ihe: a model for driving adoption of standards
TRANSCRIPT
IHE: a model for driving adoption of standards
Christopher D. Carra,*, Stephen M. Mooreb
aRadiological Society of North America, Oak Brook, IL, USAbMallinckrodt Institute of Radiology, St Louis, MO, USA
Received 15 July 2002; accepted 25 August 2002
Abstract
The development of communication standards in healthcare is a major ongoing engineering effort. While there is little doubt that this effort
has made possible significant advances in the performance of healthcare information and imaging systems, overall levels of systems
interoperability have not improved as dramatically as one might reasonably expect and the cost of implementing effectively integrated
systems remains high. The lag between the development of information standards and their implementation in real systems and institutions is
a genuine problem in healthcare. This paper describes an ongoing initiative that attempts to bring together healthcare professionals and
industry experts to coordinate the implementation of standards in ways that enhance operational efficiency and the quality of patient care.
q 2002 Elsevier Science Ltd. All rights reserved.
Keywords: Radiology; Informatics; Integration; Systems; Standards; Industry; Medical associations; Picture archiving and communication system; Modalities;
Workflow; Presentation consistency; Structured reporting; Charge posting; Security; Post-processing
1. Introduction
Despite the fact that great progress has been made in
developing data communication standards in healthcare—
notably, DICOM and HL7—the level of interoperability
among systems in most healthcare institutions remains
frustratingly low.
By intention and by consequence of the process through
which they are created, these standards often describe an
information architecture somewhat more general and
abstract than that required by engineers designing and
implementing systems. They may leave issues open to
interpretation or provide a range of choices to the
implementer.
Consequently, it frequently requires a major effort to
achieve significant integration of multiple systems—even
when all the systems involved comply with established
standards. Moreover, there is not a reliable way for
professionals seeking to acquire or upgrade systems to
specify a level of adherence to communication standards
sufficient to achieve truly efficient interoperability. There is
not a clear road map from the vast body of technical
information assembled by standards groups to its
application in solving specific clinical problems. A gap
persists between the establishment of standards to make
interoperability possible and the actual implementation of
integrated systems [1].
The integrating the healthcare enterprise (IHE) initiative
was established to help bridge that gap [2]. The IHE process
provides an organized way for healthcare professionals to
communicate to industry the integration capabilities they
need in order to work efficiently in providing optimal patient
care. Representatives of imaging and information systems
companies develop and document a consensus implemen-
tation of established communication standards to provide
those capabilities.
Their selections are recorded in the IHE Technical
Framework, a detailed and freely available implementation
resource. A testing process enables refinement of both the
documented information model and each participating
vendor’s implementation of the relevant pieces of it.
Demonstrations and educational sessions disseminate infor-
mation about the process and provide tools for purchasers to
use in acquiring systems with specific integration
capabilities.
Overall, the process helps to build a market for
standards-based integration by supplying incentives, edu-
cation and tools for both providers and purchasers. It defines
an iterative cycle of activity leading to a significant result
0895-6111/03/$ - see front matter q 2002 Elsevier Science Ltd. All rights reserved.
doi:10.1016/S0895-6111(02)00087-3
Computerized Medical Imaging and Graphics 27 (2003) 137–146
www.elsevier.com/locate/compmedimag
* Corresponding author. Tel.: þ1-630-368-3739; fax: þ1-630-571-7837.
E-mail address: [email protected] (C.D. Carr).
point (testing and public demonstration) and creates a
feedback loop for the design, testing and implementation of
standards-based integration solutions (Fig. 1).
1.1. Goals of systems integration
The healthcare enterprise is understood to consist of a
complex of facilities and care providers necessary to
perform diagnosis and treatment across the spectrum of
patient care. An increasingly vital element of this complex
is an interconnected array of information systems that
acquire, process, store and distribute data required for
diagnosis and care, as well as the associated administrative
and financial processes.
