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					90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM


Docent Script for:
Group 1, Subgroup A
Group 1, Subgroup B
Group 2, Subgroup A
Group 2, Subgroup B


Docent Script for Group 1A
Case: Fractured Ankle

[ADT: start registering the patient now.]

Welcome. I’m <my name> from <my company>, here representing the IHE
(Technical/Planning) Committee.

Thank you for taking the time to join us. I think you’ll be glad you did – because we are about to
see a demonstration showing the remarkable economic and clinical efficiencies gained when
systems communicate using the IHE framework. And we’ll see it on {gesture} real equipment
from {gesture} real vendors in real time. Whether your institution's current workflow relies on
paper and film or is already automated to a high degree, IHE can improve the way it operates.
Before you leave, you will understand how.


Registration

In this scenario, a male subject is involved in a motorcycle accident and is transported to a local
hospital. The patient is unable to identify himself and will be entered into the registration system
as “John Doe”. We will start our tour at the registration desk. Our registration person, <SMS
person> of SMS, will register and admit the patient.

[Order Placer: start ordering both procedures as soon as the data is available.]

We have now registered the patient and captured the demographic data. In many institutions
today, that data is entered many times – at the registration desk, at the RIS, at the modality – and
aside from the extra work involved, errors lead to {voice inflection} inconsistent information,
duplicate patient records, identity mismatches, lost studies, and the tedious work of correcting
the errors and even re-examining patients.

Let’s contrast this with an integrated information flow. {Gesture to workflow chart here.} IHE
assigns a unique patient identifier and allows patient demographic data to be shared with all the
relevant systems in the enterprise, eliminating the errors and the extra work.



                                                                                        -1-
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM

Orders Placed

The ER physician examines the patient and has observed a fractured left ankle. He places an
order for a MR imaging exam to access the extent of the fracture.

[Order Filler: schedule procedure for both modalities as soon as the orders are received.]

The orders have been entered at the HIS by <GMD person> of GMD. (Note: since we have 2
MR vendors participating in this demonstration, 2 orders have been placed.) The HIS combines
the previously entered patient demographic information from the ADT system with the order
information from the operator and communicates the orders automatically to the RIS in the
radiology department.


Orders Filled

Now we’re in the radiology department. The RIS has received the order from the HIS and a
technologist, in this case <IDX person> of IDX, will schedule the procedures.

With the procedures scheduled, the RIS communicates the schedule information to the PACS to
allow it to take the necessary actions to prepare for the diagnostic evaluation of the new studies.
For example, the system could retrieve relevant prior studies for review.


Modalities

[Modality operators: query for the worklist as soon as possible.]

To move ahead quickly with this demonstration, we will ask both of our modalities to perform
their examinations at the same time. Here, <Marconi person> of Marconi and <Siemens person>
of Siemens will each perform a MR study.

The modalities will first obtain a list of the ordered procedures from the RIS. In many
institutions today, this information comes on paper - frequently carried by the patient –and has to
be {voice inflection} transcribed by the modality operator. But IHE provides a common
mechanism--called DICOM Modality Worklist--for all modalities to obtain the demographic and
procedure information automatically, allowing them to set up the equipment for the ordered
procedure and freeing the technologist to work with the patient. The result is greater patient
throughput, more efficient use of the modality, less delay for the patient at the modality, fewer
errors, and fewer retakes.

The technologists have now selected the procedures to be performed from the list provided by
the RIS, and have started their examinations. As they began, each modality informed the RIS and
the PACS that the exam had started. And at the completion of the study, the modalities inform
the RIS and the PACS that the study is done. In many institutions, this kind of status information
is not available in real time. But with IHE, care providers can track the immediate status of


                                                                                        -2-
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

patients’ examinations and enterprise information systems can take scheduling and billing
actions much more reliably. The result is more efficiency for both personnel and equipment.

The modality combines the patient demographic information acquired from the RIS with the
images and the technologist prepares the images for viewing by the radiologist. It is possible to
save the presentation information for later viewing. For more information see the self guided tour
demonstrating the Hardcopy and/or Softcopy consistency. The modality then sends the study to
the PACS with this presentation information if available. It then confirms with the PACS that the
images are safely stored before removing them from the modality’s internal storage. In many
cases today, examinations get lost because a technologist can't verify that they are stored in the
PACS before deleting them from the modality. This problem occurs when the technologist either
neglects to send the study to the PACS or fails to notice when a communication error occurs. But
whatever the cause, it results in retakes - not to mention delays in patient treatment. And IHE
eliminates it by closing the loop between the modality and PACS.


Image Manager / Archive

{PACS operators: bring up the images as soon as they arrive.]
In this case there are now PACs review stations only Kodak and Philips Diagnostic WS? Will the
Archives show lists of patient studies here? Do the archives have a means to display images?

Let’s check with the PACS folks to verify the images have arrived. In order to demonstrate
equipment from all the companies that support IHE, we have sent the Marconi MR study to
<Adac person> of Adac and the Siemens MR study to <Imco person> of Imco. I’d like you to
look at the images on their workstations, and you’ll see that all the data is correct.

[Diagnostic workstation operator: display the study when it becomes available.]


Diagnostic Workstation

With the images stored in the PACS, they are available to all the workstations that access the
PACS.

The radiologist retrieves images from the PACS and displays them for diagnostic interpretation
or post processing. The diagnostic workstation displays the demographic and study information
originally obtained from the Registration System and RIS and conveys the reason for the study to
guide the radiologist’s interpretation.

Our workstation operators <Kodak person> of Eastman Kodak, <Philips person> of Philips, and
<GMD person> of GMD will display the study. While viewing the study, the radiologist can
view the original images, the images with the saved presentation information, or create new
presentation information, for example window level, contrast, and transformations, with the
original images in the PACS, describing how the procedure is to be displayed when retrieved.
The PACS makes that information available when the studies are viewed at a workstation,
ensuring that referring physicians see the study in the same way as did the radiologist.


