IHE - Integrating the Healthcare Enterprise

Overview

There are 3 focus areas of the IHE EyeCare Technical Framework*:

 1) Eye Care Scheduled Workflow

2) Charge Posting - Billing Workflow

3) Displayable Report - Evidence Documents  

These Integration Profiles all address a real-life integration problem in eye care, and propose a solution, based on established standards such as DICOM and HL7.  

Eye Care Scheduled Workflow

Click for detailed IHE "Actor" & "Required Transaction" list used for RFQ & RFP compairsion 

Figure 1

1) The Eye Care Workflow Integration Profile deals with the following activities that are part of every patient visit:

 i)    admit or register patients

ii)    order tests/images for patient

iii)   schedule procedures

iv)   create a worklist (or list of procedures that were ordered)

v)    monitor the status of procedures performed

vi)   create images

vii)  manage or keep track of images created

viii) store images

ix)  display images.

For example, a set of generic orders could be created for every patient, for routine procedures such as lensometry and autorefraction. Normally these are done by the staff, but not tracked with the patient identifier information. If they are part of the order set, then the worklists will have the patients listed, with the correct identifier information. This alone could save staff time, and assure that the right information is tracked back with the right patient.

Another step is notifying the technician when a test should be performed. This could be done by a verbal order, or through this workflow, the ophthalmologist places and order and the technician looks at the worklist to see exactly who needs which procedure to be performed. The creation and use of worklists saves time, because they can be used to automatically and accurately fill in information into images, eliminating the need for re-entry by the technician operating the device.

Within this system of interconnected devices and systems, there are several actors or elements that are formally defined and have specific actions to perform.

In the Eye Care Workflow:  

 a) a patient registration system (also known as an Admit, Discharge and Transfer (ADT) system)) which is responsible for patient demographic and encounter information.

b) An order placer generates eye care orders, such as having a fundus photo or visual fields performed, and distributes these orders.

c) An order filler takes the eye care order and coordinates with the image device to provide worklists of all the procedures being performed, and monitors the progress of the work being done.

d) An acquisition modality is the imaging device or equipment (e.g., ultrasound equipment, fundus camera) that acquires the image and creates a DICOM object (so that it can be exchanged and displayed with other systems)

e) An image manager/image archive keeps track of the images (stored as DICOM objects) and provides long-term storage.

f) An image display provides the ability to see and browse patients’ image studies.

 In the future, image manager/image archive/image display products will be more involved in networking in ophthalmology. In a network, the devices will acquire the images, the image manager/archive products will store the images and evidence documents, and the image display will show this information on workstations. This is commonly done in radiology, where these are known as PACS (picture archiving and communication systems).

Figure 1 illustrates the eye care workflow from when a patient is registered, the order for a procedure is placed, scheduled, performed, stored, and ultimately retrieved by the ophthalmologist to view, in order to make a diagnosis or a treatment decision.

 These actions are enabled through defined, structured messaging from one system to another.

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Billing Workflow

Click for detailed IHE "Actor" & "Required Transaction" list used for RFQ & RFP compairsion 

Figure 2

 2) Charge Posting Profile provides a solution for collecting and posting timely billable procedural details. This would work in the office as follows:

i) The registration system would provide the billing system with the patient demographic information, accounts, insurance, and guarantors.

ii) After a procedure has been completed, the acquisition modality or device would send the procedure code and the patient identifier information to the order filler.

iii) The order filler would map the procedure code to a CPT code.

iv) The order filler would notify the billing system that a billable procedure has been completed.

v) The billing system and administrator would then perform any remaining steps to generate the appropriate bill.

 The benefits include: ensuring complete data, less staff resource requirements for billing reconciliation, reduces redundant data entry, and maintains data integrity. The end result is that the billing system will receive more complete, timely and accurate data.

Figure 2 shows the automated flow of information among the different systems.

The billing system would receive patient demographic information from the patient registration system, the procedure information from the order filler, and in turn, let the registration system know that the account had been completed, i.e., billed.

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Evidence Documents Integration

Click for detailed IHE "Actor" & "Required Transaction" list used for RFQ & RFP compairsion 

Figure 3 

3) Evidence Document Profile:

i)  is intended for the incorporation of additional measurements and observations as documents

ii) creating

iii) storing

iv) retrieving and using these different documents as a record of evidence.

Detailed information, such as reconstructed or derived images, measurements, post processing results, etc. could be made available as input in the generation of a clinical report to the ophthalmologist.

Examples include:

a) glaucoma progression analysis performed on visual field analyzers

b) retinal nerve fiber analysis performed on an optical coherence tomography (OCT) device

c) measurements on fundus images

d) corneal ablation planning based on corneal topography maps.

 Figure 3 shows the creation of the evidence document, the storage of the evidence document on an image management system, and the retrieval and display of the evidence documents.

These Evidence Documents can be transferred, stored, and retrieved just like images.

*From The Electronic Office; Flora Lum, M.D., Policy Director, Quality of Care and Knowledge Base Development, American Academy of Ophthalmology & Lloyd Hildebrand, M.D., Chair, AAO Medical Information Technology Committee