Transcript IHE: scheduled workflow and patient information reconciliation

IHE:
consistent presentation of images
and key image notes
and how to order IHE-systems
Prof. Berthold B. Wein, MD
User co-chair IHE-Europe
Praxisgemeinschaft Kapuzinerkarree
University Hospital Aachen Germany
Understanding IHE, BIR
20 Oct 2004
Problems
• Ensuring print quality outside of the
department
• Radiologist discussing images with remote
physicians
• Capture image manipulation to avoid
redundant work (coronal CT, MR reading, etc.)
Understanding IHE, BIR
20 Oct 2004
Consistent Presentation of Images
Reporting Radiologist
Area Of
Interest
Referring Physician or
Reviewing Radiologist
Presentation State
Presentation LUT
Grayscale Standard
Annotate
Zoom
Area Of
Interest
Achieving
Consistent Presentation
Flip
Window Level
Without
Consistent Presentation
Original Image
Understanding IHE, BIR
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Grayscale Standard Display Function
(GSDF)
6 modalities  4 cameras, 26 workstations
The current way = 180 calibrations
The IHE way = only 36 calibrations
DICOM
Standard Display Function
Acquisition
Soft Copy
Review
Barten Curve
L
u
m
i
n
a
n
c
e
Just Noticeable Differences
Independent device calibration
delivers consistency with simplicity
Film
Review
Understanding IHE, BIR
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Consistent Presentation of Images
• With films, image quality was the imaging
department problem….
• Softcopy image distribution across the healthcare
enterprise
–
–
–
–
Enabled by digital radiology
Avoids lost films, reduce delays
Decreases utilization of staff and equipment
But …need to ensure quality and consistency !
• This IHE Integration Profile is the cost effective and
technically correct solution.
Understanding IHE, BIR
20 Oct 2004
Don’t Call Us, We’ll Call You
• “Dave, you read that 3000 slice MR study last night.
Can you highlight the 5 most important images for
me ?”
– Thinking… “#$@%!%# You”, saying “Sure, Joe.”
• “Dr. Channin, I just reviewed 40 cases and marked
my questions on yellow stickies. Can you review
those ?”
– Thinking... “He has to much paper at home...”
• Technician to radiologist: “The patient wouldn’t hold
still !”
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for referring physician
Here you can
see the renal
osteopathy.
For teaching
Fibroosteoclasia
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Note2
Note3
for referring physician
for referring physician
for
physician
Here you can
seereferring
the
This is the hematoma.
renal rupture.
Hematoma everywhere
Note1
Different notes on different images
Note1
for refering physician
Here you can see the
renal rupture.
Note2
for refering physician
This is the hematoma.
Same note on different images
Note3
for refering physician
Hematoma everywhere
Note3
for refering physician
Hematoma everywhere
Note3
for refering physician
Hematoma everywhere
Note3
for refering physician
Hematoma everywhere
Understanding IHE, BIR
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Key Image Notes Titles are Coded
Defined by DICOM Supplement 59. May be extended
Codes
The note title defines the semantics
of the reason of significance.
Of Interest
Rejected for Quality Reasons
For Referring Provider
For Surgery
Key Image Notes can be queried by
code.
For Teaching
For Conference
For Therapy
For Patient
The user comments are meant to be
informal.
For Peer Review
For Research
Quality Issue
Understanding IHE, BIR
20 Oct 2004
Key Image Notes
• There is more to teamwork than images and reports
• With IHE, it is possible to attach « electronic post-it™ » to
images to increase informal but critical communication
between:
– The Technologist and the Radiologist about specific examination events
– The Radiologist and the Technologist about image quality issues
– The Radiologist and other department clinicians (surgeon, orthopedist,..)
– The Radiologist and collegues about selecting images for conferences
– The Radiologist to the Referring Provider, …..etc.
• This IHE Integration Profile is the cost effective solution
(increases radiology and overall efficiency).
Understanding IHE, BIR
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Direct Advantages ?