                                                                                      -3-
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM


In addition, our diagnostic workstations are also print composers, so they can print these studies
to any print server in our demonstration to ensure that a hardcopy is produced that is perceptually
consistent with what is viewed at the workstation and includes the appropriate viewing protocols.
Presentation information can also be used to present image subsets from a single acquisition
separately for diagnostic and billing purposes. We call this Presentation of Grouped Procedures.
Some of the workstations here can also create or view reports. Reports allow the radiologist to
view key information and related images in a structured fashion.

You can see all of these features demonstrated in detail in the self-guided tours that are going on
throughout the week here and the vendors here will be happy to discuss them with you at the end
of our tour.

We invite you to take one of these tours after we complete this guided demonstration. Or,
consult the schedules posted outside each of our demonstration groups and come back when it is
more convenient for you.
Patient Name Change

So far, we have seen a typical information flow – from registration to order entry to scheduling
to acquisition to diagnosis in the most convenient sequence. In the real world, though, things
often don’t work that way. One of the major advances in this year’s evolution of IHE is its’
handling of special cases in which information is available out of sequence. The most obvious
example of that is in a trauma case where the exam is done before the order is placed or the
patient is even registered. IHE has analyzed and solved five such special cases, some of which
are very complex. They would take too long to demonstrate here, but the problem is so important
that we want to show you at least the simplest case to wrap up this demonstration.

[ADT: Enter name change.]

Imagine that after the images have been acquired, the patient’s name must be changed – in this
scenario, after searching for the patient name and demographics, the registration clerk finds that
the patient has an existing patient record in the hospital.

With IHE there is no need to re-enter the patient demographic information, the registration
system merges the patient record of “John Doe’ into the existing record for this patient – and
every other system follows suit automatically.

Let’s go back to our registration area. After the update has been performed, the ADT system
sends update messages to the HIS that places orders, the RIS that schedules or fills the orders,
and the PACS.

[Reference IHE Workflow Diagram]

Each system makes the necessary internal corrections, and the PACS updates the image archive
so that the patient images may be retrieved using the correct information in the future.



                                                                                       -4-
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM


[Order Placer: display the new patient record.]
[Order Filler: display the new patient record.]
[PACS: display the new patient record.]

Now we can check that the HIS has received the update message and made the change.

Likewise, here we see that the RIS has followed suit.

And finally, the PACS does the same.

-- All automatically. And all the patient’s studies, whether new or old, are still connected.


Wrap-up


      I promised that you would see both economic and clinical efficiency. In this
       demonstration, we eliminated labor-intensive, error-prone steps from the process; we
       eliminated significant sources of retakes, and we reduced the cycle time for care in the
       institution. These are important achievements. I hope you see what an integrated
       information flow can mean to the radiology department, the healthcare enterprise, and
       effective patient care.


      Now, some of the functions you have seen here are being done already in technologically
       advanced institutions-- through single-vendor systems or painstakingly built site-specific
       solutions. What is important about IHE is that for the first time, a large group of
       vendors have come together to work out how to integrate their products in the real world
       in a consistent way. When you look around this exhibit, you will see close to <70>
       products from <33> vendors all sharing the same data and all working within the IHE
       Technical Framework. This framework enables vendors to do the integration work up
       front. This entire demonstration came together with only a few days of face-to-face
       work by vendors. As you probably know, interfacing systems even two systems now
       often takes months. Adhering to the IHE framework enables vendors to deliver
       integrated systems more efficiently, eliminating the need to develop redundant, site-
       specific interfaces among systems.


      But IHE has even more to offer. We just saw demonstrated two of the sets of
       functionality we call {enunciate carefully} "IHE Integration Profiles." They are
       Scheduled Workflow and Patient Reconciliation.
      We mentioned five other integration profiles available in IHE this year. I’d like to
       invite you again to stay longer if you can take it and see these being demonstrated. Again,
       they are:


                                                                                         -5-
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM

         Consistent Presentation of Images
      The Consistent Presentation of images integration profile allows acquisition, display and
      print devices which have been calibrated independently to correctly render the images
      received with the same presentation as originally saved at the creator. It subsequently also
      allows these presentation characteristics to be preserved and saved and archived with the
      original images on a PACs archive for future reference. Presentation features which can
      be preserved may include changes to the original data such as window/level, annotation,
      and flipping or rotation of images.
      To demonstrate these capabilities as they might be used we will ask the GE MR and
      SwissRay CR to window and level the acquired images of the fractured ankle (editors
      note: time probably won’t allow other operations) and send these images to the Applicare
      PACs archive. The PACs archive must have the capability to receive and store these
      objects as well as the original MR and CR data. The storage of the presentation state is a
      standard object similar to a CR and MR original image.
      Now we will ask our image display from Marconi Medical Systems to Q/R and display
      the GE MR images with the presentation objects just stored on the Applicare archive.
      Likewise we will ask the Softmedical and the Applicare PACs systems to Q/R and
      display the SwissRay CR image with the presentation objects.
      As you can see the window and level settings have been preserved and the images on the
      GE MR and SwissRay CR are identical to those viewed on the PACs image displays. The
      independent calibration to a common Grayscale Display Standard enable optimal
      interoperability and preservation of data as used for diagnosis.
      Consistent presentation of images is not limited to the softcopy display. In this subgroup
      the Agfa print server supports printing of the hardcopy equivelent of this presentation
      data. With calibrated displays and calibrated print servers it is possible to print the objects
      with the same presentation data and have the hardcopy output consistent with the
      softcopy display. To demonstrate this integration profile for hardcopy output we have
      asked the Kodak, Philips and Agfa CR acquisition and display devices to pre-print these
      same GE MR and SwissRay CR images with the presentation parameters as
      demonstrated a moment ago for the softcopy devices.
      The advantages to the consistent presentation of images are increased productivity due to
      not having to re-window data a second or third time and the ability to print the images
      with the original presentation parameters for use later use and persistence of the
      presentation data for hardcopy archives.
         Presentation of Grouped procedures
      The Presentation of Grouped procedures integration profile leverages the Scheduled
      Workflow and the Consistent Presentation of images integration profiles. This integration
      profile demonstrates the capability of an IHE framework to provide for the acquisition,
      viewing and reporting of multiple procedures seperately which have been performed all
      in one step at the acquistion modality.
      To demonstrate this capability we will need our SMS system to admit patient (patient
      name) and our GMD order placer to place an order for our patient on the GE MR for