For practical and historical reasons these information
functions have evolved as discrete units, each addressing
particular aspects of the overall data architecture. Connec-
tions among these systems have developed less rapidly,
leading to a situation that can be described as ‘islands of
data’, wherein much information acquired in the process of
care is accessible only within a department or subunit of a
department and no comprehensive view of all the infor-
mation relevant to a given patient’s care is possible.
IHE is organized to identify barriers to information
sharing that can be removed through the coordinated
application of established standards. Priority is given to
improvements that will provide the greatest benefit for
clinical care. It is anticipated that the work done under IHE
will enable institutions to acquire integrated systems less
expensively and more conveniently. One desired outcome
of the activity is to contribute to the development of an
overall information and communications infrastructure
sufficient to give real substance to the concept of an
electronic patient record. The broader goal is to make all
relevant patient information available to care providers as
needed to support optimal patient care.
1.2. History
The Radiological Society of North America (RSNA)
held initial meetings with interested parties in the summer of
1997 to collect ideas about the process of a more unified
approach to an integrated healthcare information infrastruc-
ture. Further discussion between the RSNA and the
Healthcare Information and Management Systems Society
(HIMSS) led to a joint project initially sponsored by the two
organizations. This 5-year program would involve collab-
oration between the professional societies and equipment
vendors with the end goal of producing commercial
solutions that offer significantly enhanced information
sharing capabilities.
The RSNA and HIMSS convened a group of imaging and
information systems vendors in the fall of 1998. Organiz-
ational meetings held to design a process for collaboration
produced two clear results. The organizational structure was
defined (and will be discussed in Section 1.3). The second
result was a policy decision that this group would not
become a standards organization, but rather would commit
itself to clarifying how existing standards can be used to
promote systems integration. Rather than competing with
the already well-established standards efforts in healthcare,
IHE would work in ways complementary to them, driving
their adoption in commercial products and providing a
feedback loop for their further development and refinement.
1.3. Organization
Four separate committees were organized to guide this
process. The Strategic Committee consists of a small
number of vendor representatives (past chairs from other
IHE committees) and RSNA and HIMSS staff and board
members. This committee provides oversight to the other
committees and provides longer-range advice on the
direction of IHE (such as new technologies to pursue).
The Review Committee consists of HIMSS and RSNA
staff and board members. This group defines the rules of
participation for vendors and intervenes in issues and
conflicts involving the competitive interests of participating
vendors.
The Planning Committee consists of vendor representa-
tives, with oversight from HIMSS and RSNA membership
and logistical and secretarial support by HIMSS and RSNA
staff. The Planning Committee determines the general scope
of technical tasks to be completed each year, prioritizing
them based on input from RSNA and HIMSS membership.
It also outlines IHE demonstration and educational
programs.
The Technical Committee consists of technical repre-
sentatives from the vendor community, again with oversight
from the HIMSS and RSNA membership and support by
staff. This group takes the integration goals defined by the
Planning Committee and produces the detailed documen-
tation—the IHE Technical Framework—that specifies the
standards-based transactions required to achieve these
goals.
A final element in the structure has been the retention of a
technical project management team to oversee the testing
and demonstration process. The responsibilities of this team
Fig. 1. Overview of IHE process.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146138
have included development of software testing tools,
organization and supervision of face-to-face testing events,
and management of the vendor demonstrations. For the first
3 years of the initiative, the Electronic Radiology Labora-
tory at the Mallinckrodt Institute of Radiology, Washington
University, St Louis has played this role, under contract to
RSNA and HIMSS.
1.4. IHE technical framework
The IHE Technical Framework is a description of how to
apply existing standards to solve system integration
problems. Version 5.0 of the framework is available on
the RSNA web site at http://www.rsna.org/IHE. The two
volumes of the framework use the HL7 and DICOM
standards to describe solutions for specific integration issues
(Fig. 2).
The Technical Framework defines and makes use of
several key concepts.
† A data model, adapted from HL7 and DICOM, which
shows the relationships between the key frames of
reference (e.g. Patient, Visit, Order, Study) defined in the
framework.
† The concept of IHE Actors, which allows systems in the
enterprise to be described in generic, product-neutral
terms. Actors exchange messages to achieve specific
tasks. A commercial system may incorporate one or more
IHE Actors.
