IHE lays foundation for multispecialty integration

Five years from now, will Integrating the Healthcare Enterprise-like initiatives function across all medical disciplines, paving the way for the first truly enterprise-wide electronic patient record? That is the vision of several participants in the IHE Year 2 demonstrations.

The demos themselves suffered less-than-enthusiastic response from attendees at the RSNA and Healthcare Information Management Systems Society meetings and certain vendor factions, but medical organizations outside radiology are warming to the idea of multidiscipline systems standardization.

A number of medical specialties are already expressing interest in IHE, according to Chris Carr, director of informatics for the RSNA, which is in discussions with organizations representing the pathology, laboratory, ophthalmology, and cardiology communities. While such efforts are still in their infancy, the interest being shown by the lab and path groups is particularly keen, and some concrete steps are imminent.

"The benefits that can be gained in agreeing on how data can be made available from department to department are huge," Carr said. "I don't think you can really have an electronic patient record until these issues are solved, and IHE is a potential approach to engaging with other disciplines."

Carr speculates that in the not-too-distant future, IHE-like demos will occur at a variety of medical meetings, with the focus on the needs of each particular specialty and on moving information across the entire spectrum of care. He sees HIMSS eventually becoming the hub demo, where all the disciplines come together and the ability to share data across the enterprise is replicated.

"I am so encouraged to see the lab, cardiology, and ophthalmology groups saying, 'We have these same problems,' and wanting to become involved in a project like this," said Gail Woods, who represents Siemens/SMS on the IHE technical committee. "In the next couple of years, we will grow and will have to figure out how to manage all these different types of specialties and vendors."

The work of the IHE committees is already changing product development, vendor representatives say. Software developers are beginning to adopt common interfaces, and tools such as the X500 object database and CORBAmed 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 business development at Siemens Health Services. "This improves time to market and customer confidence."

In Year 1, the IHE focused on integrating IT systems in the radiology department to implement a basic clinical workflow. Year 2 goes beyond basic image acquisition, addressing such concerns as patient information reconciliation, nonroutine data handling, and diagnostic and care processes.

"Years 1 and 2 have been about PACS integration with RIS and modalities," Primo said. "Now we want to expand to HIS, EMR, and clinical systems."

For example, the 32 companies participating in the Year 2 demo at the RSNA meeting showcased the seven integration profiles that have been developed within IHE so far. In particular, the Scheduled Workflow integration profile, which forms the IHE workflow foundation, was demonstrated across a set of almost 70 imaging and information systems, including HIS, RIS, PACS, modalities, and workstations.

"Visitors were amazed to see the ability to define independent views when multiple procedures, such as chest, abdomen, and pelvis, are grouped in a single acquisition using CT and MR," said Charles Parisot, GE Medical's representative on the IHE planning and technical committee and cochair of the technical committee. "Attendees realized that IHE is no longer a dream but a concrete capability they can expect from their vendors for both information and imaging systems."

Challenges remain, however. Within radiology, much of the functionality required to interface RIS and PACS to enterprise information systems still needs to be made real, according to Carr. True standardized reporting, for example, which is a necessary underpinning of any electronic patient record, is still in its infancy. In addition, most IS and IT vendors are still not participating in the IHE demos.

"IHE started in radiology and radiology's partnership with IT professionals," Carr said. "The DICOM experience helped the vendor sector that supports radiology become highly organized and set them up to cooperate very effectively, but some of the other disciplines are lagging behind in this."

These issues have prompted the newly elected HIMSS leadership to take a more aggressive approach to IHE this year. The 2001 annual meeting program includes much more IHE material than last year. The Year 2 IHE demonstration at the HIMSS meeting has been expanded to include

?reporting;
?broader access to images and reports throughout the enterprise;
?image presentation consistency;
?reconciliation of unknown patient data; and
?other workflow and transaction enhancements.

HIMSS has also implemented a second leg of its outreach process to more effectively reach the IT community, according to Carr.

"HIMSS has undertaken a very serious effort to get the body of IT companies that attend its meetings to better participate in IHE and the future of the initiative, but it is still a major challenge," he said. "When we have more involvement from other specialties, it will put more pressure on the IT companies to come to the table. And the more they participate, the more incentive there will be for other specialties to become involved."

Parisot agrees. The upcoming demonstration at HIMSS has the potential to convince IS and IT vendors and CIOs that the IHE approach is making strides where previous integration attempts have failed, he said.

"This should accelerate the extension of IHE beyond radiology to such areas as laboratory or cardiology," he said.