MO‐AB‐204‐04: Connectathons and Testing

You've experienced the frustration: vendor A's device claims to work with vendor B's device, but the practice doesn't match the promise. Getting devices working together is the hidden art that Radiology and Radiation Oncology staff have to master. To assist with that difficult process, the Integrating the Healthcare Enterprise (IHE) effort was established in 1998, with the coordination of the Radiological Society of North America.Integrating the Healthcare Enterprise (IHE) is a consortium of healthcare professionals and industry partners focused on improving the way computer systems interconnect and exchange information. This is done by coordinating the use of published standards like DICOM and HL7. Several clinical and operational IHE domains exist in the healthcare arena, including Radiology and Radiation Oncology. The ASTRO‐sponsored IHE Radiation Oncology (IHE‐RO) domain focuses on radiation oncology specific information exchange. This session will explore the IHE Radiology and IHE RO process for; IHE solicitation process for new profiles. Improving the way computer systems interconnect and exchange information in the healthcare enterprise Supporting interconnectivity descriptions and proof of adherence by vendors Testing and assuring the vendor solutions to connectivity problems. Including IHE profiles in RFPs for future software and hardware purchases. Learning Objectives: Understand IHE role in improving interoperability in health care. Understand process of profile development and implantation. Understand how vendors prove adherence to IHE RO profiles.S. Hadley, ASTRO Supported Activity

The Integrating the Healthcare Enterprise (IHE) provided a series profiles for decreasing costs and integrating different healthcare enterprises. In IHE Cross-Enterprise Document Sharing for Image (XDS-I), it provides a web service and Web Access to Digital Imaging and Communication in Medicine Persistent Objects (WADO) service, to access DICOM objects. This paper analyzes the operational specifications of the WADO service and extends the access capability of WADO service to get other related documents and/or reports based on IHE XDS-I profile. And then we re-design an ontology following the Unified Medical Language System (UMLS) for use in the relationship between Structure Reports (SR). By analyzing the SR to retrieve key words and using an ontology to search, we can retrieve the other related reports and/or images. This research wants to find the related medical image documents when getting a SR or DICOM image from a patient or other Enterprises. It can reduce the time for searching and improve the diagnostic accuracy, when radiologist write or read reports and images.

To explain the common conformance and interoperability testing requirements of eHealth applications through two case studies; one using a prominent eHealth messaging standard, namely HL7 v3 [1], and the other using Integrating the Healthcare Enterprise (IHE) [2] Profiles and to describe how these testing requirements can be addressed through an automated, modular and scenario-based testing framework, namely TestBATN. Summarizing the conformance testing requirements of HL7 v3 messages. Illustrating the interoperability testing requirements of IHE Profiles through a scenario based on the IHE XDS, IHE XDS-MS and IHE PIX profiles. Explaining how these requirements can be handled through a dynamic and configurable test framework addressing all the layers in the interoperability stack within a single test scenario. Conformance and interoperability testing are necessary to maintain correct information exchange as the correctness of the exchanged data is essential in the healthcare domain. There are many standards used in eHealth that the applications need to conform. Additionally, there are profiling initiatives such as IHE and Continua Health Alliance which publish integration profiles addressing a specific clinical need or a use case and describe how to combine or use the existing standards to provide interoperability. However, as the results of our case studies demonstrate, there are many commonalities in the conformance and interoperability testing requirements of these standards and profiles and therefore an integrated testing environment is needed. Our main conclusion is that rather than having individual testing tools for each standard or initiative, a generic and modular test framework exploiting the commonalities in the testing processes and fostering reusability of modular, pluggable testing components will improve the efficiency of testing. Through the TestBATN framework, we describe how this modularity can be achieved by providing common interfaces facilitating the development of adaptors which allows different testing components to be plugged into the system.

274 July/August 2002 It is hard to imagine worldwide agreement on ways to link information systems while we struggle with local systems that can't communicate. However, this vision is coming closer to reality as a result of a joint initiative sponsored by the Healthcare Information and Management Systems Society (HIMSS) and the Radiological Society of North America (RSNA). The Integrating the Healthcare Enterprise (IHE) initiative promotes coordinated use of established communications standards such as HL7 and DICOM to address specific integration needs. Not even the most advanced institutions have begun to realize the full potential of computer systems to reduce medical errors, improve the efficiency of care providers, and enhance the overall quality of clinical care. To do so, health care demands a framework for information sharing that meets the needs of care providers as well as patients—and gains acceptance among the companies that build the systems they rely on. Standards provide the foundation for such a framework, but alone do not solve the problem. In any standard there may be gaps, options, and room for conflicting interpretations. No standard could map perfectly to the complex and ever-changing information domain of a health care enterprise. Filling the gap between standards and systems implementation has, until now, required expensive, site-specific interface development to integrate even standards-compliant systems. To close that gap, a process for building a detailed framework for the implementation of standards is needed. IHE provides that process. Clinicians, administrators, and other health care professionals are frustrated by computer systems that don't effectively share information. They envision a day when vital information can be passed seamlessly from system to system within and across departments and made available as needed at the point of care. The IHE initiative aims to make this vision a reality. IHE integration profiles organize the integration capabilities needed to address specific patient care needs. Integration profiles offer a convenient way for vendors and users to reference the functionality defined in the IHE Technical Framework without having to restate all of the detail. They describe clinical information and workflow needs and specify the functional units (actors), and transactions required to address them. Volunteer members of HIMSS and RSNA, including radiologists and other clinicians, health care executives, and information technology experts, play a key role in guiding the development of IHE and determining priorities for integration. Vendor representatives also collaborate in the process, which is making progress toward removing the obstacles to integration and optimal patient care. During the third year of the initiative, which commenced at the HIMSS Annual Conference and Exhibition this February in Atlanta, 33 companies representing 68 systems completed the testing process “Envision a day when vital information can be passed seamlessly from system to system within and across departments and made available as needed at the point of care.”

