Dr Peter MacIsaac, Vincent McCauley, Christopher Lindop, Marco Eichelberg, & Jane Grimm.
Abstract
With the move to use of digital modalities, on-screen reporting and digital archive of images the radiology profession is moving rapidly to make both analogue film for image capture and presentation obsolete. One change has downstream impacts and also requires a change in how images are transported to treating doctors. The problems encountered have been described in another conference presentation by Grimm et al. A key element of the profession’s strategy is to encourage the production of image CDs which are capable of being read on any computer, by any operating system and opened by a broad range of specific purpose image viewers. Before the radiology industry can expect external clinical practitioners to adopt new technology, at their cost and effort to change, the least that they can expect is to receive images in a way that they can be reliably accessed.
Purpose
This paper outlines the process for defining and implementing the standards required. There are multiple standards that are required to operate together and integrating these standards into a single profile is critical if imaging information is to play a role in integrating healthcare enterprises. Through examining this small real world issue, currently being played out on the Australian health informatics stage, we can understand both the principles for moving from standards creation, past simple adoption and conformance to reliably solving problems at the coalface.
Approach: Integrating the Healthcare Enterprise is an international organisation with local deployment groups across Europe, North America and Asia and now in Australia. Founded in 1998 it has set about incrementally tackling systems integration and interoperability problems based on the principles of:
- User engagement in defining the problem and solution requirements
- IT Industry engagement in identifying the technical solutions
- Selection of the most appropriate standard for each component of the overall task from the menu of existing standards such as ISO, HL7, W3C, NEMA (DICOM), OMG, IEEE and so on.
- Integration of these standards and the user defined workflow to define an integration profile or system based on a pragmatic approach of what can be delivered now, with a “weather eye” on the future.
- Testing of standards for usability initially in a connectathon, an engineering event where different systems are connected and profiles are validated, and later through monitoring of early implementations – the Draft Standard for Trial Use model.
- Rigorous testing of individual implementations of profile components in the connectathon in both bench tests and interoperability tests with multiple other vendors
- Public demonstrations of tested components by vendors to industry and users at major IT conferences
- Input of profiles to national health IT specification projects such as the UK NHS Connecting for Health, US Health Informatics Standards Board, Canada Health Infoway and the International Standards Organisation.
Results
The application of these principles as they applied to the development of a standard profile for Portable Data for Imaging (IHE-PDI) will be described, with consideration of implementation issues in various realms covering the USA, Germany and Australia. This is one of a suite of profiles aimed at supporting integration and interoperability in the radiology domain (and only one of many domain and general infrastructure profiles developed by IHE). The components of the profile will be outlined covering CD format (ISO 9660), DICOM data (NEMA), Web Content (W3C) and workflow and integration (IHE).
Discussion
Integrating the Healthcare Enterprise is rapidly gaining international momentum and acceptance as it moves beyond radiology industry solutions to embrace many other sectors and the provision of infrastructure for systems. This infrastructure is tackling the major communication problems in healthcare such as shared clinical documents for emergency and hospital referrals and discharge summaries, image archive and access, public health reporting, integration of monitors and equipment with clinical records, electronic referrals and results, integration of clinical records and research documentation and results and patient held clinical records. The scope is bewildering and outcomes surprising given the largely volunteer nature of the input and funding model that does not rely primarily on government funding. IHE is an industry lead non-profit consortium providing the solutions that national health IT programs are seeking and the means to see them implemented. For many on us involved in informatics and standards communities for up to 3 decades, this approach builds on our work and experiences, overcomes many of the inherent problems with implementation of standards and provides the international drive to engage with vendors and users alike. The process for implementing standards for images on CDs is a small example of how this process works in practice and could be more generally adopted in Australia to ensure that we remain innovative yet in step with international standards and marketplace for health IT.
IHE profiles are open for development. With improvement in internet speed and more ubiquitous access, it is now possible to consider image storage and access via an open web based profile. The development of the infrastructure for cross enterprise document sharing (XDS) over the internet, has led to the development of a a more powerful web based open standards model to support image archive and sharing within the context of a longitudinal health record called XDS-I. Even still while PDI remains a rather low “tech” model it remains an excellent place for application vendors to start in developing the capacity for image exchange.