                                                                                        -6-
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

      (editors note: need valid procedure for MR). The IDX order filler will schedule the
      requested procedures for the GE MR and create the worklist items. The GE MR will
      retrieve the worklist and group the scheduled procedure steps which each correspond to
      the requested procedures into one performed procedure and perform a single acquisition
      which satisfies the multiple scheduled and requested procedures. The GE MR will now
      demonstrate the ability to apply separate presentation parameters to each of the originally
      scheduled and requested procedures and report on each of them seperately. The images
      and associated presentation objects are then sent to the Softmedical image archive along
      with the storage commitment request.
      Each set of images has a corresponding presentation object which enables softcopy
      display devices such as the GMD workstation to retreive and display only the subset with
      the corresponding presentation parameters originally created on the acquisition modality.
      The benefits of the Presentation of Grouped Procedures profile allows an operator to
      group multiple procedures for patient comfort or more efficient use of equipment into one
      procedure. The Presentation of Grouped Procedures also facilitates better use of network
      resources retrieving and viewing only those images necessary from the larger set of
      images and increased flexibility in billing or reporting of separate performed procedures
      associated with each subset of images and presentation parameters.
         Key Image Note Integration Profile
      (editors note: copied from slides need vendor coordination and product names)
      GMD - Report Reader
      IDX - Report Mgr/Rep
      Softmedical - Rept Creat/Mgr/Rdr/Rep
      Agfa - Report Reader
      Marconi - Report Creat/Rdr
      Vital Images - Report Creator
      This feature enables a Technologist, a Radiologist or any other healthcare professional to
      simply flag significant images and keep a record of this as an integral part to the imaging
      study where the images are grouped. This record of significant images will be transferred
      as part of the imaging study between Modalities, PACS, RIS and Workstation. Today, it
      is very often lost when images move between products of different vendors.
      This IHE Integration Feature is achieved based on the new DICOM Structured Report
      object. It makes a very elementary use of the capabilities of DICOM SR.
      Today, we will demonstrate this integration capability.
      On this product you may flag key images. Let us choose the reason for flagging images,
      select the images we want flagged, and add a specific comment you may want to give me.
      I will now send this study to an other vendor product directly or store it for later retrieval
      in an image archive or report repository.On this product you may review images and see
      that some have been flagged. Lets view the reason which is stated in the title of the Key
      Image Note as well as the comments you may have entered on this other product.
      As you see, the exact same images are flagged, same note title and comments.


                                                                                       -7-
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM

      Simple Image and Numeric Report Integration Profile
       (editors note: copied from slides need vendor coordination and product names)
       GMD - Report Reader
       IDX - Report Mgr/Rep
       Applicare - Report Creat/Rdr
       Softmedical - Rept Creat/Mgr/Rdr/Rep
       Agfa - Report Reader
       Marconi - Report Creat/Rdr
       Provides mechanisms for Report management: creation, amendment, verification, access
       from the Radiology Department•Simple Image Report supports encoding of common
       radiological reports including references to the images that served as evidence in creating
       the report
       Numeric Report is used for more advanced reports that may include numeric
       measurements (such as ultrasound) Typical Reporting workflow:–Report Creator creates
       report using, submits to Report Manager–Report Manager handles editing/verification of
       the report, issues report to Report Repository
       –Report Reader retrieves report from Report Repository for display
       –Incorporated pointers to images facilitate side-by-side display of reports and referenced
       images
          Access to Radiology Information integration profile
        The last integration profile to be mentioned today but for which we have no
       demonstration in this group of actors is the Access to Radiology Information integration
       profile. You can see this integration profile in either group 2 or group 3 and I invite you
       to see them if you have time once you are finished here.
       This last integration profile defines a number of query and retrieve operations which
       enable access to radiology information such as reports and images by other radiology or
       non-radiolgy systems in a structured way. Through the use of DICOM structured reports
       systems in radiology, pathology, oncology, surgery and labs may access radiology and
       non radiology information.
   More detail about the self-guided tours is given in the IHE Demonstration Brochure.


      [Show the brochure, IHE Integration Profile: A buyers Guide]


      Please also keep and review this brochure: IHE Integration Profiles: Guidelines for
       Buyers. Use it as a basis for talking about integration with the vendors you work with.
      Finally, thanks to all of our participants, who showed what a smoothly running, no
       excuses radiology department can look like; and thanks again to you for taking the time
       to join us.


                                                                                       -8-
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

      If you have any further questions about IHE for me or for any of the participants in this
       demonstration, we'd be happy to try to answer them now.

Thank you.




Docent Script for Group 1B
Case: Fractured Ankle

[ADT: start registering the patient now.]

Welcome. I’m <my name> from <my company>, here representing the IHE
(Technical/Planning) Committee.

Thank you for taking the time to join us. I think you’ll be glad you did – because we are about to
see a demonstration showing the remarkable economic and clinical efficiencies gained when


                                                                                      -9-
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

systems communicate using the IHE framework. And we’ll see it on {gesture} real equipment
from {gesture} real vendors in real time. Whether your institution's current workflow relies on
paper and film or is already automated to a high degree, IHE can improve the way it operates.
Before you leave, you will understand how.


Registration

In this scenario, a male subject is involved in a motorcycle accident and is transported to a local
hospital. The patient is unable to identify himself and will be entered into the registration system
as “John Doe”. We will start our tour at the registration desk. Our registration person, <SMS
person> of SMS, will register and admit the patient.

[Order Placer: start ordering both procedures as soon as the data is available.]

