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Integrating the Healthcare Enterprise: A Primer

Part 5. The Future of IHE¹

¹ From the Department of Radiology, Northwestern University Medical Center, 448 E Ontario St, Suite 300, Chicago, IL 60611 (D.S.C.); Department of Diagnostic Imaging, University of Maryland School of Medicine, Baltimore (E.L.S.); Department of Informatics, Radiological Society of North America, Oak Brook, Ill (C.C.); and Department of Professional Services, Healthcare Information and Management Systems Society, Chicago, Ill (J.S.). Received August 24, 2001; accepted August 29. Address correspondence to D.S.C. (e-mail: dsc@radiology.northwestern.edu).

Index Terms: Information management • Radiology and radiologists, departmental management

	Introduction

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
The future of Integrating the Healthcare Enterprise (IHE) is you. All who are interested in advancing integration of healthcare information to improve patient care are welcome to participate in the IHE initiative. In particular, the stakeholders identified in a previous primer article (1)—the department chief or chairman, department manager or administrator, technologist, radiologist, nonradiologist clinician, chief information officer, imaging information system vendor, and nonimaging information system vendor—should actively participate in IHE efforts. In this article, we review the structure of the IHE initiative, educational opportunities, the Year 3 demonstration, and how to specify and purchase IHE functionality. We also suggest other ways for the stakeholders in medical informatics to participate.

	Structure of the IHE Initiative

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
The IHE initiative is organized into a set of committees, each of which has been given a specific role to play in making the initiative a success. The initiative is directed by an executive committee made up of senior members and senior staff members of the two (to date) sponsoring professional societies of the IHE, namely the Radiological Society of North America (RSNA) and the Healthcare Information and Management Systems Society (HIMSS).

If you are a member or senior staff member of a professional healthcare-related society, you should be lobbying your society to become a sponsoring society of the IHE. Although there is a small financial burden to becoming a sponsoring society, there is a potential for a tremendous return on investment as the IHE expands to meet the particular needs of your society and its membership. Studying the lessons learned from the radiology examples and experience documented in these primer articles (1), as well as other reports, should help you identify analogous problem areas in your domain that could be addressed by expansion of the IHE initiative.

The IHE Executive Committee directs the Strategic Development Committee. This recently constituted committee consists of clinical and clinical informatics experts from radiology, pathology, nursing, and internal medicine. There are also technical representatives from the Electronic Communications Committee of the RSNA and the IHE Special Interest Group. The latter represents chief information officers of major healthcare institutions. The emeritus chairs of the IHE planning committee are also included. Staff from the RSNA and HIMSS round out the committee. The committee is charged with identifying steps in patient care work flow, recommending priorities of clinical and operational domains for IHE consideration, identifying integration needs and barriers (problems and solutions) within and across domains, and lastly, helping to populate the domain planning committees.

The domain planning committees (of which there is currently one [radiology] with others in formation) are responsible for filtering the problem and solution sets from the Strategic Development Committee down to those sets that can realistically be addressed by IHE. These committees consist of vendors and domain experts (eg, system users, administrators, hospital information system experts), and they direct parallel technical committees to develop the solutions identified.

The technical committees are typically, although not exclusively, made up of vendor experts. These experts are the unsung heroes of the IHE effort. These individuals spend (and their companies generously sponsor) an inordinate amount of time delving into the nitty-gritty detail of the integration to ensure that it works.

Last, and certainly not least, the IHE initiative has a technical project manager, Dr Steven Moore of the Mallinckrodt Institute of Radiology at Washington University in St Louis, Missouri. Dr Moore and his team, working under subcontract from the RSNA and HIMSS, develop the test software used by participants in the IHE connect-a-thon and demonstrations and manage these events. The software for the current year is available to only current participants in the connect-a-thon and demonstration. The small charge to participate is typically trivial in comparison to the value of the knowledge gained by the vendor, the value of participation in the connect-a-thon, and the value to the vendor’s products in complying with the IHE technical framework. The software used in previous years’ demonstrations is available at no charge to the general public from the IHE Web site, www.rsna.org/IHE.

	Educational Resources

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
There are numerous IHE educational resources. In addition to the demonstrations and workshops at the annual meetings of both RSNA and HIMSS, there are presentations and sessions on IHE-related topics at many medical and medical informatics meetings held throughout the year.

