Building Interoperable Healthcare Systems Through IHE

Abstract

The value of connecting clinical and technical devices and systems was seen as early as the late 1960s with initiatives such as Project MEDLAB, launched at the Latter Day Saints Hospital in Salt Lake City, UT, and the Myocardial Infarction Research Unit (MIRU) under Dr. Charles Sanders at Massachusetts General Hospital in Boston, MA. These efforts and others sought to communicate patient information for storage, recall, display, and/or analysis. More recently, the development of standards such as Digital Imaging and Communications in Medicine (DICOM), Health Level 7 (HL7), and ISO 11073:2008, Health informatics—Pointof-care medical device communication have empowered the healthcare community to imagine and build systems that not only communicate, but do so on an interoperable basis. Interoperability is defined as the ability of two or more systems or components to exchange and use information accurately, securely, verifiably, when and where needed, with minimal or no effort, in effect to become “Plug and Play.” (Adapted from HL7, www.hl7.org) Implied in this definition is that interoperable systems are vendor independent—that is, a system from Vendor “A” can exchange information with Vendors “B” through “N,” where N is the number of vendors that subscribe to the interoperability standards and protocols. A number of efforts are under way to create profiles or use cases for interoperability between medical devices and other healthcare systems. The most active of these are led by the Center for Integration of Medicine and Innovative Technology (CIMIT) at Partners Healthcare in Boston; the Continua Health Alliance, an industry group; and the Integrating the Healthcare Enterprise (IHE) initiative. CIMIT is most concerned with specific-use cases and the interrelationship of multiple devices used at the point of care. Continua is focused on care that occurs outside of the hospital, including the integration of home-care “utilities.” The IHE is focused on interoperability across the enterprise and the development of a common framework for all information flow. When the IHE began its work in 1998, under the joint sponsorship of the Radiological Society of North America (RSNA) and the Healthcare Information Management and Systems Society (HIMSS), all vendors were communicating using proprietary protocols or variations on “standard” protocols. This made it expensive and hard to integrate with other vendors’ systems, requiring continual monitoring to ensure data quality and expensive Building Interoperable Healthcare Systems Through IHE