Transcript Image Sharing- the NIBIB/RSNA image sharing project employing IHE solutions IHE-Providing the Foundation for Interoperability David S.

Image Sharing- the NIBIB/RSNA image
sharing project employing IHE solutions
IHE-Providing the
Foundation for
Interoperability
David S. Mendelson, M.D.
Professor of Radiology
Chief of Clinical Informatics
The Mount Sinai Medical Center
Co-chair IHE International Board
Fourth ChinaU.S.
Roundtable
Meeting on
Scientific Data
Cooperation:
Presentation Objectives
 Integrating the Healthcare Enterprise (IHE)
 Overview- How is IHE organized?
 Healthcare Interoperability in the United States
 Challenges
 ARRA (American Recovery and Reinvestment Act)
 Image Sharing
 Via HIE
 Image Sharing Project- Personal Health Records
(PHRs)
Integrating the Healthcare
Enterprise
The state of IHE - 2010
David S. Mendelson, M.D.
Chief of Clinical Informatics
The Mount Sinai Medical Center
Co-chair IHE Board
International Adoption of IHE


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
Austria
Local Deployment
National Extensions (Local Adaptions)
Promotional & Live Demonstration Events
Funding
China
Spain
Holland
Norway
Taiwan
Korea
Canada
Japan
UK
Italy
France
Germany
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Pragmatic
global standards harmonization + best practices sharing
Year 8 (2006)
Year 7 (2005)
Year 6 (2004)
Year 5 (2003)
Year 4 (2002)
Year 3 (2001)
Year 2 (2000)
Year 1 (1999)
USA
National and Regional Projects Using IHE Profiles
Lower
Austria
Netherland
Amsterdam
UK CfH
(Radiology WF)
France
DMP
Denmark (Funen)
Italy (Veneto)
Spain (Aragon)
Italy
(Conto Corrente Salute)
Austria
Quebec, Toronto,
Alberta, British Columbia
Canada Infoway
VITL-Vermont
Boston Medical
Center - MA
Philadelphia HIE
CPHIC –
Pennsylvania
CareSpark – TN & VA
South Africa
CHINA-Shanghai
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Imaging Info Sharing
Malaysia
CHINA-MoH
Lab results sharing
JAPAN-Nagoya
Imaging Info Sharing
THINC- New York
NCHICA – N. Carolina
IHE Organizational Structure
IHE International Board
Global Development
Regional Deployment
IHE North America
IHE Asia-Oceania
Canada
USA
China
Japan
Korea
Taiwan
Radiology
IT
Infrastructure
Laboratory
Cardiology
Patient Care
Coordination
Pathology
Radiation
Oncology
Patient Care
Devices
Eye Care
IHE Europe
Austria
Italy
France
Norway
Germany
Spain
Netherlands
Sweden
UK
Professional Societies / Sponsors
ACC
ACCE
ACEP
ACP
GMSI
HIMSS
RSNA
SFR
SFIL
COCIR
SIRM
ESC
EAR-ECR BIR
DRG
EuroRec
JAHIS
JIRA
JRS
METI-MLHW
MEDIS-DC
JAMI
Contributing &
Participating
Vendors
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IHE China: http://www.ihe-c.org
Thank You for Your Attention
Prof. Jianping Dai, MD
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Events: Promotion
Education and Promotion by Journals
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Education and Promotion by Workshop
Events: Connectathon
Dr. Zhu, Chairman of IHE China, past vice
Minister of Healthcare attended
There are 7 companies attended
The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital
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Events: Connectathon
The IHE-C Connectathon was held at April 26, 2008 in Beijing Tiantan Hospital
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IHE – the process
 Identify Interoperability issues
 Develop Integration Profiles
 Actors and Transactions
 Workflow
 Gather relevant standards
 Connectathon Testing
 Publish Integration Statements
 Vendors list tested profiles
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Problem to Profile
Problem
Domain
Integration
Profile
Patient Identity
across multiple
settings
IT
Infrastructure
Patient
Patient Identity
Identifier Cross- feed
Referencing
(PIX)
Patient Identity
Source
Evidence
Documents
