Frequently Asked Questions

• What is IHE?
• Why is IHE needed?
• What can IHE do for me?
• How does IHE work?
• Who is IHE?
• How did IHE get started?
• What areas of healthcare does IHE address?
• What is the IHE Technical Framework?
• What are IHE Profiles?
• What are IHE Integration Statements?
• How do I use IHE?
• How can I find out more about IHE?

What is IHE?

IHE is an initiative by healthcare professionals and industry to improve the way computer systems in healthcare share information. IHE promotes the coordinated use of established standards such as DICOM and HL7 to address specific clinical needs in support of optimal patient care. Systems developed in accordance with IHE communicate with one another better, are easier to implement, and enable care providers to use information more effectively. Physicians, medical specialists, nurses, administrators and other care providers envision a day when vital information can be passed seamlessly from system to system within and across departments and made readily available at the point of care. IHE is designed to make their vision a reality by improving the state of systems integration and removing barriers to optimal patient care.

Optimal patient care requires efficient access to all relevant information. Despite the advanced state of technology, however, healthcare enterprises have not yet 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 requires 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 basis for such a framework, but alone do not solve the problem. In any standard there are gaps, options, room for conflicting interpretations. No standard maps perfectly to the complex and ever-changing information domain of a healthcare enterprise. Filling the gap between standards and systems integration has, until now, required expensive, site-specific interface development. To close that gap a process for building a detailed framework for the implementation of standards is needed. IHE provides that process.

Clinicians
Care providers are hampered by systems that do not share information effectively. Vital patient information may be missing or difficult to access. Redundant entry of information, aside from being inefficient, leads to errors and mismatches that must be corrected or reconciled. Care decisions frequently must be made without a comprehensive view of current patient information.

IHE offers a framework for information sharing designed to optimize clinical workflow. Systems implemented in accordance with IHE can streamline the flow of clinical information, reduce errors and improve efficiency. IHE strengthens the information link between different departments—for example, between referring physicians and consulting physicians—to enable the enterprise to function as a single unit in providing optimal clinical care.

Information Technology Professionals
Interfacing systems is one of the key challenges faced by any healthcare institution’s IT staff. Understanding the differing implementations of standards in various vendor systems and trying to find ways to reconcile them is an expensive, labor-intensive and often painful process.

IHE offers a common framework for vendors, IT departments, clinical users and consultants to understand and address clinical integration needs. The IHE Technical Framework allows flexibility while ensuring that key integration needs are met.

Healthcare Administrators
Administrators must balance technical, fiscal, clinical and personnel constraints in making operational and purchasing decisions. Inadequate systems integration impacts many aspects of a clinical department of concern to administrators: financial performance, cost of information technology, efficiency of personnel and, most importantly, the quality of care.

IHE eases this burden by offering a clear path toward acquiring integrated systems. Referring to IHE Integration Profiles in RFPs and purchasing agreements allows purchasers and vendors to agree on the interoperability of systems being acquired or upgraded, making multi-vendor, best-of-breed solutions more feasible. It enables information technology specialists to concentrate on improving the core functionality of systems, rather than developing and maintaining redundant, point-to-point interfaces. Finally, it makes it possible to implement a streamlined workflow so that care providers can make more efficient use of their time.

IHE involves an intensive, ongoing process of collaboration and communication among key parties, which can be divided into four phases:

• Problem Identification: Clinicians and IT experts identify common integration problems in access to information, clinical workflow, administration and underlying infrastructure.
• Integration Profile Specification: Stakeholders select standards that address each identified integration need. The technical specifications for implementing these standards are documented in the IHE Technical Framework.
• Implementation and Testing: Vendors implement these profiles and test their systems with software tools and at a face-to-face Connectathon, where they test interoperability with other vendors’ systems.
• Integration Statements and RFPs: Vendors publish IHE Integration Statements to document the integration profiles supported by their products. Users can reference integration profiles in requests for proposals, simplifying the systems acquisition process.

Click here for a more detailed description of the IHE process.

IHE is sponsored by associations of healthcare professionals around the world and has welcomed participation by many of the leading manufacturers of imaging and information systems. Volunteer members of these associations, including clinicians and other care providers, healthcare executives and information technology experts, play a key role in guiding the development of IHE and determining priorities for integration. They collaborate with vendor representatives to identify obstacles to integration and optimal care and remove them by developing and implementing standards-based solutions for information sharing.

IHE International, the organization overseeing the development and publication of IHE Technical Frameworks worldwide, is sponsored by the Healthcare Information and Management Systems Society (HIMSS) and the Radiological Society of North America (RSNA). IHE has expanded continually and developed strong international support. The list below identifies the organizations that currently sponsor IHE initiatives and domains. Other groups representing healthcare stakeholders are invited to participate.

