Planning Committee
Focus Group
8:00 - 17:00, Friday, September 24, 2010
8:00 - 10:00, Saturday, September 25, 2010
ASTRO HQ, Fairfax, VA
1) Welcome and Introductions
PC Radiation
Oncologists
Kevin Albuquerque
PC Medical
Physicists
Charles Able
Tony Quang
Akkamma Ravi
PC Vendors
TC Representatives
Adam Earwicker
(Varian)
Walter Bosch
(ATC)
Sha Chang
Nick Linton
(Elekta)
Bruce Curran
(TC Co-chair)
Colin Field
(PC Co-chair)
Martin Pellinat
(Vision Tree)
Rishabh Kapoor
(U of Florida)
Prabhakar Tripuraneni Todd McNutt
(Co-chair)
Jacob Philip
(Elekta)
Stuart Swerdloff
(TC Co-chair, Elekta)
ASTRO
Representatives
Norman Trapp
(Siemens)
Jatinder Palta
(Co-chair)
Sidrah Abdul
Barbara Muth
Harold Beunk
(Nucletron)
Kevin Riddell
Regrets: May Wahab (PC Co-chair), Mika Miettinen (PC co-chair, Varian), Ramesh Rengen,
Christopher Rose
2) Meeting Goals

Quick overview of IHE and IHE-RO

Establish directions & goals for IHE-RO PC

Have brief joint TC and PC meeting

Changes to Agenda ?
3a) Overview of IHE
Integrating the Healthcare Enterprise, formed in 1998
 Global initiative to facilitate sharing of health information




from application to application
system to system
across multiple healthcare enterprises
Brings together health information technology
stakeholders to implement standards for communicating
patient information efficiently throughout and among
healthcare enterprises by developing a framework of
interoperability
 Because of its proven process of collaboration,
demonstration and real world implementation of
interoperable solutions, IHE is in a unique position to
significantly accelerate the process for defining, testing,
and implementing standards-based interoperability
among electronic health record systems

(from http://www.ihe.net/News/ihe_intl_expands_incorporates_2009-12-31.cfm )
IHE Organizational Structure
Anatomic
Pathology
Pharmacy
ASTRO AAPM
ACR
AROI
CARO
CSRO
ESTRO
Quality, Research & Public Health
JASTRO
About IHE-RO
2004: Prabhakar Tripuraneni and Jatinder
Palta formed IHE-RO at RSNA
 2004: Bruce Curran and Stuart Swerdloff
spear-headed the TC
 2006: First IHE-RO Domain Pre-testing
 2007: First Connectathon (Aug)
 2007: PC became more active
 2007: First Public demonstration (Oct)

How Does This All Happen ?

ASTRO Significant Support
Since 2006, spent well over US$ 1.0M
 Test Tools and Administrative support


RT Vendors Significant Resources
Domain Pre-testing
 Connectathons
 Product Development and Documentation


End Users


Volunteer time and energy
Florida grant (Jatinder and May)
Acknowledgements
IHE-RO Connectathon Vendors
 Accuray (2009/10)
 BrainLAB (2007/8/9/10)
 Candelis (2010)
 Elekta (2007/8/9/10)
 GE Healthcare (2009)
 MIMVista (2008/9)
 Nucletron (2007/8/9/10)
 Philips (2007/8/9/10)
 Siemens (2008/9/10)
 Third Way Software (2010)
 Tomotherapy (2007/8/9/10)
 Varian (2007/8/9/10)
Numerous Volunteers
Other IHE-RO Members
 ASTRO
 AAPM
 ATC
 Bogardus Medical Systems
 Brigham & Women’s Hospital
 Cogent Health Solutions Inc.
 Cross Cancer Institute
 ESTRO
 IBA Particle Therapy
 Loyala University Medical Centre
 Radion, Inc
 SEFM
 SJS Targeted Solutions
 Sun Nuclear
 TSG Integrations
 University of Florida
 VisionRT
 VisionTree Software, Inc
 Wake Forest
Links to more info

