IHE Europe - Integrating the Healthcare Enterprise
White Papers - Case Studies
Patients, Activities, FAQ, Glossary, Statutes
Patients are the winners
The seamless flow of health information between the different healthcare systems across Europe brings tremendous benefits to patients, as well as the doctors and nurses providing vital care.
IHE-Europe is dedicated to interoperability in health information technology. It begins with an open process of developing integration profiles to assure IT systems can talk to each other. Then it requires testing these systems to verify that complex computer coding delivers the data. Finally, IHE-Europe actively promotes wider awareness and use of these methods for assuring continued conformance and compatibility.
IHE integration and content profiles have been adopted by national and regional projects in countries such as Austria, France, Italy, Switzerland, Slovenia, Luxembourg, The Netherlands and considered by several others. These specifications provide the guidance necessary to implement specific standards and profiles in commercial and self-developed systems that will help realize efforts towards large scale interoperability of health information in Europe.
Activities of IHE in Europe
- IHE-Europe develops workflow descriptions and associated integration and content profiles in specific healthcare domains based on user requirements as well as the testing software (Gazelle tools) required to support vendors in developing interoperability.
- IHE-Europe organizes live interoperability testing between vendors at the annual European Connectathon, as well as follow-on live interoperability demonstrations. IHE-Europe has a permanent technical team that contributes to developing testing software (Gazelle tools) and provides an independent oversight body to publish the participating vendors Connectathon results.
- IHE-Europe’s core activities also include education and promotional activities, such as publishing interoperability Success Stories for creating awareness and encouraging utilisation of IHE integration profiles.
- Serving as a voice for European interests, IHE-Europe coordinates IHE development worldwide with IHE initiatives for North America, Asia and Oceana in the international IHE organizational structure as well as close collaboration with Standards Development Organizations (ISO, HL7, CEN, DICOM, etc) and other profiling organizations such as the Continua Health Alliance that is leveraging IHE profiles.
- Finally, IHE-Europe offers a unique suite of tools and services to hospitals, regional and national eHealth networks as well as vendors through its dedicated operational branch IHE-Services.
IHE-Europe plays a vital role
Europe is famously diverse and the different approaches taken by Member States in implementing health IT reflect this rich diversity. IHE-Europe plays a vital role by coordinating shared efforts among national initiatives and maintaining regular communications with Member States.
The open organizational structure of IHE-Europe also enables manufacturers to develop and market products for European customers with only minor variations to reflect national preferences.
By gathering key leaders and actors for health IT in Europe, the association is able to coordinate activities and development with IHE North America and IHE Asia and Oceania. IHE-Europe is an active participant to the international Strategic Development Committee, the broadest oversight body of IHE-International, that oversees adherence to goals and guidelines, communication and coordination among domain committees and harmonizes diverse national and regional initiatives.
Frequently Asked Questions
Driven by national and regional initiatives, Integrating the Healthcare Enterprise has grown worldwide to steadily improve interoperability and integration.
The national focus for IHE is especially important in Europe due to the nature of the healthcare environment. National IHE initiatives have developed in a growing number of European countries, and these initiatives coordinate their activities at the European level within the association IHE-Europe aisbl.
IHE-Europe has developed responses to frequently asked questions about IHE and its processes, which are now available as a PDF document for download:
If you have additional questions about IHE or IHE-Europe, please send an email to [email protected]
Glossary of Terms
IHE-Europe Internal Rules are available on request to [email protected]
Structure, Board, Participants and Sponsors
User Co-Chair: Peter Mildenberger
Vendor Co-Chair: Lapo Bertini
Interim Co-Chair: Peter Mildenberger
Interim Co-Chair: Lapo Bertini
Chair: Geert Claeys
IHE-Services General Manager
European Affairs Committee
Chair: Charles Parisot
IHE-Europe Director of Interoperability
IHE-Europe Technical Manager
Participants and Sponsors
Interoperability, Benefits, EHR, Profiles
What is interoperability?
According to ISO/IEC 2382-01, Information Technology Vocabulary, Fundamental Terms, interoperability is defined as follows: "The capability to communicate, execute programs, or transfer data among various functional units in a manner that requires the user to have little or no knowledge of the unique characteristics of those units”, according to ISO/IEC 2382-01, Information Technology Vocabulary, Fundamental Terms.
