IHE coordinates pursuit of electronic health record

The Integrating the Healthcare Enterprise initiative has released a series of new guidelines that should help secure its role in the move toward electronic health records. Medical information technology is tackling a growing list of issues related to this effort, according to a panel presentation at CARS 2005.

The guidelines, which the IHE calls integration profiles, are designed to assist vendors and users as they make development and purchasing decisions. The profiles initially covered issues in interoperability of medical imaging systems but are now addressing other medical specialties and, more recently, information technology.

Developing electronic health records has become a key focus of global medical informatics efforts. Four new profiles released by the IHE in 2004 and tested this year can help smooth information exchanges in the broader healthcare enterprise, said presenter Cor Loef of Philips Medical Systems. One in particular-cross-enterprise document sharing-is the first step toward an interinstitutional longitudinal electronic health record.

The cross-enterprise document sharing profile is intended to allow safe and easy sharing of medical documents between different healthcare enterprises. It is designed around a document registry that maintains a database of all known clinical documents, their location, and metadata describing them. The profile defines transaction standards that determine how users provide data and access them in different repositories.

Other recent IT profiles include the following:

- Personal white pages. This profile collects and provides access to basic information about workforce members. It is intended to provide fast access to workflow information through staff phone numbers and e-mail addresses.

- Audit trail node authentication. This defines basic security features for healthcare IT infrastructure, including system-to-system authentication, encrypted network communication, and a security audit trail repository.

- Patient demographics query. This enables applications to query a central patient information server for a list of patients based on user-defined search criteria. It is intended to allow users to select from the list in lieu of retyping patient data.

Now in its seventh year, the IHE continues to gain support worldwide. The initiative started in 1998 with the support of the RSNA and the Healthcare Information and Management Systems Society. The organization has since expanded to incorporate three regional IHE bodies covering North America, Asia-Oceania, and Europe.

National IHE committees, which help with local deployment of integration profiles, are currently operating in the U.S., Canada, France, Germany, Italy, Norway, Spain, the Netherlands, the U.K., Japan, Korea, and Taiwan. Further geographical expansion of membership is expected within the next few years, according to Nikolaus Wirsz of Siemens Medical Solutions, a member of the IHE Radiology Planning Committee and IHE Europe.

Week-long cross-vendor testing sessions, or connectathons, remain a crucial part of the IHE process. These annual events let vendors trial their systems face to face with those of competitors. Full results are then made available online.

Only systems that pass through the connectathon process can be featured at the IHE's live demonstrations at major exhibitions.

The IHE continues to develop guidelines tailored to individual applications areas. Fourteen aspects of radiology workflow are now covered by an IHE integration profile. Cardiology-specific solutions have been developed to address cardiac catheterization and echocardiography workflows along with retrieval of ECG summaries and results. Work is also under way to devise profiles for laboratory work, including scheduled workflow, point of care testing, and device automation. Preliminary studies will assess how the IHE can help in the domain of radiation oncology.

Details of the IHE's activities, including a breakdown of connectathon results, can be found at the main IHE Web site (www.ihe-net) and the IHE-Europe Web site (www.ihe-europe.org).