Wiki.ihe.net

www.ihe.net

http://www.astro.org/Research/ResearchHi
ghlights/IHERO/index.aspx
3b) PC Membership

Google docs Roster

Governance document


http://www.ihe.net/governance/index.cfm
Join IHE
Process is easy, and it is free !
 Institutional politics may not be as easy
 Link to on-line application

4) ASTRO IHE-RO and
Research Committee
a)
b)
c)
EMR and Registry
CCHIT and IHE-RO
Patient Safety
ASTRO safety initiative named
to 25 Most Influential list
ASTRO has been named as one of RT Image's
25 Most Influential people, institutions or events
that shaped radiology in 2010. ASTRO ranked
sixth for its Target Safely initiative, a six-point
patient protection plan that will improve safety
and quality and reduce the chances of medical
errors. To learn more about Target Safely, visit
www.astro.org/targetsafely, or ASTRO
Chairman Williams’s article.
5) Use Cases
Process
 Review


old, in development, on hold, new

http://wiki.ihe.net/index.php?title=Radiation_Oncology
#Use_Case_Selection
Steps of IHE Process

Identify Inter-operability problems (Use Cases)
 describe how end-users will
 accomplish
a goal by performing a task or a series
of tasks using systems (or software)
 includes the responses of the systems (or software)
to user actions






Select Use Cases to develop (process)
Specify Integration Profiles, Develop Test Tools
Domain Pre-testing
Test Integration Profiles at Connectathon
Public Demonstration ?
Publish Integration Profiles for use in RFPs
Successfully Completed Use Cases

Basic RT Treatment Planning (2007)

Multimodality Registration (2008)

Advanced RT Objects (2009)

Treatment Delivery Workflow (2010?)
Use Cases in Development (2010)

Treatment Delivery Workflow
Public comment (07-Mar-2010)
 Domain pre-testing (June 2-11, 2010)
 2010 connectathon (Sept 20-26, 2010)


Dose Compositing
Public comment (26-Feb-2010)
 Domain pre-testing (2011 ?)
 2011 connectathon (2011 ?)


Enterprise Schedule Integration

Japan IHE-RO
Use Cases requiring more support

Prescription Automation

Needs DICOM WG 7 extension of standards

Structure Templates: Creation, Export
and Import

User Authentication and Authorization

IHE-ITI XUA++ (Cross-Enterprise User Assertion
– Attribute Extension)
2010 Use Case Selection
http://www.doodle.com/k62626a552iy6y6r
 Flesh out top 3 details for ASTRO AGM

Ensure problem is well defined
 Suggest how things should work
 Sell TC on necessity to support the Use Case


Let’s review each Use Case in ranked order
Very brief summary by Champion
 Questions, comments, discussion


Currently 15 others Use Cases on the list

http://wiki.ihe.net/index.php?title=Radiation_Oncology#Use_Case_Wish_List
Radiation Oncology Workflow
Exchange

Data dictionary needed
Closed Loop Patient Safety

Categories:
Handshaking check of data transfer
 Feedback loop, plan, deliver, cf plan
 Imaging closed loop

Population of a Registry
 End to end check - phantom

Anonymization
Anonymize specific dicom tags
 Template for data to send
 reader to ensure all links are preserved
between related items

Radiation Oncology Patient
Portal
Data dictionary required
 Source: RT data; Destination: secured
web browser
 Interactive record of patient data
 Updating of followup data
 2015 requirement for meaningful use

