Focus on ...

Integrating the Health Enterprise (IHE)

Integrating the Health Enterprise (IHE)

IHE and EHR

This month the eMessenger focuses on the topic of Integrating the Health Enterprise (IHE). Our first contributor is Dr. Alexander Schanner, Programme Manager for ELGA, an Austrian task force studying Electronic Health Records (EHR). Dr. Schanner’s work with ELGA makes him particularly interested in how IHE can support the objectives of EHR (the subject of last month’s eNewsletter focus).

IHE has defined a common framework to deliver the basic interoperability needed for local and regional health information networks. It has achieved this by developing a foundational set of standards-based integration profiles for information exchange with three inter-related efforts.

“One of these is Cross-Enterprise Document Sharing (XDS), which supports document content interoperability,” says Dr. Schanner. “As XDS supports standards-based EHR across clinical encounters and care settings, I am delighted to see that it has been formally adopted by health ministries and is in deployment for national health information exchange projects in Austria, Canada, France, Italy and the US. Several countries such as China, Japan and the Netherlands are also planning pilot projects.”

According to Dr. Schanner, 400,000 patients in the Lower Austria region have their online records exchanged on the basis of IHE specifications. “The region’s target is to reach 1.5 million patients by the end of the year and to cover all of Austria by 2009,” he reports.

Security and consistency issues

The other two efforts relate to a security framework for protecting the confidentiality, authenticity and integrity of patient care data, and a cross-domain patient identification management to ensure consistent patient information and effective searches for EHRs.

These were two of the key issues at this year’s IHE Europe Connectathon, an annual event which conducts interoperability of healthcare IT systems. It was held in Berlin during the eHealth Week of the German EU Presidency and the ITeG Congress on 15-20 April.

“I was really impressed by the Connectathon,” says Dr. Schanner. “It attracted government representatives and vendors from most of Europe as well as from Canada, Israel, Japan and the US.”

The six-day event was a unique opportunity for vendors to identify and solve interoperability issues. A team of around 30 monitors carried out a total of more than 1,500 tests.

IHE accelerates deployment of EHR

Patient safety is also a key element of the Electronic Health Record, although it should be regarded as part of an integrated approach that includes consistency of healthcare, practice and information standards, and consistency and standardization of healthcare data. Only then will EHR reach its full potential.

Dr. Schanner is also aware that the proliferation of computerized electronic health records in hospitals, clinics and pharmacies might create "islands of information" that are not widely compatible. He therefore welcomes the thrust of IHE to reduce these potential islands of information while protecting patients from medical errors as they move between them.

He is also convinced that the second World of Health IT Conference & Exhibition, to be held in Vienna in October, will further enhance the link between IHE and EHR.

“The worldwide expertise encapsulated in the IHE specifications, which are based on well-recognised standards as well as the testing of several products used in Austria at the IHE Europe Connectathon, have significantly facilitated the deployment of the Austrian national EHR,” he says.

Dr. Alexander Schanner studied electrical engineering and biomedical engineering at the University of Technology, Graz, Austria. He has held positions as Sales Manager and Project Manager for Radiology Information Systems (RIS) and Picture Archiving and Communication Systems (PACS) in the international market, latterly at Tiani Medgraph AG. He provides technological consultancy for the regional hospital authorities of Lower Austria in the areas of IT and medical engineering, and has managed a project connecting all 27 regional hospitals of Lower Austria in a Wide Area Network.

The Challenges Ahead

Our second contributor on the topic of IHE is Alexander Ihls from InterComponentWare AG (ICW). A patient information database from ICW – Master Patient Index (MPI) – recently passed IHE conformance tests at the European IHE Connectathon in Berlin.

Alexander Ihls was one of the founding members of IHE Germany and thinks that IHE faces two particular challenges in the years ahead. One is the ongoing challenge of connecting different IT systems from different sectors when the IT systems are not based on HL7 but on proprietary communication functionalities.

“In Europe, an increasing number of governments are strongly pushing healthcare IT standardisation initiatives. The challenge for IHE is to get involved in these projects right from the outset. We are doing this by talking with the relevant ministries – Health and IT for example – and showing them the benefits of deploying the IHE approach. Their vendors can then develop interfaces that not only comply with their own national requirements but which can also communicate with IT systems of other countries that are following this same standard.”