We have now registered the patient and captured the demographic data. In many institutions
today, that data is entered many times – at the registration desk, at the RIS, at the modality – and
aside from the extra work involved, errors lead to {voice inflection} inconsistent information,
duplicate patient records, identity mismatches, lost studies, and the tedious work of correcting
the errors and even re-examining patients.

Let’s contrast this with an integrated information flow. {Gesture to workflow chart here.} IHE
assigns a unique patient identifier and allows patient demographic data to be shared with all the
relevant systems in the enterprise, eliminating the errors and the extra work.
Orders Placed

The ER physician examines the patient and has observed a fractured left ankle. He places an
order for a CR and MR imaging exam to access the extent of the fracture.

[Order Filler: schedule procedure for all 3 modalities as soon as the orders are received.]

The orders have been entered at the HIS by <GMD person> of GMD. (Note: since we have 2 CR
modality vendors and 1 MR modality vendor participating in this demonstration 3 orders will be
placed.) The HIS combines the previously entered patient demographic information from the
ADT system with the order information from the operator and communicates the orders
automatically to the RIS in the radiology department.


Orders Filled

Now we’re in the radiology department. The RIS has received the order from the HIS and a
technologist, in this case <IDX person> of IDX, will schedule the procedures.




                                                                                       - 10 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

With the procedures scheduled, the RIS communicates the schedule information to the PACS to
allow it to take the necessary actions to prepare for the diagnostic evaluation of the new studies.
For example, the system could retrieve relevant prior studies for review.


Modalities

[Modality operators: query for the worklist as soon as possible.]

To move ahead quickly with this demonstration, we will ask all of our modalities to perform
their examinations at the same time. Here, <SwissRay person> of SwissRay and <Agfa person>
of Agfa will perform a CR study and <GE person> of GE will perform a MR study.

The modalities will first obtain a list of the ordered procedures from the RIS. In many
institutions today, this information comes on paper - frequently carried by the patient –and has to
be {voice inflection} transcribed by the modality operator. But IHE provides a common
mechanism--called DICOM Modality Worklist--for all modalities to obtain the demographic and
procedure information automatically, allowing them to set up the equipment for the ordered
procedure and freeing the technologist to work with the patient. The result is greater patient
throughput, more efficient use of the modality, less delay for the patient at the modality, fewer
errors, and fewer retakes.

The technologists have now selected the procedures to be performed from the list provided by
the RIS, and have started their examinations. As they began, each modality informed the RIS and
the PACS that the exam had started. And at the completion of the study, the modalities inform
the RIS and the PACS that the study is done. In many institutions, this kind of status information
is not available in real time. But with IHE, care providers can track the immediate status of
patients’ examinations and enterprise information systems can take scheduling and billing
actions much more reliably. The result is more efficiency for both personnel and equipment.

The modality combines the patient demographic information acquired from the RIS with the
images and sends the study to the PACS. It then confirms with the PACS that the images are
safely stored before removing them from the modality’s internal storage. In many cases today,
examinations get lost because a technologist can't verify that they are stored in the PACS before
deleting them from the modality. This problem occurs when the technologist either neglects to
send the study to the PACS or fails to notice when a communication error occurs. But whatever
the cause, it results in retakes - not to mention delays in patient treatment. And IHE eliminates it
by closing the loop between the modality and PACS.

One of our modalities (Agfa) is also a print composer and a report reader. You can see this in
detail and learn more about this IHE functioanlity during the self-guided tours for
hardcopy/softcopy consistency and structured reporting.


Image Manager / Archive




                                                                                       - 11 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM

{PACS operators: bring up the images as soon as they arrive.]

Let’s check with the PACS folks to verify the images have arrived. In order to demonstrate
equipment from all the companies that support IHE, we have sent the CR studies to <Applicare
person> of Applicare and the MR study to <SoftMedical person> of Softmedical. I’d like you to
look at the images on their workstations, and you’ll see that all the data is correct.

[Diagnostic workstation operator: display the study when it becomes available.]

One of our PACS systems (Applicare) is also a print composer, so they can print the studies on
any print server in the institution. They can also use the presentation state information we
discussed a minute ago; again, you can see this in detail during the self-guided tours for the
hardcopy and softcopy consistency.


Diagnostic Workstation

With the images stored in the PACS, they are available to all the workstations that access the
PACS.

The radiologist retrieves images from the PACS and displays them for diagnostic interpretation.
The diagnostic workstation displays the demographic and study information originally obtained
from the Registration System and RIS and conveys the reason for the study to guide the
radiologist’s interpretation.

Our workstation operators <Vital Images person> of Vital Images will display the CR study and
<Marconi person> of Marconi will display the MR study. While viewing the study, the
radiologist can save presentation information, for example window level, contrast, and
transformations, with the original images in the PACS, describing how the procedure is to be
displayed when retrieved. The PACS makes that information available when the studies are
viewed at a workstation, ensuring that referring physicians see the study in the same way as did
the radiologist.

Some of our diagnostic workstations are also print composers, so they can print these studies to
any print server in our demonstration to ensure that a hardcopy is produced that is perceptually
consistent with what is viewed at the workstation and includes the appropriate viewing protocols.

In addition, some of the workstations here can also create or view reports. Reports allow the
radiologist to view key information and related images in a structured fashion.

Presentation information can also be used to present image subsets from a single acquisition
separately for diagnostic and billing purposes. We call this Presentation of Grouped Procedures.

You can see all of these features demonstrated in detail in the self-guided tours that are going on
throughout the week here and the vendors here will be happy to discuss them with you at the end
of our tour.



                                                                                      - 12 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

We invite you to take one of these tours after we complete this guided demonstration. Or,
consult the schedules posted outside each of our demonstration groups and come back when it is
more convenient for you.
Patient Name Change

So far, we have seen a typical information flow – from registration to order entry to scheduling
to acquisition to diagnosis in the most convenient sequence. In the real world, though, things
often don’t work that way. One of the major advances in this year’s evolution of IHE is its’
handling of special cases in which information is available out of sequence. The most obvious
example of that is in a trauma case where the exam is done before the order is placed or the
patient is even registered. IHE has analyzed and solved five such special cases, some of which
are very complex. They would take too long to demonstrate here, but the problem is so important
that we want to show you at least the simplest case to wrap up this demonstration.