In addition to the current RadioGraphics series of primer articles (in the September-October 2001 and November-December 2001 issues), the IHE Web site (www.rsna.org/IHE) has numerous other documents and PowerPoint presentations that can be used as educational materials. This Web site is also home to the latest revision of the IHE technical framework (2), although some might consider the framework to be graduate-level educational material. An IHE presentation is available through the HIMSS Web University at www.himss.org. In addition, an IHE monograph of relevant articles describing IHE functionality, solutions, and future directions will be published by HIMSS in early 2002.

	Year 3 Demonstration: RSNA 2001 and HIMSS 2002

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
After participating in the connect-a-thon in early fall 2001, vendors will gather for public demonstrations of IHE integration at both the annual meeting of the RSNA (November 25–30, 2001) and the annual meeting of HIMSS (January 27–31, 2002). After 2 years of rapidly expanding integration capabilities, the IHE committees designated Year 3 as a consolidation period: a time to educate users about the solutions that IHE has made available to improve patient care, while these enhancements simultaneously become broadly available in commercial products. For Year 3, the vendor demonstrations were redesigned to communicate the clinical benefits available through IHE and how to obtain them. The demonstration groupings will be organized by the seven IHE integration profiles (3): Scheduled Work Flow, Patient Information Reconciliation, Consistent Presentation of Images, Presentation of Grouped Procedures, Access to Radiology Information, Key Image Note, and Simple Image and Numeric Reports. These integration profiles are discrete blocks of integration capability that provide specific enhancements to clinical practice. Attendees at the demonstrations will be guided through the full sequence of integration profiles.

The demonstrations will be supplemented with educational workshops targeted to the specific need of clinicians, information technology and radiology administrators, systems implementers, and technical support staff. Of particular interest will be sessions on clinical problems and solutions, with use of IHE to acquire integrated systems, and on user perspectives from clinicians and administrators whose institutions have implemented IHE functionality. A kiosk that features an interactive video highlighting the IHE initiative will also be available.

A full schedule of the demonstrations and educational workshops at the RSNA annual meeting can be found at www.rsna.org/IHE/ihedemo2001/. A similar schedule for the IHE demonstration and related events at the HIMSS annual meeting can be found at www.himss.org.

Professional societies and other organizations interested in incorporating components of the demonstrations, workshops, and other presentations into their societal events should contact representatives of the IHE initiative (see below). A miniature speaker’s bureau is available, and there are numerous IHE experts available to speak at other meetings.

	How to Specify and Purchase IHE Functionality

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
Anyone involved in making information system purchasing decisions at healthcare institutions should be well aware of the IHE initiative, the IHE information model, and the integration profiles. A specific document, "IHE Profiles: Guidelines for Buyers," is available from the RSNA Web site.

The IHE technical framework is a revision-controlled document that can be incorporated by reference into legal contracts. Although typically a purchase contract requires that equipment or services conform to standards, the contract can also specify compliance with the IHE technical framework. Thus, one can specify conformance to the HL7 and DICOM standards and additionally require compliance with the IHE technical framework.

The role of radiology executives, radiology department administrators, and senior management in advancing the efforts of IHE by specifying IHE compliance (and DICOM and HL7 conformance) in purchase contracts cannot be underestimated. Although altruistic to a point, most healthcare information system vendors are driven by marketing and sales organizations. Vendor engineering groups typically receive significant direction and guidance from these groups. If IHE compliance and adherence to standards is not loudly and clearly communicated as being of great importance to the user community, future IHE engineering efforts may be diluted by perceived need to develop other functionality.

Vendors, on the other hand, will be thrilled to receive uniform, loud and clear feedback from their customers, especially when it leads to significant overall improvement in their products; lowers the complexity (and therefore cost) of their interface development, deployment, and support; and allows them to operate in a larger arena of integrated heterogeneous systems.

An important note to buyers: Beware the notion of purchasing a system that conforms to standards (notably DICOM) and complies with IHE, yet in which these functionalities are not "turned on" or in which "turning on" these functionalities requires an additional cost. IHE, DICOM, and HL7 functionality should be on and running when the system is installed and should be included in the base price of the system.

