Lapo Bertini from Integrating the Healthcare Enterprise (IHE) International, explains the importance of IHE in developing eHealth standards during his recent trip to South Africa for the free IHE workshop hosted by the South African Healthcare Informatics Association (SAHIA).
IHE is an international standard development organisation that works with the International Standards Organisation (ISO) to define interoperability standards in eHealth that improve the way systems share information. Systems developed in accordance with IHE communicate better with one another, are easier to implement and enable healthcare providers to use information more effectively.
The National Health Normative Standards Framework for Interoperability in eHealth (HNSF), which was published by the National Department of Health (NDoH) in early 2014, extensively references IHE integration profiles. It’s therefore important for South African eHealth organisations to understand what IHE does and how they can engage with us to ensure beneficial collaboration in developing eHealth interoperability standards.
Creating a plan for a complex problem
Healthcare uses a complex language to describe everything from procedures to diagnoses to billing; it therefore needs to be translated with standards to help the industry create solutions that streamline the different healthcare processes. Standards essentially define how healthcare information is packaged and communicated from one system to another – simply, setting the language, structure and data types required for seamless integration.
User process vs technical standards
IHE helps to facilitate the process when healthcare professionals seek to acquire or upgrade eHealth systems by enabling them to articulate the sufficient level of compliance to standards to achieve interoperability.
IHE Profiles provide a common language for purchasers and vendors to discuss the integration needs of healthcare sites and the integration capabilities of eHealth products. An integration profile has two faces: one is the use case for which the system is going to be used for; and the other one is the technical standards component, which is what that the industry has to use to implement the product. So the IHE Profiles essentially offer developers a clear implementation path for communication standards and give purchasers a tool that reduces the complexity and cost of implementing interoperable systems.
The power of standards
The first integration profile ever developed was for radiology codes to solve the interoperability issues associated with moving information across the radiology boundary and getting the results back. In 1999, before IHE was adopted and this integration profile was created, in a tender to describe the simple action of admitting a patient into the hospital and then into the radiology department, which involved doing the medical exam, taking the images out of the diagnostic modules and sending the report back, was 60 pages and often in a complicated language due to the different processes involved.
After the introduction of the first interoperability profile, the radiology procurement process went down to a single page. That page outlined what the radiologists’ volumes were – how many CT and MRI scans they do – and their long term objectives, what tools they want to use and the integration profile that they want to have. This is a prime example of how implementing an integration profile can solve the healthcare practitioner’s problem.
Governance vs guidelines
IHE is impressed with the HNSF and believes that it provides great interoperability guidelines based on thorough work from the CSIR and the NDoH. However, the HNSF only addresses 70% of the problem. Interoperability is a huge process, similar to a theatre production. For example, just having a stage is not enough; you also need to have the actors, a script and direction.
The next step is for the NDoH, or the CSIR under the mandate of the NDoH, to move those guidelines into the operational phase by ensuring the interoperability specifications are something that can be used in real-world SA to solve real healthcare issues. Keep in mind that this is not an easy task and it will take time because it’s a very complex matter.
It’s also important to keep in mind that standards are only enablers. IHE is not coming to SA and saying that you should do what the US has done; we provide support so that you know that the standards that you can use are established, are international, are maintained, and are being used by several million patients and clinicians world-wide.