Deformable Registration
Instance-level Query Retrieve
6) Current Issues
a)
Clinical Release of Connectathon software
- what are IHE rules? 1 year, special rules for IHE-RO?
- PC communicate rules to TC
- PC/TC cross compare passed actors with released
software, vendors and users check
b)
c)
Use of integration profiles in RFP
Wiki pages
a)
d)
Rishabh volunteered to help with updating of
Wiki
Vote using Survey Monkey instead of Doodle
a)
Consensus was that Doodle was adequate
7) Open Forum
a)
b)
Future of IHE-RO
Funding for IHE-RO
a)
b)
c)
d)
Volunteer effort
Election of Co-chairs
a)
b)
e)
IHE-RO initiative should become cost neutral to ASTRO
PC members were encourage to obtain grants in support
of IHE-RO activities
Dr. May Wahab will be stepping down as PC Chair, and
Dr. Ramesh Rengan will be assuming this role
Some thought may need to be given to transitioning
Mika’s and Colin’s PC co-chair roles, and Bruce’s and
Stuart’s TC co-chair roles
Other ?
Lunch (Connectathon, LL)
8) Technical and Planning
committee Joint meeting
IHE-RO Co-Chairs
Prabhakar Tripuraneni, MD
Jatinder Palta, PhD
Planning Committee








Technical Committee
May Abdel-Wahab, MD, PhD
Colin Field, MSc
Mika Miettinen
Recruit vendors of relevant
information systems and users with
clinical and operational experience
Prioritize & coordinate domain
activities
Identify, gather, review and prioritize
integration and information interoperability problems (Use Cases)
Approve proposals selected by the
TC for Profile development
Develop educational materials for
the domain and profiles







Bruce Curran, MS, ME
Stuart Swerdloff, PhD
Recruit vendors of relevant information
systems and users with technical
experience
Assess the feasibility and estimated
effort for PC selected Use Cases
Build consensus on the appropriate
standards-based solutions
Develop Integration Profiles for Use
Case solutions
Maintain Technical Framework for
domain Integration Profiles, describes
solutions to inter-operability problems
8) Technical and Planning
committee Joint meeting





Is more support from PC required at pre-testing and at
connectathon ? Yes, clinicians with practical experience,
Wednesday thru Friday.
Is PC input needed at TC meeting after ASTRO ? No, but
questioned will need to be answered soon after TC meeting.
Can PC help with linac configuration gold standard? NEMA
MITA working on (Stuart Swerdloff). Stuart will let us know.
Is a public demonstration needed ? No.
What else can PC do to help TC ? Chase small companies
that should be participating to get involved.
9) Budget Planning





Make test tools free. Charge for evaluation.
Make per Actor cost for evaluation the same for all
Actors (categorized as simple or complex)
How is re-testing charged ? After failed test,
charge at 100%. For voluntary re-testing, at a
discounted rate of 50%.
Retest every year? Ask TC.
With new versions of test tools, vendor can decide
whether they wish to re-test and be evaluated.
They can use the new version of test tools inhouse for their own evaluation.
10) Publicity and Promotion

Publish success stories from IHE-RO
11) Plan of Action for the future
a)





Develop a list of items for the participants to
mull overnight
Should this meeting occur next year ? Yes. Preferably on
Sunday/Monday to facilitate TC attendance ?
ASTRO has asked for a single presentation in ASTRO booth
during ASTRO AGM. Bruce nominated. Ramesh Rengen tag
team.
Create webinar with CME credits for IHE-RO (MD, Physics,
RTT, CMD). Tony to investigate. Interoperability and patient
safety.
Create annual report showing passed actors with product
releases. Verified by vendors and users
Standardize information on www.ihe.net and wiki.ihe.net.
Rishabh
Use Cases



Prioritize new Use Cases with prior ‘tabled’ Use Cases
How do we close the loop from Use Case to Integration
profile to RFP to Clinical Use ? Test tool versions. Poll
users, allowing reporting of failures. Contact initial
customers. Mini complaint system ?
Take Use cases to ASTRO Corporate Advisory Board for
support. Jatinder. Prepared after TC has vetted. Needed
by <date>
Tasks