For IHE, IT systems are interoperable, if they can properly exchange clearly defined sets of relevant information in the context of a specific clinical situation and perform appropriate actions as described by the IHE specifications.
So why is IHE needed?
There are hundreds of standards for health information exchanges, written to support a wide range of clinical processes and include many optional features. To obtain interoperability with regard to a specific clinical task IHE creates profiles of relevant standards that make essential features for supporting the clinical task mandatory for those products for which conformance with a profile is claimed. IHE profiles specify the information that must be exchanged between systems and the actions that recipient systems must take on receipt of the information. These IHE Integration Profiles do not constrain the way in which systems are designed and help to enhance to ease of use.
Benefis of using IHE
Patient data accessed through secure, interoperable health IT systems that meet IHE core requirements and specifications enhances the quality of patient care, resulting in the following benefits:
- Safety through the reduction of medical errors
- Savings through lower implementation costs and more efficient workflow
- Satisfaction through better informed medical decisions and faster results for both patient and clinician
Greater adoption of IHE in Europe brings benefits to Citizens, to Healthcare Providers, to Governments, and to Industry. IHE solutions can be used in many different settings, from single hospitals up to a (inter)national scale, in the next section the pan-European benefits are emphasized.
Benefits For Citizens
The Situation. Europeans are a highly mobile people traveling freely, whether for work or vacations, between countries. In the course of a single day a European citizen might pass through several nations. And each European citizen carries health insurance provided by his or her country of residence. In the case of an accident or a health crisis, a citizen may be treated in a foreign country by nurses and doctors speaking a different language. How can the foreign doctor determine the medications being taken by this patient, or any allergies to medications? What is the medical history of this patient? And, of course, who is paying for the often-expensive emergency medical intervention?
Benefits of Common Health Data. A system for identification of patients shared across Europe enables a medical team to quickly locate records for a patient. Creating common data for emergency medical information and medications using IHE standards puts the right information in front of the right doctor at the right moment to assure the right treatment.
Benefits For Healthcare Providers
The Situation. Healthcare Providers, be it institutions like hospitals organizations or individual doctors and nurses are working with an increasing number of information systems, all containing relevant data on the patients they are working. Typically, these systems behave like “islands”, not sharing patient-related data between systems. This leads to broken work processes, the need for repetitive data entry (with risk of mistakes) and an incomplete view on the patient’s record. The same is true when caring for patients coming from abroad.
Benefits of Common Health Data. An integrated information system, with proper flow of information from one system to the other, puts the right information in front of the right doctor at the right moment to assure the right treatment. It’s that simple – and applies to local and foreign patients.
Benefits For Governments
The Situation. Some of Europe's largest countries are made up of autonomous regions with full authority over healthcare decisions and the information systems to support healthcare delivery. For example, Spain is made up of 9 autonomous health regions, while in Italy there are 21 independent regions, and Germany is a confederation of 16 Landers. Even large nations with a single national structure, such as France or England, have seen the development of diverse health information systems over the past 20 year built around regional university hospitals. This patchwork regional development of IT for healthcare in Europe has created different, sometimes stand-alone systems for healthcare. Even within regions documents created by clinical systems for patient care may not interface with administrative systems that determine payment or citizen entitlements for healthcare.
Benefits of Common Health Data. Much is at stake for European national governments who spend hundreds of billions of euros each year as the primary insurer of its citizens' healthcare. There is an urgency in Europe which has a rapidly aging population that soon will require greater health expenditure while the base for the model for health funding, the younger working population, is shrinking. These governments see a solution in health information systems that can deliver greater efficiency and productivity, as well as supporting alternative delivery of health services for the chronically ill through community-based clinics and in-home care.
Benefits For Industry
The Situation. Europe's governments, both national and regional, have worked with different suppliers from the private sector to develop equipment or software for stand-alone systems. While this has resulted in a robust base of expertise and solutions for health IT in Europe, an innovative system or successful solution developed by a company often can not be exported without significant changes to meet variations in standards and requirement in a neighboring country.
Benefits of Common Health Data. Adoption of common protocols and standards across Europe will create a more uniform market for health IT equipment, software and services enabling manufacturers to market their products at the European and even global level with only minor variations. In addition to helping to assure compatibility between systems, a harmonised market will also lower the costs of acquiring best practices solutions for governments and citizens. Greater adoption of IHE frameworks will also enable the IT industry based in Europe to compete internationally, thereby increasing employment and sustaining the development of this sector of activity in the European economy.
