With National HIT Coordinator David Brailer, MD, PhD, announcing a new initiative to study RHIOs, this year’s Interoperability Showcase at HIMSS06 this week in San Diego was set up to represent a mock RHIO. It also included 47 participants, up from 32 participating companies last year.
   
The mock RHIO was able to exchange data in eight separate areas. Various clinical scenarios demonstrated how existing information technology can exchange health data between the systems of various vendors. Attendees could create their own virtual health record and then access it in the various healthcare settings represented. Representatives from the various participants, such as Siemens Medical Solutions and Misys, demonstrated their products and showed attendees how similar their health records looked on competing systems.
  
Clinical scenarios were enabled by the standards-based Integrating the Healthcare Enterpise (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.
   
The scenarios included topics such as IT infrastructure, improving discharge follow up, and reducing duplicate tests.
  
IHE follows a defined, coordinated process for standards adoption. These steps repeat annually to promote steady improvements in integration.

1. Identify interoperability problems. Clinicians and IT experts work to identify common  problems with information access, clinical workflow, administration and the underlying infrastructure.
2. Specify integration profiles. Experienced HIT professionals identify relevant  standards and define how to apply them to address the problems, documenting  them in the form of IE integration profiles.
3. Test systems at the annual Connectathon. Vendors implement EHR integration profiles  in their products and test their systems for interoperability at the annual  IHE Connectathon. This allows them to assess the maturity of their implementation and resolve issues of interoperability in a supervised testing environment.
4. Publish integration statements for use in RFPs. Vendors publish IHE integration  statements to document the IHE integration profiles their products support. Users can reference the IHE integration profiles in requests for proposals, greatly simplifying the systems acquisition process.

More than 100 vendors offer ready-to-integrate products that conform to this framework for implementing standards. 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:

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