The Integrating the Healthcare Enterprise (IHE) activity seems to be at the same stage as DICOM was several years ago: Most people knew at that time to ask for DICOM compatibility when purchasing a new device. However, they did not know enough about DICOM to recognize that a DICOM print command would not get your images from a modality to the PACS; that support of the DICOM image quality standard was the only guarantee to make sure images on the CR workstation would match the look of the images on the printer and PACS workstation; and that modality worklist support was a requirement to guarantee image information integrity. So, through consistent education and promotion during meetings such as RSNA, many people now know to ask for IHE support. However, the problems with IHE compliance are similar to those with DICOM in its early stages — there are 14 different profiles available in the 2005 specification alone for radiology, and another six are available as drafts. As a user, there is, first, the challenge to understand all the profiles and, second, how to prioritize among them.
In this article, let’s go through the first set of profiles and explain their functionality
1. Workflow profiles
These profiles are generic, that is, they apply to the basic workflow to conduct an exam, perform postprocessing, create the reporting, and bill for the procedure.
1.1. The Scheduled Workflow (SWF) 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. Systems involved in this profile are:
- Enterprisewide information systems that manage patient registration and services ordering. This is typically the HIS but also could be taken care of by the RIS
- Radiology department information systems that manage department scheduling, such as a RIS
- Acquisition modalities
- Image management and archiving, such as a PACS
This profile is unquestionably the most important one. It also serves as the basis for other specialties such as cardiology, eye care, and others still to be defined. It includes HL7 as well as DICOM transactions between the HIS/RIS modalities and PACS. Supporting this profile has also a major impact on the workflow because of features such as procedure updates and completed status from the modality back to the RIS and PACS, supporting Storage Commitment to transfer responsibility, etc.
1.2. The Postprocessing Workflow (PWF) integration profile addresses the need to schedule and track the status of the steps of the typical postprocessing workflow, such as CAD or image processing. Worklists for each of these tasks are generated and can be queried, work items can be selected, and task status returned from the system performing the work to the system managing the work.
This profile uses the DICOM General Purpose Worklist, a feature that does not have widespread support. Storage Commitment support from a workstation to the PACS does make sense, though. Unless the DICOM workstation worklist get wider support, this profile should not be a high priority.
1.3. The Reporting Workflow (RWF) integration profile addresses the need to schedule and track the status of the steps of the typical report workflow. Worklists are generated and can be queried, work items can be selected, and the resulting status returned from the system performing the work to the system managing the work.
This profile is very similar to the postprocessing integration profile and also uses the DICOM general-purpose worklist, a feature that does not have widespread support. Also note that the reports are assumed to be in DICOM format, which is not often the case.
1.4. The Charge Posting (CHG) integration profile specifies the exchange of information related to charges among departmental systems, enterprisewide information systems, and billing systems. Departmental systems provide billing with precise information about procedures performed, while enterprisewide information systems provide information about patient demographics, accounts, insurance, and guarantors. The exchange provides all of the procedure data required to generate a claim, resulting in more complete, timely, and accurate billing.
This profile makes sense because it closes the loop to get proper billing information. It uses the actual