† The organization of the functionality described into
discrete units, known as Integration Profile. These
higher-level views of IHE functionality consist of a set
of Actors and transactions required to address a
particular clinical need. For example, the Scheduled
Workflow Integration Profiles incorporates all of the
process steps involved in performing a radiological
procedure in a typical scheduled patient encounter,
starting with patient registration and continuing through
ordering, image acquisition and image viewing. As of the
2002–2003 cycle of implementation and testing, IHE has
defined ten Integration Profiles. Their number will grow
over time.
The Technical Framework documents in detail the
transactions between Actors. For example in Figs. 3 and 4,
Transaction 1, Patient Registration, describes the HL7 ADT
messages sent for particular registration or admission
processes. Transaction 2, Placer Order Management
(ORM), describes the HL7 ORM messages that are sent
from an Order Placer (Hospital Information System) to an
Order Filler (Radiology Information System). For each
transaction, the Technical Framework defines the scope of
the transaction, presents its use-case, enumerates the Actors
involved in the transactions and their respective roles,
diagrams the interactions of the Actors, lists each event
involved and provides detailed message semantics.
In defining individual transactions, the Technical Frame-
work often strengthens the requirements defined in a
standard for the attributes in a message, usually by
mandating the presence of, or a specific values for, attributes
that might be optional or unspecified in the referenced
standard. By mandating the values of certain attributes, the
Technical Framework allows peer applications to commu-
nicate more dependably and perform at a higher level of
Fig. 2. Organization of Information in the IHE Technical Framework.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146 139
interoperability without custom, on-site interface
development.
The Technical Framework also provides important
mappings from the messages in one domain to another.
For example, HL7 describes order messages via ORM
messages. DICOM describes a worklist procedure that
allows a modality to query an information system for
procedure information. The Technical Framework defines
an explicit mapping from the data in the HL7 ORM message
to the data supplied in the DICOM query response by the
information system. This consistent mapping should
provide for smoother systems integration between commer-
cial Radiology Information System and Modalities.
1.5. IHE Integration Profiles
IHE Integration Profiles provide a common language for
purchasers and vendors to discuss integration needs of
healthcare enterprises and the integration capabilities of
products. They are particularly useful for writing the
integration portions of purchasing specifications. The goal
for most healthcare organizations is to implement practical
capabilities such as distributed access to diagnostic images
or smooth departmental workflow. Integration Profiles
allow communication about those high-level capabilities
while referencing the underlying technical precision
necessary to make them work. They give purchasers a tool
that reduces the difficulty, cost and anxiety associated with
implementing integrated systems.
IHE Integration Profiles organize and leverage the
integration capabilities that can be achieved by coordinated
implementation of communication standards. They do not
replace conformance to standards, and users are encouraged
to continue to request that vendors provide statements of
their conformance to relevant standards, such as DICOM
and HL7. Integration Profiles rather provide a more precise
definition of how standards are implemented. This
implementation of standards is supported by the industry
partners involved in the initiative, carefully documented,
reviewed and tested in circumstances where multi-vendor
integration must be achieved in a tightly compressed time
frame.
Each of the ten Integration Profiles defined by IHE thus
far addresses a specific information management problem to
answer a specific clinical need.
1.6. Scheduled workflow
The scheduled workflow (Fig. 5) Integration Profiles
establishes a seamless flow of information that supports
efficient patient care workflow in a typical imaging
encounter. It specifies transactions that maintain the
consistency of patient information from registration through
ordering, scheduling, imaging acquisition, storage and
viewing. This consistency is also the foundation for
subsequent workflow steps, such as reporting. Systems
involved in this profile are
† Enterprise-wide information systems that manage patient
registration and services ordering (i.e. admit–discharge–
transfer (ADT)/registration system and HIS.
† Radiology departmental information systems that man-
age department scheduling (i.e. radiology information
system (RIS))and image management/archiving (i.e.
picture archiving and communication system (PACS)).
† Acquisition modalities.