[ADT: Enter name change.]

Imagine that after the images have been acquired, the patient’s name must be changed – in this
scenario, after searching for the patient name and demographics, the registration clerk finds that
the patient has an existing patient record in the hospital.

With IHE there is no need to re-enter the patient demographic information, the registration
system merges the patient record of “John Doe’ into the existing record for this patient – and
every other system follows suit automatically.

Let’s go back to our registration area. After the name change has been entered, the ADT system
sends update messages to the HIS that places orders, the RIS that schedules or fills the orders,
and the PACS.

[Reference IHE Workflow Diagram]

Each system makes the necessary internal corrections, and the PACS updates the image archive
so that the patient images may be retrieved using the correct information in the future.

[Order Placer: display the new patient record.]
[Order Filler: display the new patient record.]
[PACS: display the new patient record.]

Now we can check that the HIS has received the update message and made the change.

Likewise, here we see that the RIS has followed suit.

And finally, the PACS does the same.

-- All automatically. And all the patient’s studies, whether new or old, are still connected.



                                                                                       - 13 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM



Wrap-up


      I promised that you would see both economic and clinical efficiency. In this
       demonstration, we eliminated labor-intensive, error-prone steps from the process; we
       eliminated significant sources of retakes, and we reduced the cycle time for care in the
       institution. These are important achievements. I hope you see what an integrated
       information flow can mean to the radiology department, the healthcare enterprise, and
       effective patient care.


      Now, some of the functions you have seen here are being done already in technologically
       advanced institutions-- through single-vendor systems or painstakingly built site-specific
       solutions. What is important about IHE is that for the first time, a large group of
       vendors have come together to work out how to integrate their products in the real world
       in a consistent way. When you look around this exhibit, you will see close to <70>
       products from <33> vendors all sharing the same data and all working within the IHE
       Technical Framework. This framework enables vendors to do the integration work up
       front. This entire demonstration came together with only a few days of face-to-face
       work by vendors. As you probably know, interfacing systems even two systems now
       often takes months. Adhering to the IHE framework enables vendors to deliver
       integrated systems more efficiently, eliminating the need to develop redundant, site-
       specific interfaces among systems.


      But IHE has even more to offer. We just saw demonstrated two of the sets of
       functionality we call {enunciate carefully} "IHE Integration Profiles." They are
       Scheduled Workflow and Patient Reconciliation.
      We mentioned five other integration profiles available in IHE this year. I’d like to
       invite you again to take one of the self-guided tours where these are being demonstrated.
       Again, they are:
          Presentation consistency for print and softcopy
          Grouped procedures
          Two levels of Structured Reporting, and
          Cross-departmental information sharing
   More detail about the self-guided tours is given in the IHE Demonstration Brochure.


      [Show the brochure, IHE Integration Profile: A buyers Guide]




                                                                                     - 14 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

      Please also keep and review this brochure: IHE Integration Profiles: Guidelines for
       Buyers. Use it as a basis for talking about integration with the vendors you work with.
      Finally, thanks to all of our participants, who showed what a smoothly running, no
       excuses radiology department can look like; and thanks again to you for taking the time
       to join us.
      If you have any further questions about IHE for me or for any of the participants in this
       demonstration, we'd be happy to try to answer them now.

Thank you.




Docent Script for Group 2A
Case: Fractured Ankle

[ADT: start registering the patient now.]

Welcome. I’m <my name> from <my company>, here representing the IHE
(Technical/Planning) Committee.


                                                                                     - 15 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM



Thank you for taking the time to join us. I think you’ll be glad you did – because we are about to
see a demonstration showing the remarkable economic and clinical efficiencies gained when
systems communicate using the IHE framework. And we’ll see it on {gesture} real equipment
from {gesture} real vendors in real time. Whether your institution's current workflow relies on
paper and film or is already automated to a high degree, IHE can improve the way it operates.
Before you leave, you will understand how.


Registration

In this scenario, a male subject is involved in a motorcycle accident and is transported to a local
hospital. The patient is unable to identify himself and will be entered into the registration system
as “John Doe”. We will start our tour at the registration desk. Our registration person, <IDX
person> of IDX, will register and admit the patient.

[Order Placer: start ordering both procedures as soon as the data is available.]

We have now registered the patient and captured the demographic data. In many institutions
today, that data is entered many times – at the registration desk, at the RIS, at the modality – and
aside from the extra work involved, errors lead to {voice inflection} inconsistent information,
duplicate patient records, identity mismatches, lost studies, and the tedious work of correcting
the errors and even re-examining patients.

Let’s contrast this with an integrated information flow. {Gesture to workflow chart here.} IHE
assigns a unique patient identifier and allows patient demographic data to be shared with all the
relevant systems in the enterprise, eliminating the errors and the extra work.
Orders Placed

The ER physician examines the patient and has observed a fractured left ankle. He places an
order for a CR and MR imaging exam to access the extent of the fracture.

[Order Filler: schedule procedure for both modalities as soon as the orders are received.]

The orders have been entered at the HIS by <IDX person> of IDX. (Note: since we have 1 CR
and 1 MR modality vendor participating in this demonstration 2 orders will be placed.) The HIS
combines the previously entered patient demographic information from the ADT system with the
order information from the operator and communicates the orders automatically to the RIS in the
radiology department.


Orders Filled

Now we’re in the radiology department. The RIS has received the order from the HIS and a
technologist, in this case <SoftMedical person> of SoftMedical, will schedule the procedures.


                                                                                       - 16 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM


With the procedures scheduled, the RIS communicates the schedule information to the PACS to
allow it to take the necessary actions to prepare for the diagnostic evaluation of the new studies.
For example, the system could retrieve relevant prior studies for review.


Modalities

[Modality operators: query for the worklist as soon as possible.]

