Computer connectivity issues

This initiative was launched in 1998 by the Radiological Society of North America (RSNA) and the Healthcare Information and Management System Society (HIMMS) in the USA. It is about the integration of data within a number of different IT systems - hence Integrating the Healthcare Enterprise. Although the IHE initiative is currently focused on diagnostic imaging and PACS in the UK, the techniques that are being developed will spread throughout the institution or enterprise. Its twin aims are increased efficiency and better patient management within the current practice of medicine.

UK implementation
An IHE Europe committee has been set up to enable appropriate implementation of IHE provision in Europe. The committee acknowledges the need for national specific provisions but seeks to minimise them. There is a requirement for a UK initiative to ensure that specific UK legislation and methods of practising medicine are supported by industry and the professions. The British Institute of Radiology (BIR) has been asked to participate in the European forum and co-ordinate UK response to the IHE initiative.

The BIR has prepared documents that provide buyers and implementers of information and imaging systems with a useful guide to identify common problems in the key information pathways and the way in which these can be overcome using provisions of the IHE Technical Framework (see http://www.ihe-uk.org). The latter document is the specification that enables interoperability of systems within the healthcare domain and is also used as the basis for the demonstration of IHE provisions at various major exhibitions around the world, including UKRC.

Demonstrations in Europe have proved very successful and particularly helpful to those who are purchasing as well as those who are selling to the healthcare market.

In order to provide an appropriate UK response, the BIR has set up the BIR IHE committee which supervises the work of the IHE-UK technical committee to produce documents and to provide feedback from the UK in the IHE process.

The IHE-UK technical committee includes representatives from relevant professional bodies as well as radiologists, radiographers, physicists and industrialists. It also has representation from the Medicines and Healthcare Products Regulatory Agency (MHRA), the PACS Evaluation Centre (PACSnet), the Purchasing and Supply Agency (PASA) and from other interested parties. Mature draft documents are submitted for review to relevant professional bodies.

Benefits of Implementing IHE
The use of IT systems developed in accordance with the IHE integration profiles reduces connectivity and semantic interoperability problems. Problems with connecting IT equipment between hospital departments impede effective exchange of medical information within the healthcare enterprise. These problems arise from varying build-standards and design-age differences of the IT equipment. IHE promotes the co-ordinated use of established IT communication standards. This approach will eventually lead to an integrated healthcare enterprise.

All those who use, buy and sell healthcare IT equipment should be aware of the IHE initiative. IHE is intended to extend the integration of IT equipment beyond radiology where it started. Radiology has been using dedicated forms of large-scale IT equipment longer than most other healthcare departments. It has already experienced the problems currently being encountered by other parts of the healthcare enterprise. Non-radiology departments can definitely benefit from this past experience.

One key benefit of IHE is that it can provide a solution to the problems that arise when patients' details are incorrect or absent at the time the patient is examined. Records are automatically updated when the correct details are entered in the master patient index.

A digital acquisition system will not in itself improve the efficiency of a department. It is only when a fully integrated IT system is installed throughout an enterprise that such improvements are fully obtained. Workflow analyses should be carried out to make the most of an integrated system. IHE offers a common framework for all parties to understand, define and address clinical integration needs and allows appropriate enhancement steps to be implemented.

IHE and standards
However IHE does not replace the requirement for conformance to standards. Purchasers and specifiers should continue to request, especially in tender documentation, that vendors' products conform to relevant standards such as DICOM and HL7, but integration profiles provide a more precise definition of how these standards are to be used.

The basic IHE demonstration illustrates the use of seven IHE integration profiles (subsets of standard provisions) to support radiology information management. These are called:
1. Scheduled workflow
2. Patient information reconciliation
3. Consistent presentation of images
4. Presentation of grouped procedure
5. Access to radiology information
6. Key image notes
7. Simple image and numeric reports

Integration profiles have been tested and implemented by more than 60 vendors, representing a significant number of IT/imaging equipment suppliers, throughout Europe (see www.ihe-europe.org - connectathon results).

IHE integration profiles specify sets of 'transactions' between 'actors'. There are over 40 defined transactions. Each transaction bears a unique name and number and passes specific information between two actors. A PACS system for example might include the following actors: image manager, image archive, image display, report manager, report repository and the report reader. It should be noted that IHE only specifies the requirements for data communication transactions between actors, not the functions of individual products.

Purchasers can use IHE integration profiles to help organise their own integration priorities and to better communicate their requirements to vendors.

Describing data communication in terms of IHE transactions is advantageous because these are well defined, widely supported and can be independently assessed.

Further information
More information can be obtained from the IHE web page.

For further information about the BIR's role and details of current documents, contact Dr Nicholas Brown (Co-Chair of the IHE-UK Technical Committee, nbrown.mimic@btinternet.com) or Dr Stephen Davies (Chair of BIR IHE Committee, stephen.davies@pr-tr.wales.nhs.uk). Alternatively, you may contact PACSnet on 020 8725 3315 or Cliff Double at the MHRA on 020 7084 3039.

Cliff Double, MHRA
Nicholas Brown, Chair of BIR IHE Implementation Group