Clinical engineers face technical challenges and opportunities in healthcare technology as results of changing focus in healthcare and the computerization and interconnection of medical devices and systems. Combined, these trends will increasingly move us away from the traditional "bricks and mortar" hospitals and physician's offices and move us toward their virtual successors. Ultimately, diagnosis and treatment will take place at an earlier stage. A major challenge to achieving this goal has been the diversity of current healthcare technologies and the paucity of technical standards for exchanging useful information between different medical devices. The consequence is a technical "Tower of Babel", where these disparate devices lack a common means of communication. The answer to this challenge is an initiative known as Integrating the Healthcare Enterprise (IHE). IHE brought together healthcare information and medical imaging systems industry members "to agree upon, document, and demonstrate standards-based methods of sharing information in support of optimal patient care". By developing integration profiles that detail core processes such as scheduled workflow, image presentation, information access, record retrieval, reporting, and charge posting and adopting existing standards. IHE defines guidelines that medical device manufacturers can follow to ensure their device will interface and effectively communicate with a device from another manufacturer. IHE holds promise to transform the existing technical "Tower of Babel" into sets of integration profiles that will facilitate interoperability of medical devices. The success of IHE will lead to technological integration and thereby meet one of the most critical challenges as healthcare systems move to the next level.

Parallel to the introduction of diagnosis related groups (DRGs) for the reimbursement of hospitals, a marked reduction of financial means within the healthcare system is taking place. Healthcare enterprise information systems will play an increasing role to accommodate the new working conditions by developing reliable and efficient workflow solutions. Interfacing the systems currently in use can meet considerable obstacles. By offering high connectivity, IHE (Integrating the Healthcare Enterprise), which was initiated by concerted actions of users and vendors, ensures improved health care delivery and, furthermore, assists in acquiring new information systems in the future. IHE is not a standard but makes extensive use of existing international standards, such as HL7 and DICOM. National IHE demonstrations confirmed the power of this approach and presented its mission to large groups of users and vendors. The concept continues to grow and for the first time provides groups of various interests cooperative solutions to the problems encountered in collecting and distributing information.

The IHE (Integrating the Healthcare Enterprise) initiative has recently developed into a multi-national effort that addresses the specific needs of healthcare systems in North America, many European countries as well as Japan. The introduction of IHE in Europe is a particular challenge because the structure of the healthcare sector deviates significantly from country to country, with different legislation, language, medical and organizational procedures and, not the least, different vendors: HIS/RIS systems are typically tailored towards a specific market, and the majority of vendors is only present in one or a few countries. The first multi-national "European Connect-a-thon" was performed in April, 2002 with 57 participating systems from 33 companies, in preparation of four different public demonstrations in three countries. The systems were grouped into a French, German and Italian section (according to the national extensions supported by each system), with certain overlaps, i. e. systems participating in multiple sections in parallel. In conclusion, experiences in Europe show that IHE cannot simply be copied, but has to be adapted to the specificities of national healthcare systems. The good news is, however, that the specifics are only of minor nature compared to the overall complexity of the transactions involved.

The role of the Heart Rhythm Society in Integrating the Healthcare Enterprise

The Patient Plan of Care (PPOC) Profile addresses an urgent global call to reduce healthcare fragmentation and expand the interoperability of healthcare data. This chapter discusses the PPOC environment for use in the electronic nursing documentation system project at Bumrungrad International Hospital in Bangkok, Thailand. In January 2013, Bumrungrad International executives identified electronic nursing documentation as an organizational priority and approved standardized nursing assessment documentation as the "next step" toward integrated physician–nurse documentation. Initial planning identified the essential documents for implementation. In 2008, Integrating the Healthcare Enterprise (IHE) patient care coordination (PCC) Technical Committee approved the development of a Coded Nursing Documentation (CND) Profile to describe content structures for a PPOC within IHE's technical framework. The PPOC defines the data elements for care planning along with the IHE bindings to support the exchange of information. Often health information record systems (HIRS) use a reference terminology for patient assessment documentation without an interactive plan of care for coordination.