Develop Data Dictionary. PC role? Provided data needed to support user
cases. Todd and Walter
Develop Standard Testing facility (or resource centre) for all vendors
(outside scope of IHE-RO). Jatinder to ask ASTRO Executive
 Develop scope of facility
 FDA implications
Create ASTRO IHE-RO Task force to provide recommendations to RO
community. Evidence based info needed. Interoperability Errors
Publications subcommittee:
 Publish success stories
Continue to obtain funding in support of TC. Everyone
Correct Nucletron representative on PC. Colin, Harold.
Every issue of ASTRO news to have IHE-RO content. Barbara
Document Budget cycle for each IHE-RO vendor. Sidrah
Use PLUNC as IHE-RO test platform ?
Update PC and TC membership roster in consistent manner. Sidrah
Planning Committee
Focus Group
8:00 - 10:00am, Saturday, September 25, 2010
ASTRO HQ, Fairfax, VA
1) Finalize the plan of action for
the future
a)
b)
c)
Identify tasks and create timelines
Identify outstanding unresolved Issues
Set deliverables for ASTRO meeting
Closed Loop Patient Safety

Other patient safety use cases:









Focus on one aspect
Working group consisting of:
Kevin, May, Stephen, Nick, Akkamma, Adam
When: 15-Oct fully fleshed out; poll posted on 18-Oct, voting
completed 28-Oct


Compare what was treated with what was planned (dynalog,
gantry, etc). MU currently checked.
Handshaking check of data transfer from OIS to treatment
workstation
3 MITA propositions
Feedback loop, plan, deliver, cf plan
Imaging closed loop
Population of a Registry
End to end check - phantom
Prioritize new Use Cases with prior
‘tabled’ Use Cases





TC provides status on ‘tabled’ Use Cases
Information distributed to PC
Rank vote on 3 new and 3 ‘tabled’ Use Cases
Results for ASTRO AGM
When:




10-Oct info received from TC
15-Oct info distributed to PC
18-Oct poll posted
28-Oct voting completed
Create annual report showing passed
actors with product releases




Verified by vendors and users
ask users for confirmation
Survey tool for test
Who:



Colin to ask Bruce for passed actors and software
versions from previous connectathons
Colin, Jacob to create table
When: draft table to be shown at ASTRO AGM
How do we close the loop from Use Case to
Integration profile to RFP to Clinical Use ?







Add Test tool version number
Poll users, allowing reporting of failures.
Contact initial customers to validate clinical
release.
Establish Mini complaint system for tracking
issues?
Aside: End to end ‘scripting’ test to verify RT
process
Who?
When? Table to AGM after matrix is available
Publicity and Promotions
Success Stories
Wait for use case / software version
matrix, talk to vendors to get users to
approach
 Set timelines for ASTROnews publications
and AAPM newsletter, PRO

Create webinar with CME credits for
IHE-RO (MD, Physics, RTT, CMD


Interoperability and patient safety
Who:





Tony to investigate/create (Lynn Brown ASTRO)
With assistance from Publications and Promotions ?
Everyone to bombard Tony with facts. Dick Fraass
1 hour presentation ?
When: update at ASTRO AGM
Create a ASTRO IHE-RO Task force to
provide recommendations to RO
community





Evidence based info needed
Errors resulting from interoperability
Cost of not having interoperability
Who ? Akkamma, Kevin, Jacob, Charles
When ? Table (tie to webinar)
Develop Standard Testing facility (or
resource centre) for all vendors





Develop scope of facility
FDA implications
Jatinder to ask ASTRO Executive
Who? Jatinder, Adam, Nick, Tony, Todd, Sha,
Martin
When? Create a separate working group outside
of IHE-RO.
2) ASTRO PC & TC Meetings

PC
7:00-10:00am, Tues, 02-Nov-2010
 Where: TBD


TC
Potentially noon-1:00pm, Tues, 02-Nov-2010
in room used for NEMA meeting 7:30am-noon
 Where: TBD

 3)
Meeting Wrap Up
Comments, Questions