To move ahead quickly with this demonstration, we will ask both of our modalities to perform
their examinations at the same time. Here, <Konica person> of Konica will perform a CR study
and <Philips person> of Philips will perform a MR study.

The modalities will first obtain a list of the ordered procedures from the RIS. In many
institutions today, this information comes on paper - frequently carried by the patient –and has to
be {voice inflection} transcribed by the modality operator. But IHE provides a common
mechanism--called DICOM Modality Worklist--for all modalities to obtain the demographic and
procedure information automatically, allowing them to set up the equipment for the ordered
procedure and freeing the technologist to work with the patient. The result is greater patient
throughput, more efficient use of the modality, less delay for the patient at the modality, fewer
errors, and fewer retakes.

The technologists have now selected the procedures to be performed from the list provided by
the RIS, and have started their examinations. As they began, each modality informed the RIS and
the PACS that the exam had started. And at the completion of the study, the modalities inform
the RIS and the PACS that the study is done. In many institutions, this kind of status information
is not available in real time. But with IHE, care providers can track the immediate status of
patients’ examinations and enterprise information systems can take scheduling and billing
actions much more reliably. The result is more efficiency for both personnel and equipment.

The modality combines the patient demographic information acquired from the RIS with the
images and sends the study to the PACS. It then confirms with the PACS that the images are
safely stored before removing them from the modality’s internal storage. In many cases today,
examinations get lost because a technologist can't verify that they are stored in the PACS before
deleting them from the modality. This problem occurs when the technologist either neglects to
send the study to the PACS or fails to notice when a communication error occurs. But whatever
the cause, it results in retakes - not to mention delays in patient treatment. And IHE eliminates it
by closing the loop between the modality and PACS.


Image Manager / Archive

{PACS operators: bring up the images as soon as they arrive.]




                                                                                       - 17 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM

Let’s check with the PACS folks to verify the images have arrived. In order to demonstrate
equipment from all the companies that support IHE, we have sent the CR study to <Canon
person> of Canon and the MR study to <CSIST person> of CSIST. I’d like you to look at the
images on their workstations, and you’ll see that all the data is correct.

[Diagnostic workstation operator: display the study when it becomes available.]

One of our PACS systems (Canon) is also a print composer, so they can print the studies on any
print server in the institution. They can also use the presentation state information we discussed
a minute ago; again, you can see this in detail during the self-guided tours for the hardcopy and
softcopy consistency.


Diagnostic Workstation

With the images stored in the PACS, they are available to all the workstations that access the
PACS.

The radiologist retrieves images from the PACS and displays them for diagnostic interpretation.
The diagnostic workstation displays the demographic and study information originally obtained
from the Registration System and RIS and conveys the reason for the study to guide the
radiologist’s interpretation.

Our workstation operators <Marconi person> of Marconi will display the CR study and
<Siemens person> of Siemens will display the MR study. While viewing the study, the
radiologist can save presentation information, for example window level, contrast, and
transformations, with the original images in the PACS, describing how the procedure is to be
displayed when retrieved. The PACS makes that information available when the studies are
viewed at a workstation, ensuring that referring physicians see the study in the same way as did
the radiologist.

One of our diagnostic workstations are also print composers, so they can print these studies to
any print server in our demonstration to ensure that a hardcopy is produced that is perceptually
consistent with what is viewed at the workstation and includes the appropriate viewing protocols.

In addition, some of the workstations here can also create or view reports. Reports allow the
radiologist to view key information and related images in a structured fashion.

Presentation information can also be used to present image subsets from a single acquisition
separately for diagnostic and billing purposes. We call this Presentation of Grouped Procedures.

You can see all of these features demonstrated in detail in the self-guided tours that are going on
throughout the week here and the vendors here will be happy to discuss them with you at the end
of our tour.




                                                                                      - 18 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

We invite you to take one of these tours after we complete this guided demonstration. Or,
consult the schedules posted outside each of our demonstration groups and come back when it is
more convenient for you.
Patient Name Change

So far, we have seen a typical information flow – from registration to order entry to scheduling
to acquisition to diagnosis in the most convenient sequence. In the real world, though, things
often don’t work that way. One of the major advances in this year’s evolution of IHE is its’
handling of special cases in which information is available out of sequence. The most obvious
example of that is in a trauma case where the exam is done before the order is placed or the
patient is even registered. IHE has analyzed and solved five such special cases, some of which
are very complex. They would take too long to demonstrate here, but the problem is so important
that we want to show you at least the simplest case to wrap up this demonstration.

[ADT: Enter name change.]

Imagine that after the images have been acquired, the patient’s name must be changed – in this
scenario, after searching for the patient name and demographics, the registration clerk finds that
the patient has an existing patient record in the hospital.

With IHE there is no need to re-enter the patient demographic information, the registration
system merges the patient record of “John Doe’ into the existing record for this patient – and
every other system follows suit automatically.

Let’s go back to our registration area. After the name change has been entered, the ADT system
sends update messages to the HIS that places orders, the RIS that schedules or fills the orders,
and the PACS.

[Reference IHE Workflow Diagram]

Each system makes the necessary internal corrections, and the PACS updates the image archive
so that the patient images may be retrieved using the correct information in the future.

[Order Placer: display the new patient record.]
[Order Filler: display the new patient record.]
[PACS: display the new patient record.]

Now we can check that the HIS has received the update message and made the change.

Likewise, here we see that the RIS has followed suit.

And finally, the PACS does the same.

-- All automatically. And all the patient’s studies, whether new or old, are still connected.



                                                                                       - 19 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM



Wrap-up


      I promised that you would see both economic and clinical efficiency. In this
       demonstration, we eliminated labor-intensive, error-prone steps from the process; we
       eliminated significant sources of retakes, and we reduced the cycle time for care in the
       institution. These are important achievements. I hope you see what an integrated
       information flow can mean to the radiology department, the healthcare enterprise, and
       effective patient care.


