IHE goes beyond proof of concept with profiles showing user success

RSNA meeting will mark new stage in development

The Integrating the Healthcare Enterprise has proven its potential value. Now its promoters hope to prove that it is ready to make a real-world difference.

At the upcoming RSNA meeting, the IHE will move beyond the large, complex vendor equipment demonstrations of the past to feature vendor-to-vendor connections designed to prove that the IHE can work. This year the IHE will present a roster of user success stories intended to highlight pioneer institutions that are already benefiting from IHE integration profiles in actual clinical use. Prerecorded videos and presentations on how to integrate will provide education and promote the initiative.

"IHE is now evolving from the initial proof-of-concept phase to addressing real-world integration needs in the clinical routine," said Nikolaus Wirsz, Ph.D., Siemens Medical Solutions' manager of IT standards and a former cochair of the IHE planning committee.

This year the IHE will focus on two main topics: a significant extension of the integration profiles and a shift of focus to real-world, IHE-based, integrated solutions. The new integration profiles will address acquisition security, protocol management, postprocessing workflow, and charge posting functions for IHE solutions.

These four join the existing seven integration profiles already defined by the IHE technical framework:

• scheduled workflow, ensuring key information flow for typical patient care from admission to reading;

• patient information reconciliation, reconciling performed procedures on unidentified or mistakenly identified patients;

• consistent presentation of images, viewing images and annotations consistently across different displays and film;

• presentation of grouped procedures, managing images acquired for multiple procedures in a single folder;

• access to radiology information, sharing images and data across department boundaries;

• key image note, adding notes and pointers to key images; and

• simple image and numeric reports, standardizing a method for creating, managing, storing, and viewing reports with image links and measurements.

The addition of security was inevitable, given the ever-growing presence of the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The possibility that an enterprise might have to manage audit trails on every device without the help of professional standards promoted the IHE to act.

Based on existing and emerging standards from HL7, DICOM, and others, the year-four technical framework specifies how sites might set up secure connections between network nodes and track access‹specifically who accessed or modified information‹for auditing purposes, said Lawrence Tarbox, Ph.D., who chairs the DICOM working group 14. This group deals with adding security and privacy features to the DICOM messaging standard.

"Certain aspects of security, such as physically protecting the equipment, training users in security policies (logon/logout procedures), and then enforcing those policies, are the responsibility of each individual healthcare provider," Tarbox said. "In future years, the IHE technical framework may adopt additional features that will allow providers to further enhance security policies."

Meanwhile, DICOM, HL7, the American Society for Testing and Materials (ASTM), and the NEMA/COCIR/JIRA security and privacy committee continue to cooperate in an effort to create standards that others, including the IHE, may use in providing a security framework and in setting up security policies in their products and organizations, Tarbox said.

IHE's pragmatism is a key reason industry has embraced its principles. Recognizing the value of the IHE has led vendors to implement the many IHE functions not just in demo systems but in their mainstream products as well.

"A clear acknowledgment of the success of IHE is its expansion and acceptance worldwide," Wirsz said. "Nearly as many international as domestic companies have participated in IHE in Europe at various events in France, Germany, and Italy. IHE activities have already been started in the U.K., and a first IHE demonstration also took place in Japan."

A standards-based technical framework and common denominator integration profiles are prerequisites to managing integration in a structured‹rather than a project-specific‹way, according to Henri "Rik" Primo, director at Siemens Medical Solutions. In the long run, the IHE takes the guesswork out of integrating and prevents costly engineering and training iterations of the interfaces when an IT system moves to the next release.

"In light of the frequent release and version changes of PACS and other IT applications, a structured integration approach as defined in IHE is the only manageable way from a technical, economical, and functional point of view," Primo said.

Without the IHE, healthcare is divided into islands defined by distinct and noncomplementary workflows, information flows, and information systems. Compatible connections are the bridges for linking these islands, but an interest in using those bridges is needed. The new IHE initiative is intended to develop that interest.