Innovative solutions are needed in Healthcare to deliver interoperable and secure digital services. Big data and Artificial Intelligence (AI), Personalized medicine, are considered as the main priorities by the European Commission for the coming years. As such, topics are placing high demands on medical data to ensure that they are consistent, relevant, and structured. In order to achieve this degree of consistency data that is to be exchanged, needs to be underpinned with protocols and standards which need to be clearly understood by those charged with implementation. To increase data quality, integration guidelines called profiles allow a harmonious combination of standards for answering specific clinical needs and workflows. Alignment and conformity of the IT systems to the requirements is the preferred approach to build trusted healthcare IT ecosystem. The chapter describes a comprehensive process that allows reaching the goal of developing Digital Health Space. Based on two concrete examples, firstly, the Integration Healthcare Enterprise (IHE) is a profiling organization that proposes a use case driven methodology for successfully deploying interoperable systems that are tested during events called Connectathons. Secondly, The Conformity Assessment Scheme for Europe (CASforEU) designed in the European project EURO-CAS completes the process by proposing a rigorous evaluation of the conformity of products and solutions for better confidence of the interoperability implementation. This chapter initially introduces the concept of interoperability and then describes in detail how to implement the process in healthcare setting, It also provides some concrete examples of deployment projects, and introduces the concept and process of the conformity assessment scheme for healthcare IT products and solutions.

With the growing demands to increase the efficiency and the quality of medical services, healthcare organizations should support optimized workflows. The first step towards efficient workflow management is to identify and understand the various aspects of this workflow. The imaging department workflow, in particular, is relatively well-defined and expressively profiled by the integrating the healthcare enterprise (IHE) technical framework. The goal of this work is to analyze the IHE imaging departmental workflow form both the internal and external perspectives, as stated in the IHE technical workflow. This is achieved though creating the 3-layer models of the imaging department workflow utilizing the 3LGM <sup xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink">2</sup> tool. The created models have been able to provide support for structured and comprehensive analysis of the departmental workflow in all its aspects: processes, information, applications and organization In this way, the workflow management technology provides a better understanding of the IHE-workfiow prior to its real-world implementation to increase the overall services efficiency.

Due to the increasing adoption of Electronic Health Records (EHRs) for primary use, the number of electronic documents stored in such systems will soar in the near future. In order to benefit from this development in secondary fields such as medical research, it is important to define requirements for the secondary use of EHR data. Furthermore, analyses of the extent to which an IHE (Integrating the Healthcare Enterprise)-based architecture would fulfill these requirements could provide further information on upcoming obstacles for the secondary use of EHRs. A catalog of eight core requirements for secondary use of EHR data was deduced from the published literature, the risk analysis of the IHE profile MPQ (Multi-Patient Queries) and the analysis of relevant questions. The IHE-based architecture for cross-domain, patient-centered document sharing was extended to a cross-patient architecture. We propose an IHE-based architecture for cross-patient and cross-domain secondary use of EHR data. Evaluation of this architecture concerning the eight core requirements revealed positive fulfillment of six and the partial fulfillment of two requirements. Although not regarded as a primary goal in modern electronic healthcare, the re-use of existing electronic medical documents in EHRs for research and other fields of secondary application holds enormous potential for the future. Further research in this respect is necessary.

In August of 2006 the US Government passed an executive order to implement electronic health records by 2014. Recent moves in global healthcare IT standards address many medical domains; however, there has been little attempt to provide interoperability in transport medicine. We present an Integrating the Healthcare Enterprise (IHE) profile for Transport Medicine, to facilitate interoperability between various healthcare facilities and the transport environment utilizing distributed computing technologies such as SOAP envelopes for ebXML over mobile networks.

Complex modern healthcare delivery depends on appropriate access to currently relevant data, which implies interoperability of computer systems at a national scale.There is a growing expectation that relevant records will be multimedia records that include or reference images, waveforms and other large information objects as stored in PACS.The Integrating the Healthcare Enterprise (IHE) initiative has implemented a methodology to enable users and suppliers in the medical imaging domain to work together to implement interoperable systems using subsets of existing standards.IHE provisions can form the basis for an important part of the patient record stored in electronic form.

Many countries have set the long-term objective for establishing an electronic healthcare records (EHRs). Various IT Strategies note that integration of EHR systems has a high priority. Because the EHR systems are based on different information models and different technology platforms, one of the key integration problems in the realization of the EHRs for the patients’ continuity of care is the inability to share patient records across enterprise. Integrating the healthcare enterprise (IHE) committee has defined the detailed implementations of existing standards such as DICOM, HL7, in a publicly available document called the IHE technical framework (IHE-TF). Cross-enterprise document sharing (XDS), one of IHE technical frameworks, is describing how to apply the standards into the information systems for sharing of medical documents among hospitals. This study aims to design clinical document architecture (CDA) schema based on HL7 and to apply implementation strategies of XDS using this CDA schema.