• Composing of complex IT environments
– PACS
– Radiology Departments
– Hospital information systems
Understanding IHE, BIR
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Patient Information Reconciliation
Radiology 2000-2005
Scheduled Workflow
Presentation
of Grouped
Procedures
Consistent
Presentation
of Images
Charge
Posting
PostProcessing
Workflow
Evidence
Document
Reporting
Workflow
Key
Image Notes
Simple Image
and
Numeric Report
Access to Radiology Information
Basic Security
Understanding IHE, BIR
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Result Communication
Connect-a-thon - Matrix:
Integration Prof.1 Integration Prof.2 Integration Prof.3
Act1 Act2 Act3 Act4 Act5
Act1 Act2 Act3
Act1 Act2 Act3 Act4
Comp1
Comp2
Comp3
Comp4
Comp5
Comp6
Comp7
Understanding IHE, BIR
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European Connect-a-thon 2004
Understanding IHE, BIR
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Vendors should and will offer
Integration Statements
to the users
Product UVW supports
IHE K Actor with
IHE X and Y Integration Profiles
IHE J Actor with
IHE T Integrations Profil
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IHE Integration Statement
IHE Integration Statement
Vendor
Product Name
Version
Date
Huge Imaging Medical Systems
IntegrateRAD
V2.3
12 Oct 2002
Integration Profiles
Implemented
Scheduled Workflow
Simple Image and Numeric Report
Link to vendor IHE page
Actors Implemented
Options Implemented
Image Manager/Archivee
none
Image Display
Performed Procedure Step
Order Filler
PPS Exception Management
Report Creator
none
www.HImedicalsystems.fake/ihe
Links to Standards Conformance Statements of the Implementation
HL7
DICOM
www.HImedicalsystems.fake/hl7
www.HImedicalsystems.fake/dicom/integrateRAD.pdf
Understanding IHE, BIR
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IHE Integration Statement
Understanding IHE, BIR
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Integration Profiles - Table
Integration Profiles
Actors
SWF
PIR
CPI
PGP
ARI
KIN
SINR
SEC
CHG
PWF
Modality
Image Creator
Image Display
Image Manager/
Archive
DSS/Order Filler
ADT
Report Creator
Maximum table
Understanding IHE, BIR
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Example: PACS
• Standard:
– Actors: Image Manager, Image Archive, and
Image Display
– Integration Profiles: Scheduled Workflow and
Patient Information Reconciliation
• Display and Printout:
– Actors: Image Display and Print Composer
– Integration Profile: Consistent Presentation of
Images
Understanding IHE, BIR
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Example: Tender
Actors
SWF
PIR
CPI
PGP
ARI
KIN
SINR
SEC
CHG
PWF
Image Display
Image Manager/
Archive
Report Creator
Secure Node
Maximum table for this tender
Understanding IHE, BIR
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Example: Tender
Actors
SWF
PIR
CPI
PGP
ARI
KIN
SINR
SEC
CHG
PWF
Image Display
Image Manager/
Archive
Report Creator
Secure Node
Maximum table for your intention
Understanding IHE, BIR
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Example: PACS X, Vendor Y
Actors
SWF
PIR
CPI
PGP
ARI
KIN
SINR
SEC
CHG
PWF
Image Display
Image Manager/
Archive
Report Creator
Secure Node
Offered system by vendor Y
Understanding IHE, BIR
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What did we learn ?
• IHE gives solutions for real world problems
• IHE guarantees the understanding
between users and vendors
• IHE deals with actors and transactions
• IHE thinks in Integration Profiles
• IHE is not a standard, but uses standards
heavily
IHE is something for hands-on, try to feel it
work (demonstrations)
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More Informations available:
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Websites:
www.ihe-europe.org -> www.ihe-uk.org ?
www.rsna.org/ihe
www.himss.org/ihe
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IHE-Europe:
user-co-chair: [email protected]
vendor-co-chair: [email protected]
secretariat: [email protected]
Understanding IHE, BIR
20 Oct 2004
Thank you for your attention !
Understanding IHE, BIR
20 Oct 2004