Standards vs. IHE – What’s the Difference?
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With an imposing variety of healthcare standards, Initiate's Bill Klaver wades through the differences
While there is an increasing call for healthcare providers, payers and specialists to share information across the ecosystem, work must still be done to further agree upon standards for exchanging data. Though many different sets of standards do exist, they sometimes contradict each other, especially across international boundaries.
Groups like Integrating the Healthcare Enterprise (IHE) are helping unify the worldwide need for best practice use of standards. IHE is NOT a standards development organization (SDO); rather, IHE serves as a liaison with SDOs, including HL7, DICOM, ISO and others. Founded by HIMSS, RSNA and ACC, IHE is a worldwide volunteer organization whose main mission is to promote interoperability and prove the viability of interoperable healthcare.
Going one step further, IHE’s goal is to take real-world healthcare use cases and create interoperability profiles using proven industry standards. This helps promote unbiased selection and coordinated use of established healthcare and IT standards that address specific clinical needs.
So what are IHE profiles?
Profiles are designed to solve “real world” business problems that healthcare practitioners face on a daily basis. An interoperability profile is a collection of steps that a user would go through to share healthcare information using industry standards. For example, profiles are designed to facilitate the exchange of:
- Patient information – patient records, visit information
- Images - x-rays, PACS
- Documents - discharge summaries
Additionally, one can view IHE as having three types of profiles:
Composite Profiles – Generally the overarching profile used to solve a healthcare business problem:
- XDS – Cross-enterprise Document Sharing
- XDSI – Cross-enterprise Document Sharing for Images
- XDS-M – Cross-enterprise Document Sharing for Media
Specific profiles – Individual vendors agree to provide this functionality through international standards:
- XDS Registry – The document location service that tracks where patient information is stored
- XDS repository – The secure and reliable location where patient information is stored
- PIX manager – Responsible for the proper resolution of all patient identity information
- PDQ Supplier – Accurately addresses questions about a patient via that patient’s demographic information
- BPPC – Basic patient privacy and consent, used to restrict access to patient information to valid users
General profiles – Everyone must comply with these:
- Consistent Time (CT) Profile – Ensures use of an endorsed time server to make sure dates and times are synched across all systems
- Audit Trail & Node Authentication (ATNA) Profile – Required encryption of all communications and data exchanges with the audit trail and logging of all transactions
These profiles are important, as they enable vendors and healthcare organizations alike to gain a clear understanding of which standards are essential to achieve efficient, cooperative and reliable interoperability. By outlining the standards needed for integrating and sharing data – along with how to apply the standards – both sides can better understand what must be implemented to meet their needs.
IHE creates, researches, tests and publishes a number of profiles designed for specific clinical care scenarios, from home-based patient care to emergency treatment to provider-to-provider exchanges and provider-to-patient care. More specific information about IHE profiles is available on their website.
Why is IHE Different than Other SDOs?
IHE, uniquely, requires that any vendor who says they support a profile should prove it. You prove that your product supports a profile by attending a weeklong testing event called a "Connectathon."
At a Connectathon, you are required to prove your product complies with the profile and standards by testing all the profile’s specific transactions with at least three other vendors. All tests are logged and then graded by proctors for completeness and accuracy.
A Connectathon is unlike any other event in the world. Vendors, whether partners or competitors, work diligently to get their products through testing while helping each other so their products will also pass the test.
Why? If my product passes but yours doesn't, then how do we connect in the real world?
Initiate has participated in 15+ Connectathons over the past 6 years around the globe. Initiate has tested in North America, Europe, Malaysia, Australia and Japan.
In each Connectathon, Initiate not only tests with our current partners, but also with small and/or country-based companies from other parts of the world. We do this is because there is no other avenue where we can work directly with other product engineers to determine how we can integrate our technologies.
While we may be competitors, in the real world, we may share customers who need to know that our products can play well together. The Connectathons improve relationships between companies, improve products and provide the only place where theory meets reality.
While each standards development organization focuses on its most pertinent challenges, coordination among them via IHE helps everyone involved in HIT ensure that we stay focused on a common goal: encouraging and enabling interoperability among healthcare organizations.
In my next posts, I’ll dig into the specifics of how you go about building a solution, from starting with core services to leveraging a PIX/PDQ manager.
This is part of Bill Klaver's series, Building a Health Information Exchange Through International Standards. For other posts in the series, visit the Table of Contents.
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