Evidence
Creator (Post
Processing
Workstation
Make CAD
results available
with images
Radiology
Transaction
Evidence
Document
Stored
Actors
Patient Identity
Cross Reference
Manager
Image
Manager/Image
Archive
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Interoperability in the USChallenges
 Privacy rights
 HIPAA
 No Single identifier
Office of the National Coordinator
for Healthcare IT (ONC)
 Health Information Technology Standards Panel (HITSP)
 Certification Commission for HIT (CCHIT)
 American Recovery and Reinvestment Act (ARRA)
 Includes financial incentives for adoption of the Electronic
Health Record throughout the US
 Interoperability is a cornerstone
 Funding for related research- NIH
 Quality -Comparative Effectiveness
 EHR
XDS (Cross-Enterprise Document
Sharing)
 XDS.a
 XDS- I.a
 XDS.b
 ?? XDS-I.b
 a vs. b
 Related to web standards and transactions
XDS
XDS-I
NIBIB contract summary
 Consumer Control
 Employ IHE solutions
whenever possible
 IHE generally has not
focused on consumer
driven solutions but rather
on institutional and
enterprise workflow
 5 Academic Institutions
 Mayo Clinic
 Mount Sinai Medical
Center
 University of California
San Francisco
 University of Chicago
 University of Maryland
 Establish a clearinghouse
 Engage PHRs
 300,000 patients over 2
years
Elements of Solution
 Edge Server
 Register a patient
 Listens to a Radiology Information System (RIS)- looking for a
complete exam
 Retrieves Image set from PACS and Report from RIS
 Send both to clearinghouse
 Clearinghouse – functions as a secure router
 Transiently hold encrypted patient data
 PHR
 Consumer controls upload and future access
 Develop web based viewers
 Download full DICOM data set
XDS (Cross-Enterprise Document
Sharing)
 XDS.a
 XDS- I.a
 XDS.b
 ?? XDS-I.b
Software architecture
Protocol Flow
From RIS
R
S
R
C
H
A
D
M
I
N
Web/
MIRTH Java
DICOM
Srv
Dbase
HL7
PACS
Qry/Rtrv
OS
Edge
Appliance
Prepare content
Poll database, get report, get
exam,prepare big fat file
Background java srvlet
25 days
Transfer content
Poll database for transfer out, package
content into xds.b
Background java srvlet
35 days
HL7 receiver
Receive HL7 A04 messages, extract
reports and store them in database
Mirth HL7 Channel. Let Mirth create its
default database, all script work-but may
have to customize per site
65 days for 5 sites
Token App
Create new tokens based on two parts,
associate token with accession
numbers, update database, user
interface with login, get patient
info,create job
Ajax based web front-end ,JavaServlet
for CFIND using dcm4che, creating job in
the RSNA database, creating tokens
using kerberos – tokens generated locally
30 days
Database
Store reports, logs, audit trails, user
accounts, etc.
Mirth instance for HL7 & DICOM, RSNA
instance for everything else
50 days – 2 databases
Management App
Create users, monitor logs, check
health
Ajax gui front end, backend servlet,
dicom targets etc.
45 days
Firewall
XDS.b &
token
Clearing
House
Future Directions
 Refine Workflow
 Initial workflow is to replace a CD
 Exam updates
 Download DICOM data and archive in a local PACS
 Edge server as a platform
 Radiation Monitoring
 Peer Review
 Quality Metrics
Radiation Exposure Monitoring Profile REM
 Supplement to Technical Framework for Trail
Implementation
 Acquisition modalities inlcudes information regarding dose
exposure
 Estimates
 Permits communication of that information to other systems
 Useful for Individual lifetime estimates as well as Population
analysis
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Radiation Exposure Monitoring (REM)
 Includes
 CT
 Plain X-Ray
 Mammography
 Current Exclusions
 Nuclear Medicine
 RT
 Brachytherapy
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 DICOM Dose SR objects
 DICOM 2008 PS 3.3: A.35.8 X-Ray Radiation Dose SR IOD