In addition to these sponsoring organizations, IHE boasts more than 200 member organizations. The current list of IHE member organizations is available at http://www.ihe.net/governance/member_organizations.cfm.

Information about becoming an IHE member organization and sponsoring organization is available at http://www.ihe.net/participation/.

IHE began in 1998 with the mutual realization by HIMSS and RSNA that through cooperative efforts they could promote a higher level of interoperability among imaging and information systems. Both organizations were aware that public events could help drive the integration process by encouraging the participation of vendors and raising the awareness of users and purchasers. They convened a working group of their key members, industry representatives, standards experts and others. This group outlined an approach that led, a year later, to the formation of the IHE Planning and Technical committees. These committees have worked continuously and intensively since that time.

IHE promotes integration within and across all units of the healthcare enterprise. The initial successes of IHE were achieved in radiology and IHE Radiology remains very active. The IHE process has since been adopted in other domains, as well. Working in coordination with the others, each of these domains will develop its own Technical Framework and Integration Profiles, and implement its own part of the testing and demonstration process. Domains frequently work together on profiles of common interest. Several IHE domains address interoperability issues of interest to multiple clinical fields. The currently active IHE domains are:

• Anatomic Pathology
• Cardiology
• Eye Care
• IT Infrastructure
• Laboratory
• Patient Care Coordination
• Patient Care Devices
• Quality, Research and Public Health
• Radiation Oncology
• Radiology

Further information on each of the IHE domains is available on their respective home pages, linked above.

The IHE Technical Framework is a detailed, rigorously organized document that provides a comprehensive guide to implementing the defined integration capabilities. The Technical Framework delineates standards-based transactions among systems (generically defined as IHE Actors) required to support specific workflow and integration capabilities. Click here to see a graphical representation of the organization of information in the Technical Framework.

IHE Actors:
Information systems or applications that produce, manage or act on information are represented as functional units called IHE Actors. Each actor supports a specific set of IHE transactions. A given information system may support one or more IHE actors.

Transactions:
Transactions are exchanges of information between actors using messages based on established standards (such as HL7, DICOM and W3C). Each transaction is defined with reference to a specific standard and additional detailed information, including use cases. This is done to add greater specificity and ensure a higher level of interoperability between systems.

The current version of the IHE Technical Framework is available at www.ihe.net/technical_frameworks.

IHE Integration Profiles organize sets of IHE actors and transactions in order 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 regarding IHE actors and transactions. They describe clinical information and workflow needs and specify the actors and transactions required to address them.

Brief descriptions of the current IHE profile are available at www.ihe.net/profiles/.

IHE Integration Statements are documents prepared and published by vendors to describe the intended conformance of their products with the IHE Technical Framework. They identify the specific integration capabilities a product is designed to support in terms of the key concepts of IHE: Actors and Integration Profiles. Links to the Websites of companies that publish IHE Integration Statements for their products are provided at www.ihe.net/resources/ihe_integration_statements.cfm.

How you use IHE depends on your specific role and your specific needs. Clinicians and administrators should be aware of the clinical and operational benefits that can be realized through IHE Integration Profiles and encourage their departments to demand those capabilities when acquiring or upgrading systems. Information technology professionals should know how to use IHE Integration Profiles in RFPs and purchasing agreements and should familiarize themselves with sections of the Technical Framework that describe interfaces between systems under their supervision. Developers and systems integrators should have a detailed knowledge of the sections of the Technical Framework relevant to their systems.

If IHE is about achieving a common language for integration, then an analogy can be made to how one uses various resources to understand a foreign language. . . .

Standards such as DICOM and HL7 provide the vocabulary and basic grammar for the language of integration. The Technical Framework organizes these elements somewhat like a language textbook, fitting together the most relevant pieces and eliminating confusion and ambiguity. Integration Profiles are like a phrase book for essential communications. They further organize the language to enable vendors and purchasers to communicate about systems integration—even if DICOM or HL7 is not their native language.

IHE can make systems integration faster, more efficient, less expensive and more successful. Standards-based integration solutions like those defined in IHE are flexible, durable, easier to implement and less expensive to maintain than proprietary methods. Achieving systems integration through IHE is a dramatic step toward providing optimal patient care.

The www.ihe.net Website includes an array of information resources for developers and users of healthcare IT systems. An overiew is available at www.ihe.net/resources.

You can learn more about IHE by attending demonstrations and presentations at the medical professional society meetings other major medical gatherings.

For further information about IHE, including how to become involved, contact the staff of IHE sponsoring organizations at secretary@ihe.net.