHE Organizational Structure IHE North America USA Canada IHE Asia Japan Korea Taiwan China IHE International Board Global Development Regional Deployment Contributing & Participating Vendors ACC ACCE ACEP JAHIS JIRA JRS METI-MLHW MEDIS-DC JAMI RSNA SFR SFIL SIRM BIR EuroRec COCIR EAR-ECR DRG ESC Professional Societies / Sponsors ACP GMSIHIMSS Radiology Cardiology IT Infrastructure Patient Care Coordination Patient Care Devices Laboratory Pathology Eye Care Radiation Oncology Public Health, Quality and Research IHE Asia-Pacific New Zealand Australia Malaysia IHE Europe France Netherlands Spain Sweden UK Italy Germany Norway Austria

IHE Testing Process Users Sponsors: Project Management Team Vendors Sponsors: Exhibits Develop Testing Tools Testing Tools Implement Profile Actors In-House Testing Connectathon Demonstration Deploy Systems Testing Results Approves Test Logs IHE Technical Framework (IHE Profile Specifications) Product + Integration Statement

Radiology Profiles - Consistent Presentation of Images Evidence Document Key Image Notes Simple Image & Numeric Reports Presentation of Grouped Procedures Post-Processing Workflow Reporting Workflow Charge Posting Patient Info. Reconciliation Scheduled Workflow Mammo-graphy Image Image Fusion Teaching Files & Clinical Export Import Reconcil-iation Workflow Radiation Emission Monitoring Mammo-graphy Acquisition Workflow Access to Radiology Information Portable Data for Imaging Audit Trail & Node Authentication – Radiology Option Cross-Enterprise Document Sharing for Imaging NM Image Card Option

IHE Radiology – Integration Profiles Workflow Scheduled Workflow Patient Information Reconciliation Post-Processing Workflow Reporting Workflow Import Reconciliation Workflow Mammography Acquisition Workflow** Infrastructure Access to Radiology Information Portable Data for Imaging Cross-Enterprise Data Sharing for Images Security: Audit Trails & Node Authentication Charge Posting Teaching Files & Clinical Trials Export Presentation & Content Consistent Presentation of Images Key Image Notes Image Fusion ** Presentation of Grouped Procedure Evidence Documents Simple Image & Numeric Reports NM Image* Mammography Image Radiation Emission Monitoring** * Cardiology Option – in Trial Implementation ** in Trial Implementation Publications Radiology Users Guide Mammography Users Guide

IHE Scheduled Workflow Profile Registration Orders Placed Orders Filled Film Film Folder Image Manager & Archive Film Lightbox report Report Repository Diagnostic Workstation Modality acquisition in-progress acquisition completed acquisition completed images printed Acquisition Modality

Portable Data for Imaging Media Creator CD DVD * USB * DICOM Data Web Data (Optional) DICOM DICOM DICOM Web Data Required to cleanup Patient ID, Acc#, etc. * New Option Printer [Media Reader] Image Display [Media Reader] PACS [Media Importer] John Doe PC Browser

PDI Use Case for External Acquisition Radiology Enterprise A Radiology Enterprise B Provider A Radiology Site B PACS A Portable Data Creator 2. Radiology Site B creates portable media with patient images 1. Provider A orders External Radiology Procedure 3. Portable Media is sent to Reading Site A via CD. Patient Data is imported and read. 4. Study Results sent to Provider Radiologist PDI Disk Patient Data

PDI Use Case for Patient Referral Radiology Enterprise B Radiology Enterprise A PACS B Portable Data Creator 2.Relevant Data (including film) is collected and Enterprise A creates portable media with patient’s radiology information. 1. Request for Patient’s case data to be transferred from Enterprise A to B. 3.Data is transported to Site B via CD. Patient Demographics are reconciled and data is imported into archive. 4. Patient Data is now associated with B’s electronic health record system. Patient Data

XDS-I Actors and Transactions

Sharing Radiology Reports and Images in a Regional Health Information Network Radiology Enterprise A Radiology Enterprise B Physician Office Regional Health Information Network PACS B PACS A Radiology-to-radiology Radiology-to- Physicians