IHE and EHR
Access to medical records is essential for assuring optimal patient care. Yet the development of interoperable electronic health records has been slow, in comparison to the digitization of other service industries. Barriers include the incompatibility of existing hospital and general practitioners systems for sharing records, concerns for security, patients' rights to confidentiality and legal issues, as well as aligning the investment required with those who will benefit.
The overwhelming benefit of EHRs is now apparent and the conversion of healthcare systems to shared registries and archives is rapidly gaining momentum. The integration profiles developed by IHE since 1999 are now helping to accelerate the adoption of the information standards needed to support EHRs.
The annual Connectathon organised by IHE-Europe has seen a steady shift in emphasis from testing of IHE Integration Profiles for radiology to testing profiles for cross-enterprise document sharing that is at the heart of electronic record exchanges. At the 2011 Connectathon in Pisa, Italy, 81 systems will be tested for interoperability against IT infrastructure profiles while 79 systems will be tested for traditional radiology profiles.
Meanwhile the European Patients Smart Open Services (epSOS) project supported by the European Commission is driving the cross-border exchange of medical data and stimulating a more rapid development of networks within countries. In the United States a nationally coordinated effort is encouraging the adoption of shared patient records.
Integration profiles developed through IHE collaborative method create a common framework for basic interoperability being applied by local, regional and national initiatives worldwide.
- IHE integration profiles created for Cross-Enterprise Document Sharing (XDS) supports well-established, international standards for the encoding of medical messaging, reports and images.
- IHE integration profiles define a security framework for protecting the confidentiality, authenticity and integrity of patient care data.
- IHE integration profiles for cross-domain patient identification management ensures consistent patient information and effective searches for EHRs.
An IHE compliant architecture enhances the quality of patient care by enabling the secure sharing of medical records among healthcare professionals. The resulting benefits include:
- Greater safety through the reduction of medical errors
- Greater savings through lower implementation costs and more efficient workflow
- Greater satisfaction through better informed medical decisions and faster results for both patient and physician
As technology creates new opportunities, or as new requirements emerge for EHRs, the open, collaborative methods employed by IHE will continue to provide a robust response to these challenges and assure new developments find a practical application in healthcare.
Finding IHE Profiles
With over 280 autonomous regions, achieving a seamless flow of relevant information between IT systems of different healthcare systems presents unique challenges for cross-border interoperability.
All current IHE profiles can be found on the IHE International site: http://www.ihe.net/profiles/index.cfm
The details of any IHE profile are available in the Technical Frameworks on http://www.ihe.net/Technical_Framework/index.cfm
Please find here a list of relevant links to standards and norms used in the context of IHE.
* HL7 : You may also want to have a look at the following projects :
o CCOW The acronym CCOW stands for "Clinical Context Object Workgroup", CCOW is a vendor independent standard developed by the HL7 organization to allow clinical applications to share information at the point of care
o CDA : The Clinical Document Architecture, APPROVED AS AN ANSI STANDARD November 2000.
o HL7 Implementation Guide : This document contains in the appendix C.4 information about the minimal lower layer protocol.
* IETF :
o RFC-1510 : The Kerberos Network Authentication Service (V5) used by the EUA profile (IT-I)
o RFC-2616 : HyperText Transfer Protocol HTTP/1.1
o RFC-2246 : Transport Layer Security (TLS) 1.0
o RFC-3164 : The BSD Syslog Protocol.
o RFC-3195 : Reliable Delivery for Syslog
o RFC-3881 : Security Audit and Access Accountability Message XML Data Definitions for Healthcare Applications. Registered Schema. Please note that there is a minor difference between the registered schema and the one in RFC 3881. An enumeration in RFC 3881 specified for documentation purposes has been removed, since it inhibits a useful extension to the schema. This reflects the intent of RFC 3881, section 6.2, regarding schema extensions.
o RFC-2181 : Clarifications to the DNS Specification
o RFC-2219 : Use of DNS Aliases for Network Services
o RFC-2782 : A DNS RR for specifying the location of services (DNS SRV)
o RFC-1305 : Network Time Protocol (NTP) Version 3. used by the CT profile (IT-I)
o RFC-2030 : Simple Ne>twork Time Protocol (SNTP) used by the CT profile (IT-I)
* W3C : used by the RID profile (IT-I)
o Extensible Markup Language (XML) 1.0 (Second Edition). W3C Recommendation 6 October 2000.
o Web Services Description Language (WSDL) 1.1. W3C Note 15 March 2001.
