IHE 101

							IHE 101: Getting to know us
Integrating the Healthcare Enterprise (IHE) is a global nonprofit organization with active arms in North
America, Europe, and Asia-Oceania. IHE North America is organized into thirteen application-specific
"domains", each of which includes clinical, IT, standards development, education, research and
government stakeholders:

               IHE Cardiology (CARD)
               IHE Dental (DENT)
               IHE Endoscopy
               IHE Eye Care (EYECARE)
               IHE IT Infrastructure (ITI)
               IHE Laboratory (LAB)
               IHE Anatomic Pathology (ANAPATH)
               IHE Patient Care Coordination (PCC)
               IHE Patient Care Device (PCD)
               IHE Pharmacy (PHARM)
               IHE Quality, Research and Public Health (QRPH)
               IHE Radiation Oncology (RO)
               IHE Radiology (RAD)

Each domain is funded through sponsorships from industry groups (e.g., Healthcare Information
Management Systems Society, Radiological Society of North America, American Academy of
Ophthalmology). Each domain's web page offers a description of current Integration Profiles and their
status (final vs. in development) as well as any guidance or white papers published by the domain.

Integration Profiles are based on clinical workflow, and are designed to address a specific clinical need
(e.g., transmit a measurement taken off a patient). Whenever possible, IHE profiles use existing
standards like HL7 for language structure and IEEE 11073 nomenclature. Each integration profile
includes three components: transactions that specify messages sent between and among actors.

    1. Transactions: a descriptive name and an identification number assigned by the domain (e.g.,
       “PCD-01”)
    2. Messages: the content and format of information transferred (e.g., “patient name, then patient
       ID, then heart rate in BPM”)
    3. Actors: labels with defined roles and responsibilities. Actors fall into three general categories:
       provider or reporter (sends information), consumer (receives information), or filter (receives,
       modifies, and then transmits information); and a single device or system can support more than
       one actor.

    Why use Integration Profiles? Industry standards like HL7 and IEEE 11073 allow a wide range of
    implementation options, which means that two systems that conform to both standards may not be
    able to interface with each-other. However, if two systems both conform to the structure and
   nomenclature spelled out in a specific IHE integration profile, a facility can expect a certain level of
   interoperability.

   Where do profiles come from? IHE’s development cycle follows a yearly process. In the Spring,
   changes to existing profiles and ideas for new profiles are proposed to the domain committees and
   working groups, which then incorporate these ideas into draft technical frameworks. After public
   review and comment, the draft profiles are posted in “final trial implementation” format. Suppliers
   then modify their systems to support these trial implementations, and meet in a Connectathon in
   January to attempt to establish successful interfaces with other participating manufacturers’
   systems and submit their outgoing messages to comprehensive test tools developed by the National
   Institutes of Standards and Technology (NIST). The results of Connectathon testing help inform
   changes and modifications for the next year’s review process, and suppliers can also show off their
   connectivity accomplishments in Showcase demonstrations at each year’s HIMSS conference.




The National Institute of Standards and Technology (NIST) has worked closely with the members of the
IHE Patient Care Device (PCD) domain and IEEE 11073 to develop test tools and databases that support
rigorous conformance testing of the HL7 V2.6 message syntax and IEEE 11073 semantics used to convey
near real-time medical device data to and from a hospital EMR using the IHE PCD Device Enterprise
Communication (DEC) Technical Framework.

The NIST tooling has played an essential role in the IHE PCD effort and has been used for Connectathon
testing for the past several years. Their testing framework facilitates comprehensive and rigorous
message conformance testing and further legitimizes and promotes the use of open standards for
sending medical device data to the EMR in a truly ‘plug-and-play’ manner.

What about commercially available systems? Suppliers market their integration capabilities in terms of
transactions and actors in standardized reports called Integration Statements, which can be found on
IHE’s web site http://www.ihe.net/Resources/ihe_integration_statements.cfm. Healthcare facilities can
use Integration Profiles in RFP language to specify connectivity by requiring suppliers to specify whether
(and how well) their proposed product supports a particular Actor in a profile.