1.7. Patient information reconciliation (Fig. 6)
This Integration Profiles extends Scheduled Workflow by
providing the means to match images acquired for an
unidentified patient (for example, during a trauma case)
with the patient’s registration and order history. In the
example of the trauma case, this allows subsequent
reconciliation of the patient record with images acquired
Fig. 3. Sample IHE use-case diagram.
Fig. 4. Sample IHE interaction diagram.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146140
(either without a prior registration or under a generic
registration) before the patient’s identity could be deter-
mined. Enabling this after-the-fact matching greatly sim-
plifies these exception-handling situations. Systems
involved in this Integration Profiles are
† Enterprise-wide information systems that manage patient
registration and services ordering (ADT/registration
system, HIS).
† Radiology departmental information systems that man-
age department scheduling (RIS) and image manage-
ment/archiving (PACS).
† Acquisition modalities.
1.8. Consistent presentation of images (CPI)
The CPI Integration Profiles (Fig. 7) specifies a number
of transactions that maintain the consistency of presentation
for grayscale images and their presentation state infor-
mation (including user annotations, shutters, flip/rotate,
display area, and zoom). It also defines a standard contrast
curve, the Grayscale Standard Display Function, against
which different types of display and hardcopy output
devices can be calibrated. Thus it supports hardcopy,
softcopy and mixed environments.
The systems included in this profile are hospital-wide
and radiology-department image rendering systems such as
Fig. 5. Scheduled workflow.
Fig. 6. Patient information reconciliation.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146 141
† Review or diagnostic image softcopy display stations
(stand-alone or integrated with a HIS, RIS or PACS).
† Image management and archiving systems (PACS).
† Hardcopy image producing systems on various media
such as film or paper.
† Acquisition modalities.
1.9. Presentation of grouped procedures (PGP)
The PGP Integration Profiles (Fig. 8) addresses the
complex information management problems entailed when
information for multiple procedures is obtained in a single
acquisition step (for example CT of the chest, abdomen and
pelvis). PGP provides the ability to view image subsets
resulting from a single acquisition and relate each image
subset to a different requested procedure. A single acquired
image sets produced, but the combined use of scheduled
workflow and consistent presentation of images transactions
allows separate viewing and interpretation of the subset of
images related to each requested procedure. Among other
benefits, this allows generating reports that match local
billing policies without additional intervention.
The PGP Integration Profiles extends the Scheduled
Workflow Integration Profiles and the Consistent Presen-
tation of Images Integration Profiles. Systems involved
include
† Acquisition modalities.
† Image management and archiving systems (PACS).
† Radiology departmental information systems that man-
age department scheduling (RIS).
† Diagnostic image softcopy display stations (integrated
with a RIS or a PACS).
1.10. Access to radiology information
The access to Radiology Information Integration Profile
(Fig. 9) specifies support of a number of query transactions
providing access to radiology information, including images
and related reports. Such access is useful both to the
radiology department and to other departments such as
pathology, surgery and oncology. Non-radiology infor-
mation (such as lab reports) may also be accessed if made
available in DICOM format.
This profile includes both enterprise-wide and radiology-
department imaging and reporting systems such as
† Review or diagnostics image softcopy display stations
(stand-alone or integrated with a HIS, RIS, PACS or
Modality).
† Reporting stations (stand-alone or integrated with a HIS,
RIS, PACS or Modality).
† Image management and archiving systems (PACS).
† Report repositories (stand-alone or integrated with a HIS,
RIS or PACS).
1.11. Key image note
The Key Image Note Integration Profile (Fig. 10)
specifies a transaction that enables a user to flag as
Fig. 7. Consistent presentation of images.
Fig. 8. Presentation of grouped procedures.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146142
significant one or more images in a study by referencing
them in a note linked with the study. This note includes a
title stating the purpose of the flagged images and a user
comment field. These notes will be properly stored, archived
and displayed as the images move among systems that
support the profile. Physicians may attach key image notes
to images for a variety of purposes: referring physician
access, teaching files selection, consultation with other
departments, and image quality issues, to name a few.