* ITU-T: Recommendation X.509 (03/00). Information technology - Open Systems Interconnection - The directory: Public-key and attribute certificate frameworks"
o PS 115-99: Provisional Standard Specification for Audit and Disclosure Logs for Use in Health Information Systems.
o E2147-01 Standard Specification for Audit and Disclosure Logs for Use in Health Information Systems.
* ebXML : used by the XDS profile (IT-I)
- Entscheiderfabrik (GUIG) www.guig.org
- European Association of Hospital Managers (EAHM) www.eahm.eu.org
- European Association of Hospital Pharmacists (EAHP) www.eahp.eu
- European Society of Radiology (ESR) www.myesr.org
- Société Française de Radiologie (SFR) www.sfrnet.org
- Agfa Healthcare www.agfa.com
- A-Thon www.a-thon.it
- Etiam www.etiam.com
- Forcare www.forcare.nl
- Gnomon www.gnomon.com.gr
- Kereval www.kereval.com/
- GE Healthcare www.gehealthcare.com
- Philips Healthcare www.medical.philips.com
- Rogan-Delft www.rogan-delft.com
- Siemens Healthcare www.siemens.com/healthcare
- Visus www.visus.com
- IHE-Austria www.ihe-austria.at
- IHE-France www.interopsante.org
- IHE-Germany www.ihe-d.de
- IHE-Italy www.ihe-italy.org
- IHE-Netherlands www.ihe-nl.org
- IHE-Spain www.ihe-e.org
- IHE Suisse www.ihe-suisse.ch
- IHE-United Kingdom www.ihe-uk.net
epSOS, HITCH, SEHGovIA, Renewing Health, eHealth Interop
epSOS aims at building and evaluating a service infrastructure demonstrating cross-border interoperability between Electronic Health Record Systems in Europe. Sometimes called a large-scale European implementation, epSOS is driven forward by many European member states, the first European eHealth project gathering such a large number of countries in practical cooperation. Learn more at www.epsos.eu
IHE-Europe plays a unique role as an epSOS participant representing 31 industrial partners. The infrastructure and tools used for the IHE-Europe Connectathon testing process have been selected as the foundation for testing among the epSOS partners. IHE-Europe supports epSOS in organizing a “Connectathon for this Project”, hence epSOS “Projectathon” that was first held in November, 2010 and will be a parallel event during the annual European Connectathon in Pisa, Italy. www.connecathon2011.org
The epSOS initiative is seen as a ‘gate-opener' to advance interoperability across all Member States by moving beyond a focus that until recently was limited to regional or national health networks. This Commission-driven initiative to promote the emergence of a European health information network backbone linking countries is already having significant impact among Member States, as well as defining more consistent business opportunities.
A Roadmap for sustainable and effective deployment of testing and certification of eHealth systems
The Healthcare Interoperability Testing and Conformance Harmonisation (HITCH: www.hitch‐project.eu) project just concluded its 18 month study with important recommendations to the EU Commission on how to proceed with eHealth interoperability testing and certification/labelling in Europe. HITCH proposes a way forward balancing the urgency to defragment the current approach by eHealth projects, reduce cost of testing, raise the level of quality, and remain sufficiently flexible to account for local needs.
HITCH considers testing and certification related but distinct processes. While testing represents the way one assesses/measures the level of interoperability, certification is a process where a certifying entity uses the positive test results. If profile specifications and testing tools are robust, certification becomes a formality and high‐level of eHealth interoperability are realized.
In the area of testing, HITCH stressed the need to continue and amplify the progress accomplished in the last few years, with initiatives such as IHE Connectathons. HITCH identified two areas that need further improvement and more formalism. First, there is a need for a widely accepted quality guide for interoperability testing based on existing quality standards such as ISO 9001 and 17025). Second, an organized collaboration is needed to reduce the fragmentation and lack of maturity in interoperability test tools and test plans in specific areas.
In the area of certification, HITCH surveyed various certification strategies and concluded that different variants would need to coexist and evolve with profile specification stability and market maturity.
The HITCH proposes a five year roadmap for testing and certification:
- In 2012‐2013, HITCH recommends to develop and approve common guidance on testing quality and to organize a testing tool development infrastructure at the European level to fill the most critical gaps in tooling and test plans.
