HealthManagement, Volume 1 / Issue 2 Summer 2006
Author
Eric Poiseau
Title: It Manager
Organisation: Integrating the Healthcare Enterprise (IHE) Europe
Integrating the Healthcare Enterprise (IHE)
Europe
Please Tell Us a
Little Bit About IHE Europe, How was it Started and What are Your ‘Hot Topics’
for 2006/07?
IHE is a non-profit organisation sponsored by professional bodies and healthcare suppliers that gathers users and vendors around the same table to discuss and solve the problems of healthcare systems interoperability. We believe that interoperability
should be built around a core of common requirements, taking differences between EUMember States into account, but enabling manufacturers to market their products at the European and even global levels with only minor variations. To this end, IHE in Europe maintains close contacts with similar initiatives in North America, Japan and other parts of the world. The IHE approach is a win-win situation in that both vendors and users benefit from it!
IHE in Europe is busy organising activities to achieve the interoperability of existing products and facilitate the development of new interoperable products. Some of these activities consist of:
+ Development of workflow descriptions and associated integration profiles based on user requirements.
+ Organisation of live interoperability testing between vendors (connect-a-thon), and of live interoperability demonstrations at the European level, if required and appropriate.
+ Support to national IHE activities in order to incorporate national requirements into interoperability requirements.
+ Promote and facilitate the use of products that implement IHE Integration Profiles through means such as educational activities, success stories, integration statements.
Our hot topic in 2006 and 2007 is the sharing of documents across enterprises (XDS: Cross enterprise document sharing). National as well as regional projects across Europe are referencing XDS.
What is the Process
that IHE Follows for Standards Adoption?
The official IHE message on the process for standards adoption is: IHE follows a defined, coordinated process for standards adoption. These steps repeat annually, promoting steady improvements in integration.
I. Identify Interoperability Problems. Clinicians and IT experts work to identify common interoperability problems with information access, clinical workflow, administration and the underlying infrastructure.
II. Specify Integration Profiles. Experienced healthcare IT professionals identify relevant standards and define how to apply them to address the problems, documenting them in the formof IHE integration profiles.
III. Test Systems at the Connectathon. Vendors implement IHE 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.
IV. 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 system’s acquisition process.
I would like to insist on some key points from this:
+ Users and vendors are involved in the process.
+ The cycle is annual.
+ Users are involved at the beginning of the process in the identification of the interoperability problem.
+ Users can and do comment on the specifications (integration profiles).
+ During the IHE Connectathon, some users are involved in the validation of the tests performed by the vendors.
+ Users references IHE in their RFPs.
What is the IHE
Technical Framework, and How is it Organised?
The IHE Technical Frameworks, available for download, are a resource for users, developers and implementers of healthcare imaging and information systems. They define specific implementations of established standards to achieve effective systems integration, facilitate appropriate sharing of medical information and support optimal patient care. They are expanded annually, after a period of public review, andmaintained regularly by the IHE Technical Committees through the identification and correction of errata.
There is an IHE Technical Framework for each of the IHE domains. Volume I provides a high-level view of IHE functionality, showing the transactions organised into functional units called Integration Profiles that highlight their capacity to address specific clinical needs. Volume II provides detailed technical descriptions of the IHE transaction used in the domain.
How is an IHE
Integration Statement Developed, and What Benefits does it Provide for Healthcare
IT Managers?
IHE Integration Statements are documents prepared and published by vendors to describe the conformance of their products with the IHE Technical Framework. They identify the specific IHE capabilities a given product supports in terms of IHE actors and integration profiles.
Users familiar with these concepts can use Integration Statements to determine what level of integration a vendor asserts a product supports with complementary systems and what clinical and operational benefits such integration might provide. Integration Statements are intended to be used in conjunction with statements of conformance to specific standards (e.g. HL7, IETF, DICOM, W3C, etc.).
There is no requirement for a vendor to participate in an IHE Connectathon in order to be able to publish an integration statement.
IHE integration statements help users by comparing products functionalities.
What are IHE’s
Current Initiatives in Italy?
IHE Italy became involved with IHE Europe at an early stage and has been present since the first IHE Europe Connectathon in Paris in 2002. IHE Italy organised the third European Connectathon in Padova in 2004 and since then has been one of the three major countries, with Germany and France, to participate in the Connectathon (counting the number of registered systems).
IHE Italy participation to the Connectathon is noticeable with two university projects participating in the Connectathon:
+ O3C from the University of Padova with Claudio Saccavini as contact and the UTS and
+ University of Triest with Paolo Inchingolo as contact.
IHE Italy was also involved in the start up of the IHE Laboratory domain, along with France and Japan.
What are Some of
IHE’s Biggest Successes in Europe?
I guess the biggest success of IHE in Europe is to have successfully developed IHE in Europe. IHE started in the US! IHE Europe was successful in importing the initiative but more than that, in adapting it to the European context. IHE Europe is now contributing to the international level and is, in a way, forcing IHE to be international.
IHE Europe is contributing at the international level with:
+ Clinical laboratory and pathology domains;
+ IT-Infrastructure XDS and PIX integration profiles;
+ Radiology PDI integration profiles, which found their origins in Europe.
What were the Biggest
Results / Achievements of the 2006 IHE Connectathon in Europe?
Hot topics at the Connectathon were workflow and access to information, security, patient management and document sharing and patient summaries.
For the first time in Europe, we had Public Key Infrastructure (PKI) - the French Groupement d'Interet Public Carte de
Professionnel de Sante (GIP-CPS) - involved in the Connectathon process. The GIP-CPS provided the certificates to be used by the vendor for testing the security profiles.
What Integration
Challenges do You Think Healthcare IT Managers in Europe Should be Most Concerned
About?
In my opinion, access to information, document sharing and security are the biggest challenges facing healthcare IT managers in Europe. Healthcare information systems will more and more need to interoperate to exchange documents, images, patient identifiers, exchange about user rights.
Software applications are also more frequently required to interact with:
+ Audit trails: sharing of logs, security requirements to centralise logs.
+ User rights: authentication, authorisation... rights that may depend on the role and the context.
+ Patient identification: document sharing requires sharing of identification.
As an IT manager, the transition phase from today to tomorrow is not trivial and constitutes a challenge.Where do we start and what road map do we use to reach that ideal world? IHE is offering some solutions and some hints! This may explain its success.