      Now, some of the functions you have seen here are being done already in technologically
       advanced institutions-- through single-vendor systems or painstakingly built site-specific
       solutions. What is important about IHE is that for the first time, a large group of
       vendors have come together to work out how to integrate their products in the real world
       in a consistent way. When you look around this exhibit, you will see close to <70>
       products from <33> vendors all sharing the same data and all working within the IHE
       Technical Framework. This framework enables vendors to do the integration work up
       front. This entire demonstration came together with only a few days of face-to-face
       work by vendors. As you probably know, interfacing systems even two systems now
       often takes months. Adhering to the IHE framework enables vendors to deliver
       integrated systems more efficiently, eliminating the need to develop redundant, site-
       specific interfaces among systems.


      But IHE has even more to offer. We just saw demonstrated two of the sets of
       functionality we call {enunciate carefully} "IHE Integration Profiles." They are
       Scheduled Workflow and Patient Reconciliation.
      We mentioned five other integration profiles available in IHE this year. I’d like to
       invite you again to take one of the self-guided tours where these are being demonstrated.
       Again, they are:
          Presentation consistency for print and softcopy
          Grouped procedures
          Two levels of Structured Reporting, and
          Cross-departmental information sharing
   More detail about the self-guided tours is given in the IHE Demonstration Brochure.


      [Show the brochure, IHE Integration Profile: A buyers Guide]




                                                                                     - 20 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

      Please also keep and review this brochure: IHE Integration Profiles: Guidelines for
       Buyers. Use it as a basis for talking about integration with the vendors you work with.
      Finally, thanks to all of our participants, who showed what a smoothly running, no
       excuses radiology department can look like; and thanks again to you for taking the time
       to join us.
      If you have any further questions about IHE for me or for any of the participants in this
       demonstration, we'd be happy to try to answer them now.

Thank you.




Docent Script for Group 2B
Case: Fractured Ankle

[ADT: start registering the patient now.]



                                                                                     - 21 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

Welcome. I’m <my name> from <my company>, here representing the IHE
(Technical/Planning) Committee.

Thank you for taking the time to join us. I think you’ll be glad you did – because we are about to
see a demonstration showing the remarkable economic and clinical efficiencies gained when
systems communicate using the IHE framework. And we’ll see it on {gesture} real equipment
from {gesture} real vendors in real time. Whether your institution's current workflow relies on
paper and film or is already automated to a high degree, IHE can improve the way it operates.
Before you leave, you will understand how.


Registration

In this scenario, a male subject is involved in a motorcycle accident and is transported to a local
hospital. The patient is unable to identify himself and will be entered into the registration system
as “John Doe”. We will start our tour at the registration desk. Our registration person, <IDX
person> of IDX, will register and admit the patient.

[Order Placer: start ordering both procedures as soon as the data is available.]

We have now registered the patient and captured the demographic data. In many institutions
today, that data is entered many times – at the registration desk, at the RIS, at the modality – and
aside from the extra work involved, errors lead to {voice inflection} inconsistent information,
duplicate patient records, identity mismatches, lost studies, and the tedious work of correcting
the errors and even re-examining patients.

Let’s contrast this with an integrated information flow. {Gesture to workflow chart here.} IHE
assigns a unique patient identifier and allows patient demographic data to be shared with all the
relevant systems in the enterprise, eliminating the errors and the extra work.
Orders Placed

The ER physician examines the patient and has observed a fractured left ankle. He places an
order for a CT and CR imaging exam to access the extent of the fracture.

[Order Filler: schedule procedure for both modalities as soon as the orders are received.]

The orders have been entered at the HIS by <IDX person> of IDX. (Note: since we have a CT
modality and a CR modality participating in this demonstration 2 orders will be placed.) The
HIS combines the previously entered patient demographic information from the ADT system
with the order information from the operator and communicates the orders automatically to the
RIS in the radiology department.


Orders Filled



                                                                                       - 22 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

Now we’re in the radiology department. The RIS has received the order from the HIS and a
technologist, in this case <Mitra person> of Mitra, will schedule the procedures.

With the procedures scheduled, the RIS communicates the schedule information to the PACS to
allow it to take the necessary actions to prepare for the diagnostic evaluation of the new studies.
For example, the system could retrieve relevant prior studies for review.


Modalities

[Modality operators: query for the worklist as soon as possible.]

To move ahead quickly with this demonstration, we will ask both of our modalities to perform
their examinations at the same time. Here, <Siemens person> of Siemens will perform a CT
study and <Direct Radiography person> of Direct Radiography will perform a CR study.

The modalities will first obtain a list of the ordered procedures from the RIS. In many
institutions today, this information comes on paper - frequently carried by the patient –and has to
be {voice inflection} transcribed by the modality operator. But IHE provides a common
mechanism--called DICOM Modality Worklist--for all modalities to obtain the demographic and
procedure information automatically, allowing them to set up the equipment for the ordered
procedure and freeing the technologist to work with the patient. The result is greater patient
throughput, more efficient use of the modality, less delay for the patient at the modality, fewer
errors, and fewer retakes.

The technologists have now selected the procedures to be performed from the list provided by
the RIS, and have started their examinations. As they began, each modality informed the RIS and
the PACS that the exam had started. And at the completion of the study, the modalities inform
the RIS and the PACS that the study is done. In many institutions, this kind of status information
is not available in real time. But with IHE, care providers can track the immediate status of
patients’ examinations and enterprise information systems can take scheduling and billing
actions much more reliably. The result is more efficiency for both personnel and equipment.

The modality combines the patient demographic information acquired from the RIS with the
images and sends the study to the PACS. It then confirms with the PACS that the images are
safely stored before removing them from the modality’s internal storage. In many cases today,
examinations get lost because a technologist can't verify that they are stored in the PACS before
deleting them from the modality. This problem occurs when the technologist either neglects to
send the study to the PACS or fails to notice when a communication error occurs. But whatever
the cause, it results in retakes - not to mention delays in patient treatment. And IHE eliminates it
by closing the loop between the modality and PACS.


Image Manager / Archive

{PACS operators: bring up the images as soon as they arrive.]