Correctly structuring the data

The other major challenge is the semantic interoperability of healthcare IT systems. This refers not to the flow of documents between systems but to the information contained within those documents. If the medical data is not correctly structured, it can be unreadable, which means it will not be correctly analysed and sorted by the IT system.

“In the coming years semantic interoperability will be vital, so that all transferred data inside all documents is structured using, for example, the LOINC code, or the HL7 Clinical Document Architecture (CDA) standard,” says Ihls.

CDA provides an exchange model for clinical documents. It makes documents both machine-readable – so they are easily parsed and processed electronically, and human-readable – so they can be easily retrieved and used by the people who need them. CDA documents can be displayed using XML-aware Web browsers or wireless applications such as mobile phones.

Service-oriented architecture

Another area of change for IHE is the adoption of new technologies around service-oriented architectures (SOA). In essence, an SOA provides a time-saving information-delivery architecture that integrates all healthcare information management processes. It can enable all the providers to be more informed, timely, and efficient, while patient privacy is fully protected.

“We can meet this need through HL7 Version 3, which adopts a new methodology for developing messages,” explains Ihls. “I am confident that in a short time we will have more SOA functionalities inside the IHE profiles.”

IHE is evolving

These are thus exciting times for IHE, which is in the early stages of an initiative to develop a more professional approach within the organisation, in the EMEA region and globally.

“As we grow our membership and our activities, we need a more professional way of organising, structuring and presenting ourselves. I am involved in these discussions, and we hope to introduce a new IHE organisation at the World of Health IT Conference & Exhibition in Vienna in October. I hope you all like what you see!”

Alexander Ihls is head of the ProfessionalGate product line from InterComponentWare AG (ICW). With his team he is responsible for the development of the ICW Networking solutions, for hospitals and GPs, and for the ICW CareManager solutions, a tool for effective customer and partner management in insurance companies and call centres. In his former life he had a leading position at iSOFT Germany and MEDOS AG. In addition to these positions he was CIO of a public hospital in Leipzig.

Demonstrating IHE to a global audience

Didi Davis, Director of Integrating the Healthcare Enterprise (IHE), joined HIMSS in May 2006. She has over 15 years experience in the healthcare industry with emphasis on the development, implementation and management of IT solutions.

As part of its drive to show the benefits of deployment, IHE has drawn up a comprehensive programme of global demonstrations. Following a successful Interoperability Showcase in New Orleans at the US HIMSS conference in February, IHE is planning a similar event at the World of Health IT Conference & Exhibition in Vienna in October.

“At the Interoperability Showcase in Vienna we will connect multiple vendors to show how information can be passed from system to system and from application to application. For example, we will demonstrate data coming in from an ICU unit and going directly into an electronic health record. Or show how data can move with a patient; from a hospital to a GP.

“Our plug-and-play interoperability demonstrations show that no matter what product the physician is using or the hospital has to begin with, you can actually have access to data.

“In Vienna we will also cover a range of user scenarios – such as radiology, cardiology, ICU units – on a rotation of two or three demonstrations per hour. This will allow visitors to pick the scenario that they most want to see.”

Addressing the fragmented European market

“An issue we are facing in Europe is that the market is fragmented, with many vendors operating only in one country. Moreover, every country thinks that it is unique and that “there is no way that IHE will work here!”

“In Vienna we are going to counteract this viewpoint by demonstrating that the clinical workflow is not different in different countries, but that there are generic clinical workflows where IHE is applicable.

“We want to convey the main advantage of IHE over standards which is that it doesn’t require the creation of an interface. An interface needs to be redone every time one side’s application changes, which of course costs money.

We value user input

“IHE also provides a proven process that is reviewed every 18 months taking into account users’ concerns. Then vendors come to the table to explain what they can produce. IHE creates standard implementation guides, or integration profiles, so that no matter whether you are vendor x, y or z, you implement IHE as the guidelines show you.

“Once these profiles are put together, we test them at a Connectathon. In Berlin recently, we brought multiple vendors together to test these integration profiles, to help their systems communicate with one another.