	Future Directions

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
The IHE Strategic Development Committee is, as charged, expanding the model of integrated, scheduled work flow to include more patient care work flow processes. As new areas of integration problems between information systems are identified, the committee will use the concept of integration profiles to address them. The committee is currently looking at pathology work flow, and at such enterprise-wide integration frustrations as desktop integration, security (in light of forthcoming HIPAA [Health Insurance Portability and Accountability Act] requirements), and electronic master patient index issues. Other suggestions for future directions of IHE efforts are welcome.

	How to Contact the IHE

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
To learn more about IHE, please visit the IHE Web site at www.rsna.org/IHE or search for the term IHE at www.himss.org. To participate in IHE at any level, you should contact either Joyce Sensmeier, Director of Professional Services, IHE Coordinator, Healthcare Information and Management Systems Society (HIMSS), 230 E Ohio St, Suite 500, Chicago, IL 60611-3269, or Christopher Carr, Director of Informatics, IHE Coordinator, Radiological Society of North America (RSNA), 820 Jorie Blvd, Oak Brook, IL 60523.

Comments, questions, concerns, and ideas can be sent to the addresses above or electronically to IHE@rsna.org.

	Call to Action

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 
Anyone interested in realizing the dream of having all relevant patient information available to all care providers on demand at the point of care while concomitantly reducing errors, reducing costs, and increasing efficiency should be interested in the IHE initiative and its future.

Chairmen should be studying the work flow in their departments and identifying new ways that IHE can assist them in improving these work flows by better integration of information. They should identify clinicians in their departments with technical backgrounds or interests and encourage and support them in participating in IHE committees. They should encourage students and residents in their departments to recognize healthcare informatics as a legitimate area of research so as to foster the next generation of clinicians capable of further advancing medical informatics technology. Together with department administrators and senior institution management including chief information officers, they should require standards conformance and IHE compliance in all relevant purchases.

Similarly, department administrators should constantly look for work-flow problems in their departments that IHE efforts could possibly remedy. These suggestions should be forwarded to the IHE committees. As stated, administrators should demand IHE compliance and standards conformance in all purchases. When purchasing new equipment, they should consider not only the chemistry or physics and functionality of the device but make a special effort to consider its informatics and how it fits into the work flow of and communicates with other systems in the department or institution.

In the trenches, technologists, radiologists, and clinicians should be documenting information and work-flow problems they encounter in daily practice. These problems should be forwarded to the IHE committees. These individuals should not be intimidated by a lack of technical expertise (remember, you don’t need to know how to forge iron to use a hammer): The IHE initiative needs to identify clinically relevant problems to solve, and you can help. You should become active in your professional societies, and if they are not participants in the IHE initiative, lobby them to join. You can also participate directly in the IHE committees. It is extremely interesting, educational, rewarding, and even fun to participate in these efforts. It is especially rewarding to see the rapid incorporation of IHE efforts into real-world products and the immediate benefit of IHE technology in the clinical workplace.

Chief information officers and others in senior management should lobby their professional societies to join the IHE initiative. They should insist that all their information system vendors participate in the IHE effort, not just those involved in departmental or specialty systems. There can no longer be islands of information in a healthcare enterprise. All information systems must work synergistically to get the job of delivering optimal healthcare done.

Any vendor of a device that contains a computer of any sort should become involved in standards bodies related to their domain. In addition, they should participate in the IHE initiative and encourage the inclusion of the appropriate standards from their domain in the IHE toolbox.

There is a role for everyone in integrating the healthcare enterprise. Got IHE?

	Footnotes

 
Abbreviations: DICOM = Digital Imaging and Communications in Medicine, HIMSS = Healthcare Information and Management Systems Society, HL7 = Health Level Seven, IHE = Integrating the Healthcare Enterprise

	References

Top Introduction Structure of the IHE... Educational Resources Year 3 Demonstration: RSNA... How to Specify and... Future Directions How to Contact the... Call to Action References

 

1. Channin DS, Parisot C, Wanchoo V, Leontiev A, Siegel EL. Integrating the healthcare enterprise: a primer. III. What does IHE do for me? RadioGraphics 2001; 21:1351-1358.
2. Radiological Society of North America/Healthcare Information and Management Systems Society. IHE technical framework, year 3, version 4.6 Oak Brook, Ill: RSNA, March 2001.
3. Channin DS. Integrating the healthcare enterprise: a primer. II. Seven brides for seven brothers: the IHE integration profiles. RadioGraphics 2001; 21:1343-1350.

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