RSNA News - March 2005

IHE Guides Development of Electronic Health Record System

IHE is recognized as a very good process model and has taken a leadership role in establishing integrated technology solutions that affect real-world practice.
—David S. Channin, M.D.

The Integrating the Healthcare Enterprise (IHE) initiative is playing a crucial role in the dialog to develop a national health information network.

Established six years ago by RSNA and the Healthcare Information and Management Systems Society (HIMSS), IHE was among 13 health and information technology organizations that, in January, presented the Bush administration with recommendations for establishing an electronic national patient health record. In an unprecedented collaboration, the health and information groups worked to create a common framework supporting improved health information exchange in the United States while protecting patient privacy.

During a healthcare information technology summit at the Cleveland Clinic on January 27, President Bush said: "We've got fantastic new pharmaceuticals that help save lives, but we've got docs still writing records by hand. … So the fundamental question is, how do we encourage information technology in a field like healthcare that will save lives, make patients more involved in decision-making, and save money for the American people?"

He pointed to the new National Coordinator for Health Information Technology, David J. Brailer, M.D., Ph.D., who has set a goal that every American will have an electronic medical record in 10 years.

It was a request by Dr. Brailer late last year that brought together IHE and the other 12 groups to help devise a national health information infrastructure. One of the group's recommendations was connectivity built on the Internet and other existing networks.

"IHE is recognized as a very good process model and has taken a leadership role in establishing integrated technology solutions that affect real-world practice," said David S. Channin, M.D., a member of the RSNA Electronic Communications Committee (ECC). "Radiology can be very proud that it was integral in the process and is a core contributor to the collaborative response."

Under IHE, participating healthcare professionals work to improve the way computer systems in healthcare share information. Since 1998, IHE has expanded from radiology and IT infrastructure to include nuclear medicine, radiation oncology, cardiology and clinical laboratory and pathology.

IHE Connectathon

One part of the equation is providing medical technology vendors a neutral space and project leadership in testing equipment to solve integration problems. The centerpiece of the IHE testing process is the Connectathon, a weeklong interoperability testing event that takes place every 12 to 15 months at RSNA Headquarters in Oak Brook, Ill. The 2005 Connectathon was held January 17-21.

Forty-five companies and three non-commercial entities participated in the IHE Connectathon at RSNA Headquarters.

The Connectathon allows participating companies to test their IHE capabilities with corresponding systems from industry peers. During the event, their systems exchange information with systems from other vendors, performing all of the transactions required for selected roles, called IHE Actors, in support of defined clinical functions, called IHE Integration Profiles.

"They've worked out the issues on paper but vendors have to work out real-world bugs when they take equipment to the hospital for installation," said David W. Piraino, M.D., an ECC member and chairman of the IHE Strategic Development Committee. "The Connectathon leads to huge cost savings for companies selling medical equipment because they won't have to do extensive, independent testing in each hospital setting."

This year's Connectathon was the first comprehensive, multi-domain meeting in North America. Forty-five companies and three non-commercial entities participated. Thousands of tests were conducted among rows of laptop computers stretching throughout the lower level of the RSNA Headquarters building.

"It's like a beehive with engineers busily moving around, testing, exchanging messages to confirm they can share information and make appropriate use of it," said Christopher Carr, RSNA's director of informatics.

"It's a unique situation," added Dr. Channin. "Vendors participate and learn together. They are willing to help their competitors in the interoperability domain because, in turn, it facilitates how they'll get the information they need. It's tremendous."

During the Connectathon, vendors set up their equipment and begin running a series of tests. Independent project managers review log files and walk around checking off steps to verify each company's progress.

Connectathon organizers have created real-world testing scenarios so that participants can run through them to demonstrate interoperability. One scenario features a patient suffering from abdominal pain. The testing sequence follows him to his primary care physician and a gastroenterologist who orders a CT scan. The patient's history, exam results and laboratory findings are stored in an electronic patient record available to the patient and medical professionals.

"We want to make sure the vendors can complete the scenarios from start to finish in real time and in sequence," explained Carr. "We do this to prepare them for implementation and also to prepare them for public demonstrations that are based on this event."

This is the first year cardiology was included in the Connectathon.

Troy Wollman, a systems architect for GE Healthcare, brought a data management system to be tested. "I love it," said Wollman. "The great thing about the Connectathon is that we work with our own products. It's nice to be able to come here and connect with Philips and Cerner and other vendors to ensure that our systems talk the way they are supposed to when they're in the hospital."

Veteran participants also responded overwhelmingly in favor of the event, saying the IHE process addresses important issues in their product development plans.

The 2005 Connectathon test results are available at www.ihe.net. They also include a comprehensive record of successful test results at all previous Connectathon events. The table lists each vendor and the IHE Actors and Integration Profiles their systems successfully performed.

Next Steps for IHE

While this year's Connectathon represents a 20 percent growth from the previous event held in late 2003, participants in the 2006 event can expect to push their systems even farther. "Each year additional capabilities are tested, and the process moves incrementally. We create new integration profiles, new interpretations of standards to address specific clinical needs," said Carr.

Sharing of health information in the acute care and ambulatory environments was featured at the HIMSS annual conference last month in Dallas. This month, IHE will be demonstrated at the American College of Cardiology annual meeting in Orlando. The demonstration will target clinical cardiologists, cardiology administrators and information services staff. For many, it will be their first exposure to IHE.

Meanwhile, Dr. Brailer used some of the information presented to him from IHE and the other health and information groups during the annual World Health Care Congress in late January. He served as a panelist alongside international healthcare experts in the session titled, "In Pursuit of the Electronic Medical Record."