The framework for health data integration is taking shape under IHE, the Integrating the Healthcare Enterprise initiative. The key to its success will be the ability to increase efficiency and better manage patients within the current practice of
The framework for health data integration is taking shape under IHE, the Integrating the Healthcare Enterprise initiative. The key to its success will be the ability to increase efficiency and better manage patients within the current practice of medicine, according to speakers at the annual conference of the Healthcare Information and Management Systems Society (HIMSS).
Seven "integration profiles" have been developed by the IHE technical committee, established jointly by HIMSS and the RSNA. These profiles, showcased at the HIMSS conference, address key components of the diagnostic process. Their adoption by vendors is crucial to achieving the level of interoperability necessary to move hospitals and healthcare organizations into a truly integrated environment, according to Paul Vegoda, who moderated a HIMSS session on the clinical goals and technical challenges of IHE. Several vendors have already incorporated some or all of the integration profiles into products now on the market. In addition, the 33 companies participating in the Year 2 demo at the HIMSS meeting showcased the seven profiles across a set of 70 imaging and information systems.
"We need to have consistency in information models and transactions and which standards can be used, and this is what IHE brings to the vendors," said Charles Parisot, GE Medical's representative on the IHE planning and technical committee, who also serves as cochair of the technical committee. "The integration profiles add 'glue' to the standards to ensure interoperability and team play."
The first of these profiles is scheduled workflow, involving patient admission, ordering and scheduling of exams, acquisition of images, and consequent notification of completed steps. Another is the reconciliation of patient information: dropped or mistyped codes that identify unknown patients and unscheduled orders have to be found and fixed. Third is consistent presentation of images in both soft and hard copy. Fourth, images and reports must be called up consistently time after time. Fifth, grouped procedures have to be presented properly. Sixth, notes written by healthcare providers to flag key images have to be reliably applied and easily recognized. Seventh, patient reports must be linked to images and quantitative data.
These profiles are grounded primarily in the world of radiology, focusing on issues involved in the integration of radiology images and information, specifically PACS/RIS in Year 1 and RIS/HIS in Year 2. The profiles are geared toward the workflow habits of most radiology departments. The grouping profile, for example, was intended to address the issue of differing accession numbers between the PACS, RIS, HIS, and other information systems. It also deals with the problem of different vendor accession number schemes within these systems.
Radiology is a logical place to start this integration, certainly from radiologists' point of view. Imaging must be integrated into the enterprise information infrastructure if the process improvements possible with PACS are to be realized, according to Dr. Fred Behlen, an assistant professor of radiology at the University of Illinois, Chicago.
"PACS, as we've all learned by now, can't justify its cost solely by the elimination of film and film handling," Behlen said.
Savings on film and related expenses can be expected, but to prove its value, PACS ultimately has to convince potential users that it is a labor-saving device. This can happen only if PACS is integrated throughout the patient-care enterprise, Behlen said. As a result, PACS is being presented to IT and IS professionals as part of an enterprise-wide solution.
"Radiologists are trying to reach for money outside the radiology department because we don't have enough of our own," he said.
Aside from fiscal realities facing radiologists, IHE must go beyond radiology if it is to meet its own potential. IHE advocates are reaching out to other departments, one of the primary goals of the IHE technical and planning committees during Year 3, according to Vegoda. A number of medical specialty associations have expressed interest in IHE, including the American Heart Association, the American Academy of Ophthalmology, and several pathology groups.
"I am encouraged to see the cardiology, ophthalmology, and (clinical) lab groups saying, 'We have these same problems,' and wanting to become involved in this project," said Gail Woods, who represents Siemens/SMS on the IHE technical committee. "As we grow in the next couple of years, we will have to figure out how to manage these different types of specialties and vendors."
In the not-too-distant future, demonstrations of how IHE can integrate operations will occur at a wide range of medical meetings, predicted Chris Carr, director of informatics for the RSNA. Each demo will focus on the needs of a particular specialty and on moving information across the entire spectrum of care. Carr sees HIMSS eventually sponsoring hub demos, where all the disciplines come together with the ability to share data across the enterprise. The hope is that eventually a multidisciplinary feeling of camaraderie will surface, which will provide an impetus to join the network, he said.
"When we have more involvement from other specialties, it will put more pressure on the IT companies to come to the table," Carr said. "And the more they participate, the more incentive there will be for other specialties to become involved."
The work of the IHE committee is already changing product development, according to vendor representatives. Software developers are beginning to adopt common interfaces. Tools such as the X500 object database are becoming part of the IHE framework.
"The benefit of IHE is to decouple specific vendor software development and replace it with a framework that is a standard for everyone," said Rik Primo, director of new business development at Siemens Health Services. "This improves time to market and customer confidence."
In the end, however, the greatest challenge to the acceptance of IHE will be its ability to win the hearts and minds of healthcare professionals and, consequently, spur the sale of medical devices. When requesting bids for equipment, prospective buyers will have to specify IHE compliance if the medical community wants industry to truly buy into the idea. Only when money is on the line, when it's a matter of winning or losing sales bids, will vendors truly embrace IHE. Then customer demand will push vendors to integrate IHE recommendations into their products.
2/28/01, Issue # 1504, page 1.