DALLAS - The integration of images with information, long an elusive goal for many vendors and healthcare practices, continues to move towards reality. At this week’s Healthcare Information and Management Systems Society (HIMSS) meeting, representatives from HIMSS and the Radiological Society of North America are presenting the latest developments in their Integrating the Healthcare Enterprise (IHE) initiative.
IHE is a collaborative project to develop the information technology infrastructure required to enable healthcare facilities to share relevant patient data throughout an enterprise without the need for interfaces between different information systems. The project was launched in early 1998 by HIMSS and the RSNA.
IHE's five-year goal is to solve the varying levels of conformance to healthcare data exchange standards, such as DICOM and HL-7. The project's oversight committee is developing a technical framework for vendors to use to integrate their various information systems. IHE will not develop new standards, but rather will use existing standards to develop this framework.
"At the end of the five-year period, we hope that every vendor in PACS, RIS, or HIS will follow the technical framework," according to Paul Vegoda, a member of the IHE review committee and a member of the HIMSS board of directors. "Each year, the technical framework is being expanded, and as such, we will have true interoperability. My dream is that (a physician) will be able to pick up any image and any clinical demographic information they need from any place in the institution."
The first year of IHE presentations -- initially conducted at the 1999 RSNA meeting and now at the 2000 HIMSS show -- has focused on maintaining the continuity and integrity of data exchanged between information and imaging systems in the radiology department. At HIMSS, four different simulated healthcare enterprises (SHE), each modeled after a different hospital, will show patients being treated for various medical reasons, such as a torn ligament or suspected appendicitis.
Visitors to each SHE can view the following IHE technical framework process steps as they relate to each clinical scenario:
- Patient registration: A message from the ADT registration system is sent to the enterprise information system (typically a HIS) and departmental information system (RIS). Data is transmitted from a central source, and patient demographics and identification are synchronized in all systems.
- Order entry: One or more imaging procedure(s) are ordered by the information system that serves as the order placer, typically the HIS. The order message is transmitted to the RIS. If necessary, the cancel message is sent from the RIS to the order placer.
- Procedure scheduled: In this step, requested procedures are scheduled or cancelled via a message from the RIS to the PACS. The department system scheduler then assigns a resource and a time for the procedure. This step also allows for pre-fetching of prior exams.
- Modality work-list management: At this stage, a query from the imaging modality to the department information system takes place. This query, and subsequent response, ensures unified and accurate demographic information, as well as linkage to study information in the RIS. This also allows for greater automation at the imaging scanner, according to IHE.
- Procedure step started/completed: When the exam begins, the imaging modality sends a "started" and then a "completed" message to a performed procedure step manager, which then subsequently passes on the information to the PACS or RIS. This step also provides detailed information about the procedure to aid in interpretation.
- Images stored/storage commitment: In this phase, the acquired images are stored, a message is sent from the modality to the PACS, and a storage commitment is secured. This step allows the modality to efficiently manage its short-term storage, according to IHE.
- Query/retrieve for images: At this point, images can be retrieved by an external display station or storage device, and internal or external users can query the PACS.
Twenty-three IS and PACS vendors, including industry heavyweights such as Agfa, Fuji Medical Systems USA, GE Medical Systems, Marconi Medical Systems, Philips Medical Systems, Siemens Medical Systems, and Toshiba America Medical Systems, are participating in the 2000 HIMSS initiative.
In the second year of IHE, to be demonstrated at the 2000 RSNA meeting and 2001 HIMSS show, the program will be expanded to include additional PACS/RIS integration capabilities, and further HIS functions, Vegoda said. The planning committee also hopes to advance integration with other specialties, such as cardiology, ophthalmology, and pathology.
By Erik L. Ridley
AuntMinnie.com staff writer
April 10, 2000
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