IHE® Connectathon Gives EHRs Momentum
This year's Integrating the Healthcare Enterprise (IHE®) Connectathon offered a glimpse of new device profiles, progress in partnerships and the promise of achieving a universal electronic health record (EHR) in the next few years.
 More than 350 individuals representing 77 vendors participated in the 2009 IHE® Connectathon, spending four days testing 126 profiles for compliance with IHE information sharing standards. |
The Connectathon, hosted by RSNA and the Healthcare Information and Management Systems Society (HIMSS) in late February in Chicago, was attended by 358 individuals representing 77 vendors who spent four days testing 126 profiles for compliance with IHE information sharing standards. "These folks are really enjoying the journey of transforming the field," said Elliot Sloane, Ph.D., assistant professor of accounting and information systems at Villanova University and co-chair of the IHE International Board.
This year's event revealed substantial growth in the patient care devices (PCD) domain and the interoperability of monitoring devices that share vital signs.
The PCD domain is more complex than sharing images, said Dr. Sloane. "Each piece of data has a temporal component to it, as well as an amplitude value," Dr. Sloane explained. Further, he said, information is often continuous—for example, from a Holter monitor that a patient wears for several days. "That enormous volume of data is what the patient care device domain is trying to organize in an interoperable sense," said Dr. Sloane. 
(Listen in as Dr. Sloane discusses PCDs at the Connectathon.)
New to the testing floor was IHE's Radiation Exposure Monitoring profile, which enables systems to monitor radiation dose and share the measurements with dose registries.
The profile sends a DICOM object from a scanner with details about examination dose, which is stored in the PACS along with the images, said Kevin O'Donnell, R&D manager of system solutions for Toshiba America MRI's Research and Development Center and a profile developer. "As often as you decide is appropriate, you can go into the PACS, pull out all those objects and create summary reports," O'Donnell said.
The profile's progress is such that he recommends purchasers ask for the IHE Radiation Exposure Monitoring profile to be included in their requests for proposals. (Listen In to learn more about the profile.)
Also this year, the Cross-Enterprise Document Sharing (XDS) profile has emerged in a new version called XDS.b. XDS.b fits in a pure Web services model, enabling systems to use tools created by major IT companies. "The interconnectivity and Web-based standards have evolved very quickly," said David S. Mendelson, M.D., an associate professor of radiology at Mount Sinai Medical Center in New York and IHE International Board co-chair. "They're more efficient, probably more secure and used by industries outside of healthcare." The XDS profile specific to medical imaging, XDS-I, is moving into the XDS.b realm and will address incompatibility issues unique to radiologic images. (Listen In to Dr. Mendelson discussing XDS.b at the Connectathon.)
Federal agencies have recognized the natural alliance in interoperability. "We have almost 3 million people a year come through our doors to apply for disability benefits and often they come in very dire circumstances," said Diane Kistler, program director of disability determination services for the U.S. Social Security Administration. "As part of the application process, they sign a release to authorize us to gain access to their medical records to help us make a determination about their eligibility."
The current paper process takes several weeks or months, Kistler explained. "Having access to electronic records could revolutionize our claims process," she said, expressing excitement at her office becoming the first to begin transferring information by way of the Nationwide Health Information Network.
"There is a service to ensure that all requests for medical information are appropriately logged, are auditable under HIPAA and are available to the consumer to determine who has access to their health information and for what purpose," added Craig Miller, chief architect of Federal Health Architecture for the U.S. Department of Health and Human Services.
Additional progress is being made through IHE's partnership with the National Institute of Standards and Technology (NIST) and the Commission on the Certification of Health IT (CCHIT) to develop product testing tools. (Listen In to learn more about IHE’s partnerships with NIST and CCHIT.)
"At the Connectathon, you see competing vendors working together quite efficiently—we don't want to keep that in a room," said Charles Parisot, manager of architecture and standards for GE Healthcare and member of the HIMSS Electronic Health Record Association (EHRA) executive team.
Collaboration is critical to reaching the EHR goal, said Parisot. "EHRA doesn't want to be another group that is creating standards," he said. "We want to be a cheerleader in helping everybody work together and move forward."
Sharing data is incredibly complex, Parisot emphasized, and final implementation of EHR will be a monumental task. He noted problems that don't appear until installation. "Supporting EHR installation is going to be mighty necessary to success and we need all the forces and cleverness we have," he said. "If we prematurely start putting clinical data inside the infrastructure and then have to adjust, it's like telling a hospital CIO, 'We're going to upgrade your database schema every two months.'"
 This year's Connectathon revealed substantial growth in the patient care devices domain and also marked the debut of the IHE® Radiation Exposure Monitoring Profile. |
The Connectathon is the best place to learn what it takes to meet the standard, said Amit Trivedi, CCHIT certification manager and interoperability expert panel lead. "The vendor-to-vendor interoperability testing, the ability to test your product in a real-time situation, tweak your product, see what didn't work and do it again, exchanging clinical documents from different sources—it's very necessary for vendors to have confidence to move toward certification, which is 100 percent pass/fail," he said.
The Canadian Health Infoway, an independent not-for-profit organization whose goal is to accelerate EHR adoption, has established hundreds of successful projects across the country. "Our mission is not only to work at the technology level, but also to ensure standards are adopted at the clinician level and result in tangible benefits," said Alvaro Mestre, Infoway's regional director of architecture. He emphasized working efficiently with the budget established by the Canadian government and matched by individual provinces.
In the U.S., all eyes are on the economic stimulus plan, which allows significant funding for healthcare IT. Some question whether it is enough to satisfy the goal of an EHR by 2014.
"Interoperability is bigger than $22 billion," said Charles Parisot, warning that the process must evolve if the goal is to be achieved.
The good news, said Dr. Mendelson, is that much groundwork has already been done with existing funds. "One problem is that, other than the wealthiest healthcare providers, everybody has been struggling economically and they're wary of investing millions of dollars," he said. "But healthcare IT developers have built solutions that we believe will evolve in an intelligent fashion. The stimulus package puts dollars into the hands of providers and says, 'We're going to help you go out and purchase these solutions.' You're not going out there alone—your neighbors will be purchasing the same solutions." (Listen In to some Connectathon opinions about the economy’s influence on development and how the stimulus plan will boost interoperability.)
With or without the stimulus, Dr. Mendelson believes that healthcare IT development remains robust and the IHE revolution will march on. "Everyone knows that the future is in building these solutions and evolving," he said. "Otherwise, you're going to be left behind."
