The bridge builders

IHE (Integrating the Healthcare Enterprise) is an initiative by experts in the healthcare industry. They have one goal: to improve communication between various IT systems and medical devices. Many regions and countries have already developed eHealth concepts based on IHE profiles. The number of IHE projects is increasing in Germany as well, even though there is considerably less awareness and support at the national policy level than in other European countries.

IHE was actually supposed to be history more than 10 years ago. It was originally launched by the RSNA (Radiological Society of North America) and HIMSS (Healthcare Information and Management Systems Society) as a five-year initiative to improve interoperability. IHE’s goal was not to develop new standards, but to apply existing ones consistently, and to do so in conjunction with defined interpretations of them modeled on specific use cases.


IHE used new approaches to accomplish this. One of its significant features is the joint activity of manufacturers and users in the various fields where IHE continues to operate. Workflow steps were assigned to individual actors to create profiles. Actors carry out their individual tasks by means of defined transactions. The relevant standard is identified for each transaction—apart from DICOM and HL7, these are mainly web standards—along with the action to be adopted. This means that the profiles have a defined development cycle, and manufacturer implementation is tested in a five-day, real-world testing scenario (a Connectathon).

The success of this concept in radiology generated interest in other fields as well, and soon it was also being used in cardiology and ophthalmology. In addition to the clinical domains, an IT infrastructure domain (ITI) was created as a general, interdisciplinary initiative; next to radiology, it is currently the most successful IHE domain worldwide.

National and international importance
The IHE organization is active around the world, though it was originally focused on the United States. However, IHE committees quickly arose in other countries, first in France in 2001, and a year later in Germany. At the same time, IHE Europe was being set up as a regional umbrella organization; it has officially operated as a nonprofit since 2008, and has been a partner in numerous past and present EU projects. IHE is now active worldwide, with branches in Asia (China, Japan, Korea) as well as North America and Europe.

Growing interest in regional- or national-level solutions for cross-enterprise communication platforms and/or eHealth applications has found its way into many countries’ strategic planning in these areas. Some prominent examples are Austria with its ELGA (Electronic Health Record), Switzerland with eSuisse, and Luxembourg with eSanté. They have adopted nationwide initiatives built on the IHE XDS (Cross-Enterprise Document Sharing) profile family.

At the European level, IHE is involved in numerous projects. One of the major ones was epSOS, in which users designed and implemented a solution for cross-border exchange of emergency data and medication. The European Commission’s decision to officially recognize a total of 27 IHE profiles, adopted on July 28, 2015, was certainly helpful in this context, increasing IHE’s visibility in Europe.

How are the specifications designed?
IHE profiles describe specific solutions for interoperability needs, and thus represent a fundamental element of the IHE concept. Involving all systems (“actors”) in fulfilling the requirements of a profile as part of a specific work process should ensure successful collaboration, since each IHE profile allows for a specific solution for a particular task (“transactions”), thus avoiding optional variations in standards. IHE profiles are intended to address important medical issues in this context. Multiple profiles within a discipline are then incorporated into a cohesive “technical framework.”
The IHE profiles are developed by the individual specialized domains, each of which has a planning committee for strategic matters and a technical committee for development. Interested members or groups continually suggest new topics (“profile proposals”). Specific issues are prioritized according to available resources. Profile development follows a fixed cycle that repeats every year.

New profiles are initially published as “supplements” and are open for public comment for 30 days. The next step is to classify supplements for “trial implementation” in order to collect feedback from real-world implementations. The supplements are then modified, if necessary. Finally, the “final text” version is published.

Amendments and modifications to finished supplements can be handled via “Change Proposals” in a process borrowed from the DICOM standard. An important consideration for users and manufacturers: A high level of transparency and cooperation must be present, particularly at the stage where decisions are being made on new profiles and their specifications and development. The documents, including the final supplements or technical frameworks, are available for free on the Internet.

Connectathons and Product Registry
Connectathons are multi-day events where manufacturers can verify the correct implementation of the IHE profiles. They can test their solutions’ functionality directly in simulated runs and modify them if needed. This demonstrates to users that the manufacturers have a certain degree of expertise and experience in implementing those particular profiles.

Participation in Connectathons is open to manufacturers and other groups that implement IHE profiles. An independent management team of monitors is in charge of organizing and supervising the events. These individuals are IT experts, e.g. from universities or research facilities, with IHE expertise. They act as manufacturer-neutral monitors and test evaluators. Thousands of individual tests are performed and verified during a Connectathon. The results are recorded and published.

In Europe, over 370 participants from 83 companies with a total of 114 systems took part in Connectathon 2016 in Bochum, Germany. The results for the individual systems are available online at, and can be searched by various criteria, such as manufacturer, actor, or profile. Manufacturers can publish their integration statements in the IHE Product Registry. This makes it easy for users to see which systems are available for particular profiles and actors.

IHE-Services puts together Connectathons in Europe. Their experts are also involved in the development of the necessary testing tools. They do this using Gazelle, a long-standing platform, which is also available for use in regional or national projects. In addition to Connectathons, Projectathons have also been organized in past years to test specific extensions, e.g. for the epSOS project or the “FallAkte” (case record) project in Germany.