This Integration Profiles includes both the department
imaging systems and the hospital-wide image distribution
such as
† Review or diagnostics image softcopy display stations
(stand-alone or integrated with a HIS, RIS, PACS or
modality).
† Image management and archiving systems (PACS).
† Acquisition modalities.
1.12. Simple image and numeric report
The simple Image And Numeric Report Integration
Profiles (Fig. 11) facilitates the growing use of digital
dictation, voice recognition, and specialized reporting
packages, by separating the functions of reporting into
discrete actors for creation, management, storage and
viewing. Separating these functions while defining trans-
actions to exchange the reports between them enables a
vendor to include one or more of these functions in an actual
system.
The reports exchanged have a simple structure: a title; an
observation context; and one or more sections each with
Fig. 9. Access to Radiology Information.
Fig. 10. Key image note.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146 143
a heading, text, image references, and, optionally, coded
measurements. Some elements can also be coded to
facilitate computer searches. Such reports can be input to
the formal radiology report, thus avoiding reentry of
information.
This Integration Profile involves both the department
imaging and reporting systems and the hospital-wide
information systems such as
† Review or diagnostics image softcopy display stations
(stand-alone or integrated with a HIS, RIS, PACS or
Modality).
† Reporting stations (stand-alone or integrated with a HIS,
RIS, PACS or Modality).
† Report management systems (standalone or integrated
with a HIS, RIS, PACS or Modality).
† Report repositories (stand-alone or integrated with a HIS,
RIS or PACS).
1.13. Basic security (SEC)
The Basic Security Integration Profiles establishes
security measures which, together with the Security
Policy and Procedures of the enterprise, provide patient
information confidentiality, data integrity and user
accountability. The goals of the Basic Security Inte-
gration Profile are
1. User accountability. To allow security officer in an
institution to audit activities, to detect non-compliant
behavior in the enterprise, and to facilitate detection of
improper creation, access, modification and deletion of
protected health information (PHI). PHI is considered to be
the information records (Registration, Order, Study/Proce-
dure, Reports and to a lesser degree Images/Presentation
States), not the flow of information (IHE transactions)
between the systems. This includes information exported to
and imported from every secured node in the ‘secured
domain’.
The audit trail contains information so that questions can
be answered such as
† For some user: which patients’ PHI was accessed.
† For some patient PHI: which users accessed it.
† What failed user authentication.
† What failed node authentication.
2. Access control. To limit access to all ‘secured nodes’
in a ‘secured domain’ (defined as a set of cross-connected
secured nodes) to ‘authorized users’.
3. Centralized audit record repository. To provide
central Audit Record repository as the simplest means to
implement security requirements. An immediate transfer
of Audit Records from all the IHE Actors to the Audit
Record repository is required, reducing the opportunities
for tampering and making it easier to audit the
department.
4. PHI data integrity. To allow tracking of the life of PHI
information (creation, modification, deletion and location).
The key features of the Basic Security Integration Profile
are the following
† Authentication of the user.
† Authentication of the node.
† Audit record generation.
1.14. Charge posting (CHG)
The Charge Posting Integration Profile specifies infor-
mation exchange from the Department System Scheduler/
Order Filler to the Charge Processor about charges
associated with particular procedures, as well as communi-
cation about patient demographics, accounts, insurance, and
guarantors between ADT Patient Registration and Charge
Processor. The Charge Posted Transaction contains some
information to generate a claim. Currently, these interfaces
contain fixed field formatted or HL7-like data. The goal of
including this in the IHE Technical Framework is to
standardize interface between clinical systems and the
Charge Processors. Additionally, the Charge Posted Trans-
action reduces the need of the billing system to have
knowledge of the radiology internals. The result is that the
Charge Processor will receive more complete, timely and
accurate data.
Fig. 11. Sample simple image and numeric report.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146144
The Department System Scheduler/Order Filler indicates
to the Charge Processor that procedures are available for
TECHNical and/or Professional Billing. The Charge Posted
transaction may occur at various times in the workflow.
