PACS vendors fine-tune integration at IHE 'connectathon,' but not all information and systems technology vendors are on board

As the annual RSNA meeting draws near, vendors are gearing up for Year 2 of the IHE (Integrating the Healthcare Enterprise) demonstration. As part of this process, some 150 software engineers and marketing/product managers from more than 30 imaging, modality, and information systems firms gathered at RSNA headquarters in Chicago in early October for the IHE "connectathon."

This week-long systems integration marathon is a trial run designed to work out connectivity and workflow kinks prior to the main IHE event in November. The 33 companies that attended brought with them a total of 68 different systems, including RIS, PACS, displays, and modalities. They performed a number of successful vendor-to-vendor connections, according to Christopher Carr, assistant director of informatics for the RSNA.

"We need to ensure that the messaging and transfer of files is consistent and reliable. The connectathon is designed as a test to ensure that the demo runs smoothly," said Tom Pacenta, industry manager for diagnostic imaging and PACS at Marconi Communications, which is donating all of the equipment to support the gigabit Ethernet networks for both the IHE demo and RSNA exhibition this year.

The long-term goal of IHE is to bring consistency to the way standards for the exchange of data and images are interpreted and implemented. In a more practical vein, the IHE initiative should eliminate the need for vendors to develop expensive proprietary interfaces that are often incomplete and must be reconfigured and separately maintained at each customer site.

Toward this end, the IHE Year 1 demonstration held during the 1999 RSNA and 2000 HIMSS meetings demonstrated that 24 vendors (representing 47 separate information and imaging systems) could share information in an integrated, open-standards environment and maintain the integrity of the data and images exchanged. Year 1 participants included Agfa, Algotec, Canon, Cedara Software, Cerner, DeJarnette, eMed, Fuji, GE, IDX, Marconi, Merge, Mitra, Philips, StorComm, Toshiba, and Vital Images.

"The primary accomplishment of Year 1 was getting the process in place," Carr said. "Representatives from major imaging and information systems vendors sat down and agreed on a framework for implementing established standards, such as DICOM and HL7."

For practical reasons, the scope of the Year 1 demo was fairly narrow, focusing on basic registration, scheduling, image acquisition, and storage procedures in the radiology department. Four simulated healthcare enterprises, each modeling a different hospital, featured patients with conditions ranging from a torn knee ligament to suspected appendicitis. Within each simulation, spectators were introduced to the patient's ailment and could watch information being entered into the hospital's records system, where it became instantly available to the radiology department. There, x-ray, ultrasound, and other images were integrated into the record.

IHE Year 2 widens the scope, with 34 vendors representing 74 distinct systems at the RSNA meeting. New features include mechanisms to deal with a patient who is incompletely identified at the time of registration, access to nonradiology information such as lab values, image consistency across disparate display systems, and structured reporting. Vertically, new transactions and greater detail will be added to the protocols within the radiology unit. IHE is also considering incorporation of horizontal integration technologies, fostering linkage between various medical specialists within the enterprise.

Concerns linger, however, about how successful IHE will be without better support from HIS vendors, most of which have dragged their feet when it comes to actually participating in the demonstrations. For example, while representatives from Eclipsys, McKesson/HBOC, and Shared Medical Systems have been on the planning committees, these companies did not participate in the Year 1 demonstrations. IDX, Mitra, and SMS are participating in the Year 2 demo at RSNA, however.

"Our biggest obstacle is still the lack of participation by IS/IT vendors," Carr said. "We have been really successful in getting the imaging vendors to participate, and there is support from enough IS vendors to make things happen. But in order to achieve the real goal of IHE and go beyond radiology and start exchanging information across the enterprise, it will take more involvement from IS/IT companies."

This gap becomes even more critical in Year 2, where the goal is to broaden the integration more fully across the enterprise and to ensure that the HIS vendors share responsibility for adopting and implementing IHE requirements. During Year 1, the IHE planning and technical committees placed most of their emphasis on PACS/RIS integration. While the RIS/PACS interface is important, the full benefit of the IHE and PACS can be achieved only if the HIS and RIS also comply.

"This is a major problem," said Kees Smedema, international manager of interoperability for Philips Medical. "Standards only give benefit if we all use them. Our customers should require the same from their HIS and RIS vendors as they require from modality and PACS vendors."

One reason many IS/IT vendors may be less motivated to participate in IHE is because their primary trade show, the HIMSS meeting, has not pursued the concept of a networked show floor in the same way the RSNA has at its meetings. This lack of systems integration among vendors at the premier event for their industry has been a drawback in terms of promoting the value of open architecture systems and the need for full-scale connectivity.

Changes in the marketplace, however, are beginning to force the IS/IT community to recognize how a cooperative approach to systems integration can benefit not only the end users but the industry itself. Despite revenue projections of more than $20 billion for the healthcare IT industry, all but a handful of HIS vendors are reporting lower-than-expected sales and losses instead of profits. In addition, the increasing migration to enterprise computing and Internet-based thin-client technologies is creating a new market dynamic that favors software over hardware firms and start-ups (which can often move new products to market more quickly) over established legacy systems vendors.

Ultimately, the end-user community's growing need for enterprise access to patient information will likely drive the IS/IT vendors to embrace systems integration in the same way the imaging community already does.

"The IHE demonstration itself is only a means, not the goal itself," Smedema said. "Our customers ask for integration of information at their desktop. They want to improve the diagnostic process by having not only images and radiology reports, but also laboratory data and allergy information."

Ms. Kincade is editor of Health Networking News http://www.healthnetnews.com/, published by Diagnostic Imaging.