- By the end of 2012, a European interoperability framework should be agreed for testing to proceed. This framework should contain an objective set of interoperability standards‐based profiles and become the reference against which testing may be piloted in 2013‐2014.
- Based on feedback from the above testing and certification pilots, the first products could be tested and receive a “certification” in 2015 at the profile level in Europe.
HITCH proposes that national or regional eHealth projects across Europe organize their own testing and certification by building upon this common European testing and certification foundation. This foundation would leverage a common set of test tools, allow products to be tested once at the European level and further tested only for regional/national extensions to the European interoperability framework. Such a European foundation would increase consistency, reduce costs and significantly accelerate deployment across multiple national and regional eHealth projects in contrast with the current inconsistent and fragmented approach.
HITCH is partially funded by the European Commission under the 7th Framework Programme as a supportive action performed by ETSI, EuroRec, IHE Europe, INRIA, MedCom, OFFIS. For more information contact: [email protected]
SEHGovIA Thematic Network
Financed by the European Commission, SEHGovIA (Supporting the European eHealth Governance Initiative and Action) is led by the Member states to provide input on legal, ethical and regulatory issues crucial to e-health implementation. SEHGovIA will also address semantics and terminology, identification and authentication standardisation that are vital to successful information exchanges.
Starting earlier 2011 this thematic network bringing together representatives of Member States, Users and Industry will draw upon experiences from other European programs, such as Calliope, eHIC, Stork, as well as national projects.
The results of the first 36 months of consultations are expected to be :
1. A High level eHealth structure Governance mechanism and capable infrastructures to sustain effective operation
2. A proposal of recommendations on Policy instruments and for legal actions
3. A European eHealth Interoperability Roadmap
4. A European Interoperability Framework
Bringing a deep experience for developing profiles and testing processes, IHE-Europe will contribute to SEHGovIA a solid knowledge on defining interoperability. Inputs from the HITCH project will provide an interoperability roadmap on conformance testing.
Renewing Health (REgioNs of Europe WorkINg toGether for Health) gathers nine of Europe's most advanced regions for eHealth in a large-scale project to validate and evaluate innovative telemedicine services.
With a patient-centered approach, the Renewing Health partners will identify programs already offering services for the tele-monitoring and the treatment of people suffering from chronic conditions, such as diabetes, chronic obstructive pulmonary or cardiovascular diseases.
For more, visit Renewing Health www.renewinghealth.eu
As a members of the Advisory Board, IHE-Europe assists with the technical architecture of services and the standards towards which the different regional implementations need to converge to ensure openness and scalability of the solution.
eHealth Interop, also called Mandate 403 (www.ehealth-interop.eu ) addresses the requirements of the European Commission mandate to the European Standards Organisations (ESOs) on standardisation in the field of e-health. This mandate (M/403) aims to provide a consistent set of standards to address the needs of this rapidly-evolving field for the benefit of future healthcare provision.
With eHealth Interop, the European Commission and governments recognize the barrier to interoperability is not a question of creating more standards for IT, but encouraging agreement on which existing standards should be adopted to assure interoperability between health IT systems.
The implementation of the recommended eHealth interoperability process would result in a set of profiles easier to adopt in various eHealth projects across Europe. It may also include the definition and development of testing tools and the organization of testing events similar to the IHE-Europe Connectathon.
At the request of the Commission, organizations that included European Committee for Standardization (CEN), European Committee for Electrotechnical Standardization (CENELEC) and European Telecommunications Standards Institute (ETSI) will define this process to achieve effective interoperability for specific use cases.
With a strong experience integrating existing standards for specific use profiles, IHE-Europe can make a solid contribution to this pan-European effort.
The final report to M403 Phase 1 has been approved by the three European Standardisation Organisations and the European Commission in 2009.
The eHealth-Interop Report proposed to organise activities in support of five processes that would accelerate a European-wide coordinated interoperability standards adoption in health:
(1) use case definition and prioritization
(2) standards development
(3) profile development and maintenance
(4) profile quality assurance test plans and tools
(5) sharing of best practices in deploying eHealth projects
On 11th February 2009, a Workshop was organized for a number of major stakeholders to discuss the recommendations of the report to Phase 1 and to prepare proposals for Phase 2. The launch of Phase 2 is waiting for an EU Commission decision.
c/o ESR, Neutorgasse 9, 1010 Vienna, Austria