Regulations and site operating procedures determine when a
procedure is eligible for Charge Posting. Often, the events
are different for technical and professional charges. Techni-
cal charges are typically eligible at procedure completion.
Professional charges are typically eligible at result
verification.
1.15. Post-processing workflow (PWF)
The PFW Integration Profile addresses the need to
schedule and track the status of the typical PFW steps, such
as Computer Aided Detection or Image Processing. Work-
lists for each of these tasks are generated and can be queried,
work items can be selected and the resulting status returned
from the system performing the work to the system
managing the work. Typically the workitems will involve
the creation of objects such as images and evidence
documents. The created images and evidence documents
contain the necessary references for maintaining continuity
of order information.
The PFW Integration Profiles is a continuation of the
Scheduled Workflow Integration Profiles.
1.16. Implementation testing
The testing phase of the IHE demonstration process takes
place in two stages. The first round is performed with a set
of software tools called medical enterprise simulators and
analyzers (MESA), developed by the Technical Project
Management team with funding from HIMSS and RSNA.
Participating vendors use the tools to test their implemen-
tation of IHE Actors. The tools simulate the exchange of
messages with complementary Actors and analyze discre-
pancies between the vendor’s implementation and the
transactions defined in the Technical Framework. Success-
ful completion of these tests is a mandatory part of the IHE
process. While not exhaustive, the MESA tests indicate a
substantial baseline of success in implementing IHE
transactions.
The second round is a face-to-face testing event dubbed
the ‘Connectathon’, which takes place several weeks before
the actual demonstration. The event allows for broad
interoperability testing among all participating vendors
and systems. Vendors are given the opportunity to test with
all participating complementary Actors. Successful results
are recorded and documented. This information becomes
one of the most publicized aspects of the IHE process,
providing a significant incentive for vendors to work out any
remaining incompatibilities and successfully complete
interoperability testing.
As a practical matter, the vendors who attend the
Connectathon find the scheduled and unscheduled cross
vendor testing of great importance. The engineers who staff
the equipment have the opportunity to test with a large
number of other systems in a short time. In this environment
controlled by the HIMSS and RSNA professional organiz-
ations, the vendors have a chance to test with potential
partners in a non-competitive setting. Time is spent solving
issues rather than trying to convince a customer that one
product is correct while another product is not.
Each Connectathon event has included between 24 and
35 vendors testing a total of between 40 and 75 systems. In
the 5 days of the Connectathon, using the transactions
defined in the IHE Technical Framework, the participating
vendors set up, configure, integrate, and test their systems.
In all, hundreds of vendor-to-vendor connections are tested
and thousands of transactions passed among the systems
present.
The Connectathon offers vendors a unique opportunity
for connectivity testing—removing barriers to integration
that would otherwise have to be dealt with on site, at the
client’s expense. Companies taking part have responded
overwhelmingly that the IHE process addresses important
issues in their product development plans.
1.17. Public exhibitions and education
The effort to increase market awareness of the integration
capabilities available under IHE (and thereby stimulate
demand for this functionality) has involved a series of
public demonstrations at the annual HIMSS and RSNA
conferences [3]. For the first 3 years of the initiative, these
public forums have featured actual systems from a broad
array of vendors performing all of the IHE transactions,
Actors and Integration Profiles. No simulators were used in
these demonstrations. This combination has been highly
successful in establishing recognition of IHE in the
healthcare community, and providing evidence of its
accomplishments, as evidenced both by the broad and
continuing support of industry and by the high level of
recognition of the IHE project in the medical imaging and
informatics community.
Having achieved this initial progress as a demonstration
project, IHE has now shifted its focus to driving the
implementation of IHE functionality in commercial pro-
ducts and healthcare institutions. This involves implement-
ing an enhanced testing process and developing better tools
for purchasers and vendors to use in communicating about
the integration capabilities of commercial products.