                                                                                       - 23 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                  Created on 2/1/2001 6:22:00 PM


Let’s check with the PACS folks to verify the images have arrived. In order to demonstrate
equipment from all the companies that support IHE, we have sent the CT study to <RASNA
person> of RASNA and the CR study to <Merge person> of Merge. I’d like you to look at the
images on their workstations, and you’ll see that all the data is correct.

[Diagnostic workstation operator: display the study when it becomes available.]

Our PACS systems also support the ability to create and read reports. You can see this in detail
during the self-guided tours for the hardcopy and softcopy consistency.


Diagnostic Workstation

With the images stored in the PACS, they are available to all the workstations that access the
PACS.

The radiologist retrieves images from the PACS and displays them for diagnostic interpretation.
The diagnostic workstation displays the demographic and study information originally obtained
from the Registration System and RIS and conveys the reason for the study to guide the
radiologist’s interpretation.

Our workstation operators <StorCOMM person> of StorCOMM will display the CT study and
<GE person> of GE will display the CR study. While viewing the study, the radiologist can save
presentation information, for example window level, contrast, and transformations, with the
original images in the PACS, describing how the procedure is to be displayed when retrieved.
The PACS makes that information available when the studies are viewed at a workstation,
ensuring that referring physicians see the study in the same way as did the radiologist.

One of our diagnostic workstations is also a print composer, so they can print these studies to any
print server in our demonstration to ensure that a hardcopy is produced that is perceptually
consistent with what is viewed at the workstation and include the appropriate viewing protocols.

In addition, our workstations here can also create and view reports. Reports allow the radiologist
to view key information and related images in a structured fashion.

Presentation information can also be used to present image subsets from a single acquisition
separately for diagnostic and billing purposes. We call this Presentation of Grouped Procedures.

You can see all of these features demonstrated in detail in the self-guided tours that are going on
throughout the week here and the vendors here will be happy to discuss them with you at the end
of our tour.

We invite you to take one of these tours after we complete this guided demonstration. Or,
consult the schedules posted outside each of our demonstration groups and come back when it is
more convenient for you.



                                                                                      - 24 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                   Created on 2/1/2001 6:22:00 PM

Patient Name Change

So far, we have seen a typical information flow – from registration to order entry to scheduling
to acquisition to diagnosis in the most convenient sequence. In the real world, though, things
often don’t work that way. One of the major advances in this year’s evolution of IHE is its’
handling of special cases in which information is available out of sequence. The most obvious
example of that is in a trauma case where the exam is done before the order is placed or the
patient is even registered. IHE has analyzed and solved five such special cases, some of which
are very complex. They would take too long to demonstrate here, but the problem is so important
that we want to show you at least the simplest case to wrap up this demonstration.

[ADT: Enter name change.]

Imagine that after the images have been acquired, the patient’s name must be changed – in this
scenario, after searching for the patient name and demographics, the registration clerk finds that
the patient has an existing patient record in the hospital.

With IHE there is no need to re-enter the patient demographic information, the registration
system merges the patient record of “John Doe’ into the existing record for this patient – and
every other system follows suit automatically.

Let’s go back to our registration area. After the name change has been entered, the ADT system
sends update messages to the HIS that places orders, the RIS that schedules or fills the orders,
and the PACS.

[Reference IHE Workflow Diagram]

Each system makes the necessary internal corrections, and the PACS updates the image archive
so that the patient images may be retrieved using the correct information in the future.

[Order Placer: display the new patient record.]
[Order Filler: display the new patient record.]
[PACS: display the new patient record.]

Now we can check that the HIS has received the update message and made the change.

Likewise, here we see that the RIS has followed suit.

And finally, the PACS does the same.

-- All automatically. And all the patient’s studies, whether new or old, are still connected.


Wrap-up



                                                                                       - 25 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

      I promised that you would see both economic and clinical efficiency. In this
       demonstration, we eliminated labor-intensive, error-prone steps from the process; we
       eliminated significant sources of retakes, and we reduced the cycle time for care in the
       institution. These are important achievements. I hope you see what an integrated
       information flow can mean to the radiology department, the healthcare enterprise, and
       effective patient care.


      Now, some of the functions you have seen here are being done already in technologically
       advanced institutions-- through single-vendor systems or painstakingly built site-specific
       solutions. What is important about IHE is that for the first time, a large group of
       vendors have come together to work out how to integrate their products in the real world
       in a consistent way. When you look around this exhibit, you will see close to <70>
       products from <33> vendors all sharing the same data and all working within the IHE
       Technical Framework. This framework enables vendors to do the integration work up
       front. This entire demonstration came together with only a few days of face-to-face
       work by vendors. As you probably know, interfacing systems even two systems now
       often takes months. Adhering to the IHE framework enables vendors to deliver
       integrated systems more efficiently, eliminating the need to develop redundant, site-
       specific interfaces among systems.


      But IHE has even more to offer. We just saw demonstrated two of the sets of
       functionality we call {enunciate carefully} "IHE Integration Profiles." They are
       Scheduled Workflow and Patient Reconciliation.
      We mentioned five other integration profiles available in IHE this year. I’d like to
       invite you again to take one of the self-guided tours where these are being demonstrated.
       Again, they are:
          Presentation consistency for print and softcopy
          Grouped procedures
          Two levels of Structured Reporting, and
          Cross-departmental information sharing
   More detail about the self-guided tours is given in the IHE Demonstration Brochure.


      [Show the brochure, IHE Integration Profile: A buyers Guide]


      Please also keep and review this brochure: IHE Integration Profiles: Guidelines for
       Buyers. Use it as a basis for talking about integration with the vendors you work with.
      Finally, thanks to all of our participants, who showed what a smoothly running, no
       excuses radiology department can look like; and thanks again to you for taking the time
       to join us.


                                                                                     - 26 -
90eff042-9101-425f-85ba-04cd20fc5978.doc                 Created on 2/1/2001 6:22:00 PM

      If you have any further questions about IHE for me or for any of the participants in this
       demonstration, we'd be happy to try to answer them now.

Thank you.




                                                                                     - 27 -

				
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