IHE moves closer to laying foundation for standardized enterprise EPR

Five years from now, will there be IHE-like initiatives across all medical disciplines, paving the way for the first truly enterprise-wide electronic patient record? That is the vision of several Year 2 participants in the IHE committees and demonstrations. While the demos themselves continue to receive a less-than-enthusiastic response from attendees at the RSNA and HIMSS meetings and certain vendor factions, a number of medical organizations are warming to the idea of multidiscipline systems standardization.

In fact, it is becoming evident that the demos are serving more as interoperability proving grounds for participating vendors than as educational events for potential users. And that makes sense to those companies already integrating the IHE framework into their product development.

"IHE is solving the interoperability problem by publishing the technical framework," said Rik Primo, director of business development at Siemens Health Services. "Vendors still have the ability to customize products and use some creativity, but the mechanism to ensure that the systems will work together is defined within the IHE technical framework."

Although technical standards like DICOM detail the aspects of connectivity, there is no guarantee that, once connected, the systems will do something that is useful to the customer, Primo added.

"DICOM takes care of connectivity, but not interoperability," he said. "IHE is addressing questions like 'Retrieve a RIS report from the RIS and display it on the diagnostic workstation.' It addresses functionality, not just connectivity, and that is what customers really care about."

The work of the IHE committees is already changing product development, according to Primo and others. 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. Primo believes that integration will be the standard in the near future.

"The benefit of IHE is to decouple specific vendor software development and replace it with a framework that is a standard for everyone," he said. "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 HISs, EMRs, 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 Chris Carr, director of informatics for the RSNA. Carr maintains that 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 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. In fact, he says the demonstration at the upcoming HIMSS meeting has the potential to convince IS and IT vendors and CIOs that the IHE approach is making strides where previous integration attempts have failed.

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

A number of medical specialties are already expressing interest in IHE, Carr said. The RSNA is conducting discussions with organizations representing the pathology, laboratory, ophthalmology, and cardiology communities. While such efforts are still in the early stages, Carr said the interest being shown by the lab and pathology groups is particularly keen, and some forward steps are imminent.

"The benefits that can be gained in agreeing on how data can be made available from department to department are huge," he 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."

Ultimately, Carr speculates that in the not-too-distant future there will be IHE-like demos 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 the HIMSS meeting 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, senior product manager at Siemens/SMS and a member of 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."

Planning for the Year 3 demos is already under way, and guidelines for Years 4 and 5 are "on the books," Woods added. The Year 2 tools are expected to become public domain shortly after the conclusion of the HIMSS meeting.