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Integrating the Healthcare Enterprise

Background

Integrating the Healthcare Enterprise (IHE) is a non-profit organisation based in Illinois in the USA that was established in 1998 by a consortium of radiologists and IT experts, to create and operate a process through which the interoperability of healthcare IT systems can be improved. The key sponsors are:

  • the Healthcare Information and Management Systems Society (HIMSS),
  • the Radiological Society of North America (RSNA),
  • the American College of Cardiology (ACC),
  • the American Academy of Ophthalmology (AAO).

The IHE organisation in Europe is based in Vienna, Austria and is actively engaged with the European Commission by both informing policy and by organising a number of projects.

What does it do?

IHE accomplishes two things:

  1. The IHE Integration Profiles describe particular clinical information needs or workflow scenarios and then uses established standards to implement them. Many standards that use different data formats (for example DICOM) may not allow the full interoperation between different manufacturers systems. The IHE profile mechanism significantly enhances interoperability.
  2. Cross enterprise document sharing (XDS) that allows different Trusts to share electronic records.

What does this mean?

For those who are familiar with modern computer network architectures, IHE enables the equivalent of a Local Area Network switching architecture to replace existing point to point networks and its equivalent of the Wide Area routed network, XDS, to interconnect remote services.

With the right interfaces or connectors in place and with the full cooperation of all parties involved, this means that all records regardless of the system that they are hosted on, could be accessible in full by all other systems – without changing the hosting or receiving systems. The clinician can then see the results on the system that he is used to working on.

The Operation

As you can see from the diagram, each system connects via a cloud hosted interface that enables the full bidirectional connection between the hosting/viewing system and the information exchange. The limiting factor is the host system manufacturer’s willingness to create an API that has unrestricted access.

The next part of the system ensures that data formats are standardised and that the information is valid.

The exchange itself then routes the information to the requesting system(s), changing any data formatting to match the requesting system and interfacing to that system.

IHE exchange and cross domain sharing

Inhibitors

Achieving the above will not require the replacement of any systems or applications, but it will require the timely presentation of APIs by system manufacturers to not only enable connectivity but to allow bidirectional access to ALL the information within the system (subject to information governance).

epSOS – An Example

Smart Open Services for European Patients (epSOS) is an Open eHealth initiative for a European large-scale pilot of patient summary and electronic prescription services, launched in 2008. Its aim was to develop, pilot and evaluate cross-border eHealth services. The focus was on providing safe, secure and high-quality services for the exchange of patient summary data and ePrescriptions between European countries. Over its lifetime, the project expanded to encompass 25 countries and about 50 beneficiaries, before the end of the project in 2014. The epSOS website is now closed.

During the London Olympics, European (non-UK) nationals were able to visit participating pharmacists and request prescribed drugs by allowing access to their home-country patient record. The system also handled variations in manufacturers and in regulations resulting from cross-border implementation. At the same time, a UK-national from outside London had to contact his GP and request a paper prescription be sent by post before the medication could be dispensed.

At the time, UK healthcare systems used internally generated protocols so decided against IHE connectivity. The new drive towards Open Standards makes this approach now far more acceptable to the NHS.

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