Kathleen M. Dallessio
The Integrating the Healthcare Enterprise (IHE) Year 3
Demonstration focused on workflow integration and solidifying the
advances made in the first two years. Specifically, most of this
year's presentations focused on the seven Integration Profiles and
how to use the IHE framework in "the real world." Presentations on
and demonstrations of the use of hand-held computers added a new
element to this IHE demonstration.
Background
The IHE initiative was launched jointly by the Radiological
Society of North America (RSNA) and the Healthcare Information and
Management Systems Society (HIMSS) in November 1998, with the
stated goal of speeding up integration in the healthcare
environment, fostering communication between vendors and medical
information technology specialists, and proving that
standards-based integration is attainable. Each year since then, a
demonstration of the year's accomplishments has been presented at
the RSNA and HIMSS annual meetings.
In 1999, the Year 1 demonstration addressed the initial
functional system architecture and integrated radiology and
hospital information systems; particularly patient registration,
order entry and scheduling, and image communications including
image acquisition, storage, and retrieval. The Year 2 demonstration
in 2000 highlighted additional radiology transactions and some
interdepartmental communications. Areas covered included expanded
access of radiology images and reports distributed within the
radiology department as well as to other departments, access to
non-radiology information (such as laboratory reports), patient
information reconciliation, consistency of image presentation, and
report management.
The Year 3 demonstration was designed to consolidate the
advances made in Years 1 and 2 and to help drive IHE standards into
real-world implementation. According to Christopher Carr, director
of informatics at RSNA, the goal was to allow the "marketplace and
the institutional base to absorb" some of the initiative that had
been presented in prior years and to "let vendors build it into
their products and get them into the market."
Year 3 demonstration
As always, the demonstration began with the Connectathon, a
week-long event held in October at the RSNA national headquarters
in Oak Brook, IL. This Connectathon included more than 30 companies
and 72 separate systems. Using the IHE Technical Framework,
participants set up, configured, integrated, and tested systems,
employing hundreds of connections and thousands of
transactions.
The integrated system presented at RSNA 2001 in Chicago in
November and at the HIMSS meeting in Atlanta in January 2002 was
used to demonstrate the seven Integration Profiles that describe
the flow of information from registration to reporting.
These profiles, as described in a presentation entitled "IHE
Integration Profiles" by John Perry of Hampshire, IL, are:
*
Scheduled Workflow Profile
: the foundation of integration work, providing the ability of
basic data consistency between enterprise-wide (Hospital
Information Systems [HIS]) and departmental systems (Radiology
Information Systems [RIS] and Picture Archiving and Communications
Systems [PACS]) throughout the imaging order process;
*
Patient Information Reconciliation Profile:
reconciles information between HIS, RIS, and PACS with minimal data
entry; also supports the handling of data related to unidentified
patients ("John Does");
*
Consistent Presentation of Images Profile:
provides for consistency of image presentation on all formats
(i.e., film versus digital) and at each workstation;
*
Presentation of Grouped Procedures Profile:
addresses issues related to the presentation of a single imaging
study that satisfies multiple procedures and may require separate
interpretations;
*
Key Image Note Profile:
a mechanism to effectively communicate between different systems
information about which images are marked as important and why;
*
Simple Image and Numeric Report Profile:
supports tasks involved in the creation, management, storage, and
distribution of radiological reports that include image links and
utilize structured encoding; and
*
Access to Radiology Information Profile:
states requirements for consistent access to radiological images
and reports both within the department and throughout the
enterprise.
The role of IHE standards in purchasing
decisions
An additional goal for 2001, according to Carr, was to educate
healthcare technology buyers "so they know how to ask for these
capabilities and know why they want them and what the clinical
benefits of IHE are." To that end, the IHE suggested several
questions that should be asked when purchasing new technology (see
sidebar).
Key Questions to Ask When Purchasing New
Technology
* Which IHE "actors" (functions) does this product provide?
* Which Integration Profiles does each actor in this product
support?
* Has this product been tested at the IHE Connectathon?
* Which Integration Profiles were tested on this product at the
Connectathon?
* Is support for the IHE transactions tested at the Connectathon
included in the current version of the software of this
product?
According to the IHE, integrating information systems and using
IHE Integration Profiles when planning the purchase of new
equipment will result in increased access to information, improved
data accuracy, increased patient throughput, reduced clerical
workload, and the ability to purchase new equipment from a wide
array of vendors.
Looking forward
For Year 4, the IHE plans to continue to build vertical growth
within the systems with a focus on improving workflow and
reporting. Specifically, the group plans to develop a
general-purpose worklist designed to go beyond simple
image-acquisition and include such tasks as image review and report
generation. They also plan to address security issues, billing and
financial transactions, and error management. In Year 5, the IHE
hopes to integrate multiple clinical specialties and develop
significant information technology infrastructure features.
Hand-held computer technology
A focus on the use of hand-held computers or personal digital
assistants (PDAs) was new to the IHE sessions this year. In
addition to a demonstration area for these devices, several
presentations focused on innovative uses of this technology.
Terrence Lewis, MD, of Kalamazoo Radiology and Michigan State
University, described a method of converting HTML and text files
into an "E-Book" format for Palm OS-based PDAs using inexpensive
shareware software. The format also supports color images and
graphics. He presented the first publication, "MR Imaging of the
Brachial Plexus, Oncologic Abnormalities," which includes
approximately 37 typed pages and 21 radiologic images, including
both magnetic resonance images and nuclear medicine images.
"We used commercially available software and produced it for
commercially available hardware," reported Lewis. "The idea was to
show that the new hardware and the new software could not only
support the text, but also images."
In a second presentation, Osman Ratib, MD, PhD, of the
University of CaliforniaLos Angeles, introduced an experimental
system that uses PDAs as identification devices and navigation
tools to view images on wall-mounted flat screen panel display
units.
"It's based on a high-resolution monitor that we call a 'network
appliance,'" Ratib explained. "It's capable of getting images from
our database of images anywhere in the hospital. The PDA has a list
of your patients and a list of data. Once you select a patient you
can bring the images of that particular study on that particular
device."
He said that the system is expected to be used mostly in areas
where there is a need for rapid image display such as the emergency
department, the intensive care unit, and the cardiac care unit.
Palm OS Technology for AppointmentsPRO Scheduling
System
In other PDA news, SpectraSoft Inc. (Tempe, AZ) recently announced
the release of a Palm OS interface for its Windows-based front
office management system, AppointmentsPRO, enabling users to
download a selectable range of appointments to their Palm
OS-powered PDA.
The use of Palm OS technology allows the transfer of information
from a computer source to a PDA. To download data, or to refresh
the PDA with new information from the system, the user places the
device in its cradle and presses the hot sync button and the
information is transferred automatically.
"We are pleased to add this optional benefit to our system for
home therapists and doctors who do rounds," said Steven L. Petri,
president of SpectraSoft. "It's an easy way to make a difference in
the efficiency of a busy practice."