IHE: When are we going to catch up?
Herman Oosterwijk, President, OTech Inc.The integration of the healthcare enterprise activity is expanding rapidly. I had the honor of being one of the monitors at a connectathon in January, where hundreds of vendor representatives tested interoperability of their devices. It was rewarding to see the vendors conform to more detailed specifications. After the event, the results were published to reflect these great accomplishments (visit: www.ihe.net). So far, so good. Now, let’s do a reality check.

We are currently in year seven of the radiology domain, one of the major initial IHE profile definitions (in addition to cardiology, ophthalmology, radiation therapy, lab and patient care), and this domain alone has already passed its 20th mark on the number of profiles. As a matter of fact, the IHE planning committee has started to slow down the specifications of additional profiles, afraid to fall into the same trap for which the IHE was designed to solve — over complexity and too many choices. But let’s not get bogged down by too many choices, and just look at the most basic one: scheduled workflow.

According to the specification (see www.ihe.net), the scheduled workflow integration profile establishes a seamless flow of information that supports a patient care workflow for a typical imaging procedure. It specifies transactions that maintain the consistency of both the requisition and patient information from registration through ordering, scheduling, imaging acquisition, storage, and viewing.

One of the key DICOM services allowing this seamless flow, without requiring too much user interaction, is the MPPS (Modality Performed Procedure Step ). This allows a modality to communicate back to the RIS and PACS the study status (“completed,” “in progress,” “canceled”), the number of images generated and any changes in the performed procedure with respect to the original scheduled one. Note that MPPS implementation can have a major positive impact on workflow and technologist, as well as PACS administrator efficiency: It potentially makes the “verify” step in the PACS/RIS redundant, eliminates change orders and/or cancellations, and keeps the radiologist and modality work lists always current and up-to-date using the status information. I polled our PACS administrator students to find out the status of the deployment of MPPS. Based on my poll, I estimate that the number of PACS using MPPS is less than 5 percent. Why? Here are the reasons the give:
  • Lack of support by PACS. The major PACS vendors still don’t support MPPS in their current releases, even though they have been testing it and demonstrating it for many years at connectathons.
  • Lack of support by RIS vendors. The RIS vendors are even worse in supporting MPPS, most of them require an operator to change the orders and/or change the exam status manually.
  • Lack of knowledge among users. I have talked with users who had paid extra for the MPPS option when purchasing new modalities, but were unaware of this and had not enabled it.
  • Non-uniform support. As with any option, if some of your modalities support it and others don’t, there is a different workflow required for each option, which makes it complex and confusing.
  • Lack of knowledge among support personnel. One needs an orchestrated effort between the modality, PACS and RIS to make this work. I have experienced it in several cases, that the support/service engineers from either one of these systems were unaware and untrained to properly install and support this.
Support by modalities is typically not a valid reason. Almost all new radiology digital modalities support MPPS by now. 

So, here we are, back to our original question: When is the user community going to catch up with MPPS and therefore the most fundamental, useful IHE integration profile, scheduled workflow? Hopefully, this article will be the catalyst for many institutions to develop a plan for MPPS roll-out.

The first thing to do is inventarization, or create a list of which of your modalities and PACS/RIS have MPPS support. Then, find out what it takes to get it configured and installed. Next, do a workflow analysis to look at the impact and generate a training and roll-out plan. We have a great IHE organization that’s made an effort to participate in connectathons, and we’ve seen a corresponding marketing fall-out from that. Now we just need to do it.

I always encourage comments and/or questions. Please visit our website www.otechimg.com for contact information. Herman Oosterwijk is president of OTech Inc.