Educational sessions about IHE at the HIMSS and RSNA
annual meetings will target specific groups of interested
parties (e.g. clinicians, administrators, information technol-
ogists, developers and consultants) and provide detailed
information about the clinical and operational benefits of
systems integration and instructions on how to acquire
integrated systems.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146 145
1.18. Expansion and evolution
IHE was started—and continues to be sponsored—by
two professional societies whose membership is in the
imaging and IT domains. The professional and industry
experts have been able to attract into the process have
proven successful in addressing systems integration issues
within the radiology department.
The procedural model they have developed for solving
system integration issues would seem equally applicable to
other domains. Certain of the functions they have worked to
implement using established standards, such as patient
registration and ordering, also could address problems
encountered in other domains. These functions could
potentially provide building blocks for an enterprise-wide
information technology infrastructure, if sufficient represen-
tation of all the stakeholders involved could be brought
together. HIMSS and RSNA have been in communication
with professional societies in other domains to encourage
them to join in broadening the initiative.
An important step towards the expansion of IHE into a
truly multi-disciplinary effort began with the formation of the
IHE Strategic Development Committee in September 2001.
This committee consists of representatives from multiple
clinical and operational domains. Its task is to begin defining
the key integration issues within and among these domains
and populating additional committees of professionals and
industry experts to explore solutions. The domains initially
targeted by the committee are: Cardiology, Laboratory,
Pharmacy/Medication Administration, and Interdepartmen-
tal Information Sharing. Work to identify key problems and
expertise in these domains has progressed significantly.
Meanwhile, IHE has expanded internationally, as well.
IHE demonstrations have taken place or are scheduled in
several European countries and Japan. A process has been
put in place to enable all of the nationally based IHE
initiatives to contribute to a global Technical Framework.
Provision has been made to document nationally based
differences stemming from healthcare policies and typical
practices, while at the same time seeking the highest
possible level of uniformity in the recording and exchange
of medical information.
Achieving successful integration within other units of the
enterprise, and establishing a broader set of information
links between departments, will depend on the willingness
of professionals and industry sectors representing these
domains to become engaged in the IHE process. The evident
success of this process in the radiology domain should
provide persuasive evidence that they have much to gain in
doing so.
2. Summary
While the development of messaging standards for
sharing patient information in healthcare is now well
advanced, the implementation of closely integrated systems
using these standards lags far behind. IHE initiative is a
combined effort of the medical professions and healthcare
information and imaging technology industry to coordinate
the implementation of standards for systems integration.
The authors discuss the process used by IHE to gain
consensus among professionals and industry on integration
priorities and solutions; the way information is structured in
the guide for implementing standards developed by the IHE
committees, the IHE Technical Framework; the tools IHE
has made available to help administrators implement
integrated systems, including the ten IHE Integration
Profiles; and the possible future expansion of IHE across
the many domains and departments comprising the
healthcare enterprise.
References
[1] Crossing the Quality Chasm. A New Health System for the 21st
Century, The National Academy of Sciences, 2000.
[2] Eliot L, Siegel MD, David S, Channin MD, et al. IHE primer.
Radiographics 2001;21:1339–41. see also pages1343–1350, 1351–
1358, 1597–1603.
[3] Integrating the Healthcare Enterprise (HIMSS Target Issues Mono-
graph), edited by by Paul R. Vegoda, FHIMSS, HIMSS 2001.
Christopher D. Carr is Director of Informatics for the Radiological
Society of North America (RSNA). While in graduate school in the
humanities, he became involved in projects creating electronically
enhanced texts. He came to RSNA in 1997 as a manager in the
publications department, responsible for launching the electronic
versions of RSNA’s journals, RadioGraphics and Radiology. In his
current position at RSNA, he is responsible for the Society’s Web
initiatives and several special informatics projects, including serving as
staff liaison to the Integrating the Healthcare Enterprise (IHE)
initiative.
Stephen M. Moore, MS, is Assistant Professor of Radiology at the
Mallinckrodt Institute of Radiology, St Louis, MO. His main interests
are in imaging informatics and system integration of radiology
operation.
C.D. Carr, S.M. Moore / Computerized Medical Imaging and Graphics 27 (2003) 137–146146