Integrating the Healthcare Enterprise Connects IT Systems

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IHE initiative seeks to facilitate the interconnectivity of the multi-vendor systems that are commonly found in the cardiovascular environment.

In the beginning, the development and deployment of cardiology information technology took place on a case-by-case basis. Interoperability of these systems was narrowly confined to the originating department where the implementation took place. When other departments within the institution sought access to the clinical data, it quickly became apparent that these systems had become proprietary information silos unable to efficiently or effectively communicate with one another.

Cardiology informatics vendors and stakeholders, recognizing the critical need to deliver cardiac data and images throughout the healthcare continuum, turned to the Integrating the Healthcare Enterprise (IHE) initiative to craft an interoperability solution.

The IHE cardiology domain was initiated in 2003 by the American College of Cardiology, the American Society of Echocardiography, the American Society of Nuclear Cardiology, the Society for Cardiovascular Angiography and Interventions, and the European Society of Cardiology to focus on the integration of information within the cardiology department.

The IHE, originally developed with the joint support of the Radiology Society of North America and the Healthcare Information and Management Systems Society, is tasked with creating the framework for passing vital health information seamlessly—from application to application, system to system, and setting to setting—across multiple healthcare enterprises.

The IHE does not create standards, but rather Integration Profiles that drive the adoption of existing standards for meeting specific clinical needs. These profiles describe clinical information management use cases and specify how to use standards, such as DICOM or HL7, to address them.

Each profile assigns specific requirements to specific actors, defined in terms of its primary responsibility, that are responsible for producing, managing or acting on information in the context of the profile. Simply put, an actor is what a user (or another system) interacts with.

Recognizing that it’s not sufficient merely to publish Integration Profiles, the IHE created a forum in which healthcare informatics vendors could test their technology with profile and actor (system) compliance as well as its interoperability with other developers’ products. These events—called Connectathons—are held annually in North America and Europe and intermittently in Asia.
 

 
 Robert Baumgartner

For vendors of cardiology information systems, these profiles act as implementation guides. For the cardiology providers that wish to deploy these systems, the profiles provide a basis for integration requirements in their purchasing contracts.

The IHE cardiology domain, now in Year 5, has developed a clutch of profiles that have been adopted by cardiac information systems vendors. Cardiovascular Business recently spoke with Robert Baumgartner, director of product marketing for McKesson’s medical imaging group and administrative co-chair of the IHE Cardiology Planning Committee, on the status and future of the domain.


How is the IHE cardiology committee structured?


There are actually two primary committees: Planning and Technical. The Planning Committee is just that; it looks at new profiles as well as the marketing of the profiles and education. This committee is composed of a number of cardiologists and vendor representatives (who are predominantly from product management).

The Technical Committee works through the technical aspects of the profile and is comprised predominately of vendor technical-resource members as well as cardiologists, who ensure the clinical accuracy of the profile.


What is the current status of the IHE cardiology domain?


IHE Cardiology has a number of profiles that have been developed over the past four years, such as:

  • Cardiac Cath Workflow (CATH): Integrates ordering, scheduling, imaging acquisition, storage and viewing for cardiac catheterization procedures.
  • Echocardiography Workflow (ECHO): Integrates ordering, scheduling, imaging acquisition, storage and viewing for digital echocardiography.
  • Retrieve ECG for Display (ECG): Provides access throughout the enterprise to electrocardiogram documents for review purposes.
  • Evidence Documents (ED): Adds cardiology-specific options to the radiology ED profile.
  • Implantable Device Cardiac Observation (IDCO): Specifies the creation, transmission, and processing of discrete data elements and report attachments associated with cardiac device interrogations (observations) or messages.
  • Stress Testing Workflow (STRESS): Provides ordering and collecting multi-modality data during diagnostic stress testing procedures.
  • Displayable Reports (DRPT): Distributes “display ready” (using the portable document file, or PDF, standard) cardiology clinical reports from the department to the healthcare enterprise.

How long have these profiles been under development?



Cardiology has been a committee for almost five years with the first profiles released in 2004 and tested at the 2005 North America Connectathon.


What is the importance of these profiles for the vendor?


Adoption of the profiles allows a company to identify a common interface for all vendors. This decreases the costs of implementation and development of company-specific interfaces.


What is the importance of these profiles for the end-user?


The cardiology profiles are workflow-oriented and are built around real-world cases and issues. The profiles are designed to facilitate the interconnectivity of the multi-vendor deployment that is commonly found in the cardiovascular environment. This not only improves the workflow for the hospital, but since IHE provides a standard methodology for this connectivity, it decreases the costs and proprietary nature of informatics interfaces.


Is it prudent for end-users to include compliance with these profiles in cardiology information system requests for proposals?


We have put a lot of effort into demonstrating how clinical customers can use the IHE cardiology profiles in their requests for proposals from informatics vendors. We have a number of white papers, available online (see list above), that can help guide interoperability requirements.


What cardiology profiles are under development?


As Year 5 unfolds, we’re working on an Image Enabled Office Profile, an ECG Workflow Profile, and are crafting a major revision to the Implanted Device Cardiac Observations (IDCO) Profile.


We understand that the ACC has announced it will no longer be the primary sponsor of the cardiology domain. How will this affect the work of the IHE cardiology committees?


The actual impact of this decision still is somewhat uncertain; but it will most likely result in a slowing of efforts within the cardiology domain. The Planning Committee has been actively recruiting funding from the various cardiovascular societies, but given today’s tight budget cycles, this funding has been hard to find.

 

Resources for further information
IHE Cardiology 2005-2007 White Papers – a source for more detailed information regarding the implementation of IHE Cardiology Profiles
http://www.ihe.net/Cardiology/committees/index.cfm

IHE Cardiology Technical Framework – a site for the publication of cardiology IHE technical documents
http://www.ihe.net/Technical_Framework/index.cfm#cardiology

IHE Connectathon Results – a site for viewing IHE interoperability testing results by vendor, profile or actor
http://ihe.univ-rennes1.fr/con_result/

IHE Wiki – a collaborative site for the creation of IHE materials
http://wiki.ihe.net/index.php?title=Main_Page