European hospitals face multiple inconsistencies in their IT systems: weak links between administrative information systems, largely developed on the hospital scale, and emerging departmental clinical information systems; a relative disconnection between information systems, medical devices and equipment resulting in inconsistencies in patient-related information; a lack of industrial products for information systems compared with specific developments implemented by consulting companies or by the hospital IT department itself. These weaknesses have multiple consequences at patient level (eg, time wasted entering the same information several times) and at the hospital level (eg, poor return on investment for information system use and expensive, time-consuming installation and difficult maintenance).
IHE objectives and benefits
Integrating the Healthcare Enterprise (IHE) is an initiative by healthcare professionals and industries to improve information sharing between computer systems in healthcare. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs to achieve optimal patient care. Systems developed in compliance with IHE communicate better, are easier to implement and enable care providers to use information more effectively. As initially anticipated by the IHE community and verified for nearly 10 years, all hospitals and medical centres have similar needs that can be fulfilled by solutions that implement the same functional architecture. It does not mean that all of them must use the same particular product or computer platform, but that the different components in their systems should use the same communication protocols.
Thanks to a deep collaboration between users and vendors, coupled with the requirement to reuse existing standards and define modern but stable and reliable architectures, IHE is gradually affecting all healthcare IT domains: radiology, laboratory, cardiology, ophthalmology, pathology and more generally the whole healthcare IT infrastructure, including electronic healthcare records (EHRs).
IHE has an original and efficient four-step approach (see Figure 1) identifying user needs with practical scenarios in a specific clinical “domain” where IT is critical, called an “integration profile”: defining the “technical framework” (expanded each year); fulfilling these user profiles through standardised communication; testing vendors’ ability to implement this technical framework through a cross-vendor intensive test bed, the “connectathon”; and using the technical framework in requests for proposals (RFP).
At the core of the IHE technical framework are transactions between “actors” that implement the “integration profile”. One key element of IHE is to define these actors as a function of a product (eg, report creator), and not the product itself (eg, a radiology information system, an imaging workstation or a voice recognition system), so users and vendors can choose how they want to build their own solution. Transactions are based on pure existing standards because IHE defines any new protocol. In the rare cases where the existing standard is not sufficient to address all the requirements, IHE reports the issue to the relevant standardisation body (HL7, DICOM) to complete or tune the standard. IHE promotes its activity through publications, websites, demonstrations and success stories. In the 16 connectathons held from 2001 to 2007, 239 vendors tested 184 actors from 46 integration profiles in six domains.
Deployment in Europe
IHE started in the USA in 1998 with the radiology domain. The initiative has expanded in Europe since 2001 as a result of the impetus of COCIR IT, an organisation that originally brought together European radiology equipment vendors and now gathers more and more equipment and information system vendors in all medical areas. The expansion first started in France, where the Société Française de Radiologie (SFR) and the Groupement pour la Modernisation du Système d’Information Hospitalier (GMSIH) developed IHE’s interest in accelerating the adoption of IT in hospitals. Germany and Italy joined the organisation in 2002, and now the UK, the Netherlands and Spain are on board. Each expansion is organised at the European Connectathon (Paris, Aachen, Padova, Noordwijkerhout, Barcelona, Berlin, and Oxford next year), where 300 engineers from 80 companies test more than 100 systems. IHE-Europe has been structured with increasing user organisation and vendor involvement. The secretariat is shared between COCIR IT and INRIA (Institut National de Recherche en Informatique et en Automatique, or National Institute for Research in IT and Automation), which coordinates the development of open-source testing tools with other “regions”, such as North America and Asia. The influence of European actors within IHE is growing and a number of new domains have been initiated in Europe, including laboratory and pathology.
IT adoption is particularly growing in European hospital radiology departments, and is already present in cardiology and laboratories. A new very promising area where IHE should make a significant difference is the EHR for regional or specialised healthcare networks. Based on the combination of HL7 content and OASIS Web services protocols, the XDS (Cross-Enterprise Document Sharing) integration profile has largely been used by European projects, thus accelerating the convergence between various clinical information management approaches, via a document-based model. XDS, competed by peer-to-peer and specialised “content” profiles, can also apply to ambulatory care, including general practitioners. Authorities at European or Member State level have gradually become aware of IHE, and IHE-Europe has been included in the work led by the European Commission on the eHealth Information Society.
Today, in European modern hospitals, patient identity errors have significantly decreased in radiology and laboratory examinations with the help of IHE. And within two to five years, IHE will make it possible to access patients’ EHR throughout their evolution in healthcare systems, even when crossing borders. The modular approach proposed by IHE will also help to create new opportunities for European vendors to propose advanced products to the international market, thus enabling hospitals to have a better IT system at no further expense.