IHE targets workflow issues

As the Integrating the Healthcare Enterprise (IHE) initiative moves into its third year, several technical and implementation challenges must still be overcome before the undertaking can be called a success.

Even so, the first two years have yielded some important advances in the IHE technical framework. The framework is intended to guide vendors and users adopting new medical imaging and information systems and ensure interoperability of these products, according to speakers at the HIMSS conference in New Orleans this week.

"IHE is not a standard, but products implemented using the technical framework are easier to integrate," said Paul Vegoda, who moderated a session on the clinical goals and technical challenges of IHE.

Foremost among IHE's achievements to date are the seven integration profiles developed by the IHE technical committee to address fundamental components of the workflow process:

- scheduled workflow (admit, order, schedule, acquire images, notification of completed steps);
- patient information reconciliation (unknown patients and unscheduled orders);
- consistent image presentation (hard- and soft-copy gray-scale presentation state);
- access to radiology information (consistent access to images and reports);
- presentation of grouped procedures;
- key image notes (exchange flagging significant images); and
- simple image and numeric reports (exchange simple reports with image links and/or measurements).

Because the IHE has focused primarily on the integration of radiology images and information (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 directly address the issue of differing accession numbers between the PACS, RIS, HIS, and other information systems. It also overcomes the problem of different vendor accession number schemes within these systems.

"Has the IHE technical framework come up with a means for controlling grouping? Absolutely," said Charles Parisot, GE Medical's representative on the IHE planning and technical committee and co-chair of the technical committee.

Adoption of these profiles by vendors is critical to achieving the level of interoperability necessary to move hospitals and healthcare organizations into a truly integrated environment, according to Vegoda. A number of vendors already have 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 integration 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," Parisot said. "The integration profiles add 'glue' to the standards to ensure interoperability and team play."

But vendor acceptance is not the only thing needed to will ensure the success of IHE. As more products become IHE compliant, customers need to begin specifying IHE compliance in their RFPs. This is important for many reasons, including the fact that the IHE committees have no intention of forming an accreditation body to police the adoption of the technical framework. Rather, customer acceptance and even demand are expected to push vendors to integrate the IHE recommendations into their products.

"For users, the IHE framework defines what needs to be achieved in order to get the proper information to the appropriate physician and ensure best care," Parisot said.

In the long run, these same specifications should be adaptable to other departments, such as cardiology, ophthalmology, and pathology, and even enterprise-wide applications. This is one of the primary goals of the IHE technical and planning committees during Year 3, according to Vegoda. A number of medical specialties are already expressing interest in IHE, including the American Academy of Ophthalmology, the American Heart Association, and several pathology groups.