IHE Integration Profiles for Health Info Nets What is available and has been added in 2007 Clinical and PHR Content Health Data Exchange Patient ID Mgmt Other Final Text Approved Trial Implementation-2007 – Final Txt 2008 Security & Privacy Emergency Referrals Format of the Document Content and associated coded vocabulary PHR Extracts/Updates Format of the Document Content and associated coded vocabulary ECG Report Document Format of the Document Content and associated coded vocabulary Lab Results Document Content Format of the Document Content and associated coded vocabulary Scanned Documents Format of the Document Content Imaging Information Format of the Document Content and associated coded vocabulary Medical Summary ( Meds, Allergies, Pbs) Format of the Document Content and associated coded vocabulary Patient Demographics Query Patient Identifier Cross-referencing Map patient identifiers across independent identification domains Notification of Document Availability Notification of a remote provider/ health enterprise Request Form for Data Capture External form with custom import/export scripting Cross-Enterprise Document Sharing Registration, distribution and access across health enterprises of clinical documents forming a longitudinal record Cross-Enterprise Document Pt-Pt Reliable Interchange Cross-Enterprise Document Media Interchange Cross-Community Access Consistent Time Coordinate time across networked systems Audit Trail & Node Authentication Centralized privacy audit trail and node to node authentication to create a secured domain. Basic Patients Privacy Consents Establish Consents & Enable Access Control Document Digital Signature Attesting “true-copy and origin Cross-Enterprise User Attestation User Attributes fro Access Control

Enterprise Enterprise Enterprise Enterprise Imaging Center Hospital B Hospital A Emergency Room PCP Patient Admin Repository Repository Repository Repository Cross-Enterprise Document Registry (XDS) Cross-Enterprise Document Sharing

Storage Services Enterprise Enterprise Enterprise Imaging Center Hospital B Hospital A Emergency Room PCP Patient Admin Repository Repository Repository Repository Cross-Enterprise Document Registry (XDS) Cross-Enterprise Document Sharing Practice Data Centre

Cross-Enterprise Document Sharing (XDS) Transaction Diagram

Document Content and Modes of Document Exchange Document Exchange Integration Profiles Document Sharing XDS.a XDS.b Media Interchange XDM Reliable Interchange XDR Doc Content Profiles Consent BPPC Emergency EDR Pre Surgery PPH P Scanned Doc XDS-SD XDS Stored Query & Patient Identity Merge Cross-Community Access XCA Laboratory XD*-Lab PHR Exchange XPHR Discharge & Referrals XDS-MS Imaging XDS-I

XDS-MS Medical Summary S S t t r r u u c c t t u u r r e e d d C C o o n n t t e e n n t t w w i i t t h h c c o o d d e e d d s s e e c c t t i i o o n n s s : :   Reason for Referral     Vital Signs     M M e e d d i i c c a a t t i i o o n n   Studies     A A l l l l e e r r g g i i e e s s   Social History     P P r r o o b b l l e e m m s s   Care Plan Structured and Coded Header Patient, A uthor, Authenticator, Institution, Time of Service, etc. Header always structured and coded Title - coded sections with non - structured nor coded content (text, lists, tables).  Simple Viewing (XML Style sheet) Level 1 Level 2 XDS-MS enables both semantical interoperability and simple viewing ! Text Structure Entry Text Structure Entry Med, Problems and Allergies required as highly structured text.  Text easy to import/parse Text Structure Entry Level 3 Med Problems a nd Allergies have a required fine - grain structure with optional coding. Coding Scheme not standardized, but explicitly identified. Coded Section Entry Coded Section Entry Coded Section Entry Level 3

IHE, global standards-based profiles adopted by several national & regional projects Quebec, Toronto, Alberta, British Columbia Canada Infoway Denmark (Funen) Italy (Veneto) Spain (Aragon) NCHICA – N. Carolina Italy (Conto Corrente Salute) Boston Medical Center - MA France DMP UK CfH (Radiology WF) Philadelphia HIE CHINA-MoH Lab results sharing KeyHIE – Pennsylvania CHINA-Shanghai Imaging Info Sharing JAPAN-Nagoya Imaging Info Sharing South Africa Malaysia Singapore VITL-Vermont CareSpark – TN & VA Netherland Amsterdam Lower Austria Austria

Italy (Genoa Region)

IHE Profiles are consistent with HHS Accepted Standards (HITSP Interoperability Specifications)