What is IHE?
Integrating the Healthcare Enterprise (IHE) is a worldwide nonprofit initiative. IHE works with users and manufacturers on common eHealth interoperability use cases to create detailed, standards-based specifications for them that will be accepted worldwide (see chart). IHE also supports use of such profiles through an open-source test platform and product conformity certifications.
Similar use cases around the world
IHE’s role is to ensure that these global commonalities in the standards community can be worked out before they are used as a base for particular markets or implementations and possibly augmented by local requirements. This results in solutions that are similar throughout the world, which is a prerequisite for a global market comprising interoperable and tested products, which leads to healthy competition and thus cost efficiency and sustainability.
IHE’s role in patient records
Setting up a regional or nationwide patient records system is complex because there are many stakeholders to be included. This type of project usually comes under the governance of a higher-level entity, such as a regional or national authority.
Different healthcare service facilities, which may be organized within various parent entities, need to be linked to different software systems. The task is further complicated by the fact that in some cases, e.g. in Austria, central components—e.g. a national/regional patient registry, healthcare provider directory, access control system, etc.—need to be integrated into the structure. This results in a multitude of systems that would only be able to handle data exchange with a great deal of technical effort. International standards are needed in order to prevent such situations, and those standards already exist. Bilateral data exchange is already visible on the horizon, for example through the eHDSI (eHealth Digital Service Infrastructure) agenda in Europe.
Utilizing the above international standards is not the only crucial factor, however. The most important issue is whether the way they are employed in individual eHealth interoperability use cases is consistent with normal worldwide practice. This is the only way to ensure that all the phases of establishing this kind of records system—from the specification to the bidding and procurement process to system startup and testing—can be made as cost-efficient as possible. This is precisely what the IHE delivers.
IHE in Switzerland and Austria
The projects in Switzerland and Austria are prime examples. In Austria, IHE profiles formed the basis for development of the national health record system (ELGA), which began in 2006, from the very beginning. The ELGA architecture consequently follows a number of the established IHE profiles.
Thanks to the “borrowed expertise” of the entire IHE community, there were enormous cost savings during the planning, specification, procurement, and startup stages. This also made it possible to focus entirely on deployment of the profiles in Austria and the associated specific details.
One thing is clear: A solution confined entirely to deployment of IHE profiles would be even more cost-effective. In actual practice, however, project-related extensions are generally unavoidable — but should be kept to a minimum.
Extensions are generally unavoidable
The architectures in Austria and Switzerland are similar. Even though the legal framework in Switzerland is different from that in Austria—patient participation in the Electronic Patient Dossier system in Switzerland is voluntary, for example—the same IHE profiles are used. This in turn facilitated an active exchange of information between the two countries: They could learn from each other and avoid mistakes.
Important profiles and IHE standards
The most important IHE profiles for health records are undoubtedly the ones in the IT Infrastructure domain. They are also the most widely used:
- Patient identification and demographic data: PIXv3/PDQv3
- Clinical document exchange: Cross-Enterprise Document Sharing (XDS.b), XCA
- Access control, authentication, and audits: XUA, ATNA
- Patient consent: APPC, BPPC
There are also other useful profiles for health records:
- Medication: Pharmacy domain profiles: CMPD, PRE, DIS, PADV, PML, MTP
- Radiology: Radiology domain profiles: XDS-I, XCA-I
The newer IHE profiles make increasing use of the HL7 FHIR® standard, for example Mobile Access to Health Documents (MHD). They facilitate access to clinical documents using FHIR technology.
IHE International → www.ihe.net/
IHE Europe → www.ihe-europe.net
Technical Frameworks und IHE-Profile → www.ihe.net/Technical_Framework
IHE on FHIR Blog → https://healthcaresecprivacy.blogspot.com/2017/01/ihe-on-fhir.html
European Commission recognizes 27 IHE profiles that should be referenced in public procurement documents → http://eur-lex.europa.eu/legal-content/EN/TXT/?uri=OJ:JOL_2015_199_R_0011
eHealth – Digital Service Infrastructure (eHDSI) → https://ec.europa.eu/cefdigital/wiki/display/EHOPERATIONS/eHealth+DSI+Operations+Home
Technischer Hintergrund der Österreichischen Gesundheitsakte ELGA → https://elga.gv.at/technischer-hintergrund/technischer-aufbau-im-ueberblick/index.html
Schweizer Patientendossier → www.e-health-suisse.ch/startseite.html