IHE Update: Bigger, Better Events, New Standards & Guides

hiit040507.jpgIntegrating the Healthcare Enterprise (IHE) — the multi-year initiative creating a framework for passing important health information throughout a healthcare enterprise — is fast becoming a much-relied-upon mechanism for healthcare professionals in pursuit of interoperability. More vendors have been participating in IHE events, the organization has increased its output, including standards, supplements, and guides, and more professional associations are supporting IHE goals and initiatives. The activities in the first few months of 2006 alone are impressive.

Connectathon grows in participation, value

More IHE events are offered every year and ongoing annual events continue to grow. This year's 7th annual Connectathon included systems engineers from 59 leading healthcare information technology (HIT) companies from around the world. The event is designed to test the interoperability of HIT systems that acquire, manage and exchange patient data within care sites and across multiple-provider networks. The annual Connectathon has become an increasingly valuable part of product design and testing. Companies work in harmony to ensure that their systems can communicate with other systems according to specific data standards to support clinical care.

The number of participating companies increased this year by 20 percent, according to Joyce Sensmeier, MS, RN, BC, CPHIMS, FHIMSS, vice president of informatics for the Healthcare Information Management & Systems Society (HIMSS). HIMSS, the Radiology Society of North America (RSNA) and the American College of Cardiology (ACC) sponsor the event.

"The increase partly reflects growing awareness in the HIT industry," says Sensmeier. "The Connectathon's five days of face-to-face testing and debugging saves companies time and money by enabling them to perform work that would normally take months to accomplish in the field."

"The expanding scope of the IHE initiative is the other key factor in the Connectathon's growth," she adds. By the final day of testing, 140 systems from 59 participating companies had successfully completed testing. Cardiology systems were tested for the first time at the 2005 Connectathon. This year 33 systems tested five different profiles in the cardiology clinical domain, including new profiles supporting cardiology reports.

Organizers plan to expand into radiation oncology, eyecare, laboratory and patient care devices at future Connectathons. Meanwhile, an IHE-Europe Connectathon of comparable size was held in Barcelona in April. Additional events are planned this year for Japan, Korea and Taiwan.

Complete test results from 2006 and previous Connectathons in Europe and North America are available at www.ihe-europe.org/con_result.

Interoperability Showcase presented mock RHIO

Fifty-one (51) systems tested at the Connectathon were on display at the Interoperability Showcase at the 2006 Annual HIMSS Conference and Exhibition in February. Attendees could create their own virtual health record and then track them in a mock regional health information organization (RHIO). Various clinical scenarios demonstrated how existing information technology can exchange health data between the systems of various vendors.

Clinical scenarios were enabled by the standards-based IHE framework, demonstrating how different companies incorporate interoperability into their products. Attendees could see how health information is exchanged in electronic records, as well as lab results, images, medical summaries, and cardiology reports. This also showed how individuals can participate in their own healthcare management.

This year's Interoperability Showcase included 47 participating vendors, up from 32 in 2005.

Growth in cardiology

In March, the ACC became one of several cardiology organizations to showcase its support for IHE standards at its annual meeting. IHE offered its ACC 2006 IHE Demonstration which included details regarding the organization's 2006 Connectathon requirements and provided booth visitors with demonstrations they could take with them, along with new white papers and other resources (www.ihe.net/resources/index.cfm).

The IHE does your connectivity work for you, says Teri Sippel Schmidt, technology project manager, IHE Cardiology. Cardiologists don't necessarily perform their work in the most efficient manner, she says, but she has noticed that most have little interest in IT systems and how they work. "They want it to just work," she says.

Guide to managing clinical content

Another step in advancing the IHE is the availability of the Quick Start Guide for Care Record Summary Documents Using CDA Release 2.0 as a tool to support healthcare software developer implementation of the CDA/CRS (Clinical Document Architecture/Care Record Summary) standard developed by Health Level Seven (HL7). This comes from the HIMSS EHRVA (Electronic Health Record Vendors Association) and provides directives for managing clinical content in order to establish healthcare information interoperability. The Guide was developed by Alschuler Associates, LLC, a consulting firm that also worked with the EHRVA on the Quick Start Guide for Simple CDA Release 2.0 Documents.

CRS and the Quick Start Guide were central to the success of the Integrating the Healthcare Enterprise (www.ihe.net) Showcase at the 2006 HIMSS Annual Conference. The guide is supported by the Interoperability Collaborative (IC) composed of EHRVA, HL7 and IHE members. The CRS complements the EHRVA Interoperability Roadmap which was recently made available for public comment (www.himssehrva.org). Also, the IHE Radiology Technical Committee published supplements to the IHE Radiology Technical Framework for Public Comment. The same committee published supplements to the IHE Radiology Technical Framework for Trial Implementation for public comment.

The CDA/CRS Quick Start Guide is available at www.himssehrva.org or for information contact crsqsg@alschulerassociates.com.

New data standards

Aside from events and supplements, the IHE has defined an implementation of data standards, or "integration profile," that makes it possible to share patient information across networks of healthcare facilities like the regional health information organizations (RHIOs) currently being designed and implemented. This integration profile, called Cross-enterprise Document Sharing or XDS, was successfully tested by 36 electronic health records systems.

IHE also has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has developed a foundational set of standards-based integration profiles for information exchange with three interrelated efforts:

  • Cross-enterprise document sharing (XDS) support for document content interoperability.
  • A security framework for protecting the confidentiality, authenticity and integrity of patient care data.
  • Cross-domain patient identification manage≠ment to ensure consistent patient information and effective searches for EHRs.

This framework should prove valuable as David Brailer, MD, PhD, national coordinator of HIT announced at HIMSS06 a new initiative by his office to study RHIOs.

More demos on tap

Coming up later this year, RSNA will be hosting its annual demonstration of Cross-enterprise Document Sharing for Imaging (XDS-I) at its 2006 annual meeting in late November that features the XDS-I integration profile. For more information contact RSNA staff at ihe@rsna.org.


Critics of IHE aren't offering alternatives

Despite the advances coming fast and furious with Integrating the Healthcare Enterprise (IHE) standards, some naysayers voice that the standards aren't relevant due to emerging middleware that nearly every other industry outside of healthcare is using.

That argument doesn't hold water, according to David A. Clunie, MBBS, FRACR, chief technology officer for RadPharm Inc. in Princeton, N.J., who is a member of the IHE Radiology Planning and Technical Committees as well as the editor of the DICOM standard. "IT industry middleware standards are very useful for building proprietary systems and complete applications, but are not sufficient to define interoperability between systems and applications from different vendors without customization between every pair of communicating systems." Interoperability cannot happen without standards for services and objects 'on top of' the middleware, he says, and these do not exist for the current flavor-of-the-month buzzword compliant middleware initiatives (i.e., Ajax, Web services, SOA, XML, etc.). Clunie adds, "The fantasy of a panacea of 'self discovering' services that can combine to perform complex tasks is just that, a fantasy."

Clunie says critics call IHE standards old-fashioned and transaction-based. He admits that healthcare IT is based on primitive technology and does not leverage the art of e-commerce style solutions. However, critics have yet to provide a practical alternative, he says.

"Past initiatives to get beyond supporting the installed base of old-fashioned standards like DICOM and HL7 in order to develop new standards that use more modern underlying technology have largely stalled or failed," Clunie. He cites HL7 V3 as very slow to get going, and CORBAMed's CIAS and COAS services, which represent the last generation of SOA technology, as never getting off the ground. "Whether this is due to vendors focusing more on incremental rather than revolutionary improvement or some other factor, I really don't know."