“We don’t certify products in IHE, but we do perform compliance checking to make sure that vendors truly have implemented the integration profile. They have to show that they can communicate with three other peers properly. The results of the Connectathon are available on our website, and you can see all the vendors that did tests and what they implemented.”

www.interoperabilityshowcase.org

"I have heard a lot about semantic interoperability recently. What is it and how do we get it?"

Semantic interoperability means having a common understanding of the meaning of the information being exchanged. If you only speak Finnish, and your neighbour only speaks Greek, you have a semantic interoperability problem. You need to find a solution to translate the information going to and fro so that you both can understand what you are saying to each other over the garden fence.

In the context of healthcare IT, the goal of semantic interoperability is to eliminate the language bottlenecks that arise when systems that were never intended to talk to each other attempt to do so.

It’s a particularly challenging problem when one term has multiple meanings or two or more terms refer to the same thing. A physician knows that dropsy and congestive heart failure could refer to the same ailment, but a computer wouldn’t know if the terms are similar or different.

Relational databases offer a similar problem. Sharing data in relational databases is very difficult, because each has its own schema for defining tables and fields; it’s hard to understand someone else’s schema.

This means that, as Alexander Ihls points out in this eNewsletter’s Focus, all transferred data inside all documents will have to be structured using a standardized coding system. But have you ever known a standard that has been easy to develop and implement? Probably not.

However, in Europe, there is a roadmap for interoperability in e-Health with special emphasis on semantic interoperability. This is the RIDE project, which aims to promote and undertake interoperability issues in healthcare organizations at the European level.

It will lead to recommendations for actions as envisioned in the action plan “eHealth – Making Healthcare Better for European Citizens: An Action Plan for a European e-Health Area” by coordinating various efforts on eHealth interoperability in member states and the associated states.

RIDE is being coordinated by the Middle East Technical University in Turkey and includes nine partners from seven countries, which means that a lot of semantic interoperability is already being put into practice.

They have a tough ride ahead of them, but we wish them well and await their initial findings at the end of this year with great interest.

For more information on RIDE please visit:
http://www.srdc.metu.edu.tr/webpage/projects/ride/index.php

Cordula Singer
HIMSS EMEA secretariat

Questions anyone?
Challenge us to help you with your (healthcare ICT related) questions. Send your input to emea@himss.org (subject line: question time) and we will research and publish your questions and our answers in forthcoming issues of the eMessenger.

The HIMSS Mission

The Healthcare Information and Management Systems Society (HIMSS) is the premier professional member organisation exclusively focused on providing leadership for the optimal use of healthcare information technology.

The HIMSS mission is to lead change in the healthcare information and management systems field through knowledge sharing, advocacy, collaboration, innovation and community affiliations. HIMSS EMEA brings this mission to Europe, Middle East and Africa.

HIMSS EMEA

HIMSS in Europe, the Middle East and Africa (EMEA) is dedicated to bringing together all the major players in the Health ICT community to transcend borders and languages and engender a truly regional dialogue. As members of HIMSS EMEA, individual professionals (managers, administrators, clinicians, technology experts and users), vendor companies and IT providers meet, interact and learn from one another.

With the opening of its EMEA office in Brussels, HIMSS is now positioned to provide activities, programmes and education specifically designed for the EMEA Health ICT community. Guided by a Governing Council of members from within the EMEA region, HIMSS EMEA focuses on the needs of individual and corporate members to ensure dedicated services and membership value.

Membership benefits include

• A monthly e-newsletter - HIMSS EMEA eMessenger – delivered to your inbox on the third Thursday of every month.
• A series of educational eSeminars on topics reflecting the challenges of the Healthcare ICT community in the EMEA region. Following April’s successful inaugural eSeminar on Electronic Health Record systems, HIMSS EMEA is planning a challenging programme for the coming months, which covers hot topics like Privacy Protection and Patient Safety. For detailed information, please have a look at the schedule for 2007.
• An interactive website targeted at the main issues and experts within our community. This includes a weekly “Expert View” on the issues that matter to you as well as industry news (RSS feed in partnership with Healthcare IT News Europe).
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To learn more about HIMSS EMEA take a look at our website: www.himss.org/emea