For nearly 20 years, IHE has pursued the mission of driving adoption of interoperability standards in healthcare. From the beginning, that work has involved developing technical specifications, called IHE profiles, and testing systems that have implemented them at peer-to-peer testing events called Connectathons. Hundreds of health IT systems at healthcare sites around the world have achieved interoperability by implementing IHE profiles in their design.
“Connectathons give participants an unparalleled testing opportunity in a very concentrated amount of time. Organizations can find and fix problems in their software and test IHE profiles with industry peers in a non-competitive environment. This is really an engineering event,” says Lynn Felhofer, IHE technical project manager.
Effective interoperability requires stability of over time, since systems that implement different versions of a standard may not work together. So IHE has always based profiles on established, stable standards creating specifications with broad acceptance and a long service life.
But, the pace of change in health IT is accelerating. Expectations for enhanced functionality – and especially for interoperability, the ability to create, use and exchange data – continue to grow. And health IT is adopting new standards and technologies that make rapid evolution possible.
Signs of this change were evident at the IHE North America Connectathon, held January 23-27 at the Huntington Convention Center in Cleveland, Ohio and the IHE Europe Connectathon held April 3-7 in Venice, Italy. There was expanded testing based on emerging standards designed to enable rapid evolution and adoption, including HL7 Fast Healthcare Interoperability Resources (FHIR) and DICOMweb Services. These standards are based on RESTful interfaces, the data exchange architecture that drives the proliferation of interactive services on the World Wide Web.
Four IHE profiles based on HL7 FHIR were tested at the event: Mobile Access to Health Documents (MHD), Patient Demographics Query for Mobile (PDQm), Patient Identifier Cross-Reference for Mobile (PIXm) and ATNA Repository RESTful Access (ATNA Restful). These profiles all use FHIR to bring interoperability capabilities provided by existing IHE profiles into the mobile device ecosystem.
The MHD profile was created to standardize a health documents interface for mobile devices. The profile aims to create more consistency in mobile applications. “The MHD profile is a bridge between the existing and established XDS and XCA environments,” says John Moehrke, cyber-privacy and principal systems architect. “I see it as a complement to or as a bridge to the full use of FHIR.”
These profiles help push interoperability forward for health systems and vendors challenged to keep up with rapid changes in technology. Testing implementations of these profiles is essential. IHE Connectathons are designed to provide organizations a neutral and collaborative environment to help solve these problems that affect everyone in healthcare.
“It was impressive to see so many companies (large and small) testing their implementations of the standards. This was interoperability heaven,” says Marten Smits, an HL7 FHIR Monitor at the IHE Europe Connectathon.
The North America Connectathon hosted the first mHealth Plugathon and Devices on FHIR testing events, embracing the growing importance of mHealth applications (or apps) and HL7 FHIR. In April, the IHE-Europe Connectathon hosted another mHealth Plugathon.
“These types of events allow IHE to engage in the early phases of the evolutionary process, when emerging technologies and standards are still in the formative stages and both the specifications and those who are actively engaged in their development can factor in the unique requirements that healthcare applications present,” says Todd Cooper, the Devices on FHIR technical program manager. “This is much easier than trying to fit in these requirements later on and it helps accelerate the inclusion of new technology into interoperable products.”
A group of dedicated and engaged companies – including startups, established vendors, and data interfacing companies – from across the world attended the events.
“There are two roads converging around this new set of standards in health IT. One is from the world of patient-facing smartphone apps and the other is from the established health IT vendor space. The Plugathon was the first shot at bringing those two worlds together,” says John Donnelly, president of IntePro Solutions.
Eight companies took part in the North American mHealth Plugathon and explored the emerging need to build successful interfaces between apps and the data aggregated in electronic medical record systems and specialty health IT systems.
IHE-Europe also hosted an mHealth Plugathon in conjunction with the Veneto Region eHealth coordinator, Arsenal.IT. The event drew 26 participants from 16 different organizations. App developers, eHealth project leaders from across Europe, IT managers, and health information exchange vendors came together to learn more about IHE profiles for mobile health, many based on HL7 FHIR.
Participants developed and demonstrated apps that follow three IHE profiles based on HL7 FHIR: MHD, PIXm and PDQm. Typically such apps are designed to improve the patient experience and increase patient engagement. One app uses artificial intelligence to enable patients to navigate their personal health records using natural language. It allows a patient to, for example, find a specific clinical document, or the contact details of a specific care provider. Mauro Zanardini, coordinator of the mHealth Plugathon and co-chair of the IHE IT Infrastructure Technical Committee, described the role of IHE in the emerging era of digital health: “The mobile app developer community is exploring new ways to deliver healthcare services to the patient, and IHE can help them achieve this in a standardized way. IHE can be the driver for this pulse of innovation, facilitating the sharing of data to mobile applications, and enabling new clinical patient-centric workflows”
The mHealth Plugathon events have helped spark interaction between mobile app developers and users in the health IT world. Plugathons also show IHE to be an effective standards-based platform for implementers of emerging technologies. In the nascent stages of development, the IHE mHealth Plugathon event is already generating enough interest to fuel rapid growth and interest from key stakeholders.
“IHE-Europe organized many VIP tours during the Connectathon. Our VIP tour participants, among them national health authorities from the Netherlands and Belgium, were quite impressed. They urged IHE to start as soon as possible the organization of the next Plugathon,” says Mauro Zanardini, mHealth Plugathon coordinator.
During the Devices on FHIR event at the IHE North America Connectathon, the ten participating companies focused on learning how to send FHIR-based data from device sources to a server, as well as discovering how to retrieve that data using an application. The participants were able to validate emerging FHIR specifications in relation to device informatics. This inaugural event met its goal of providing a starting point for participants to explore testing of HL7 FHIR-based capabilities.
App companies and established health IT vendors are recognizing the need to share data, and FHIR is rapidly emerging as the standard for connectivity and real-time access to information sourced from devices. These events were a strong starting point, but they will likely grow as more health IT stakeholders see the value in mHealth and FHIR testing.
“IHE International and its regional/ national deployment committees are planning on similar events later this year, both in Europe and Asia. These may be at scheduled IHE Connectathons or other events and venues that are better suited to engage those advancing emerging technologies,” says Cooper.