Healthcare information technology (IT) managers seeking to build bridges between departments as disparate as radiology, cardiology, and pathology are faced with a monumental task. Recognizing that the needs of patients and clinicians demand interoperability between specialty systems, the Integrating the Healthcare Enterprise (IHE) initiative has sought to create that span, linking the independent islands of information that characterize much of modern healthcare.
The IHE is a collection of profiles, based solely on existing data standards, which seek to unify solutions to real-world integration problems. Radiology, with its data-rich environment, has been the medical specialty to first embrace the IHE initiative. However, according to the recent 2005 HIMSS Integrating the Healthcare Enterprise Survey, many facilities have yet to install systems with IHE capabilities.
Those institutions that have implemented IHE-capable systems have reported savings in both time and money with adopting the initiative. Ensuring IHE compatibility is more than a matter of requesting it from a vendor -- it's a contractual necessity.
"Lawyers exist to either make order out of chaos or turn order into chaos," quipped attorney Jeffrey Ganiban. "The contract is the key element of the purchase. The contract details, along with the terms and conditions, can make the difference between a great buy and a disaster."
Ganiban, along with Dr. Nogah Haramati, provided their insights on creating a vendor/user framework for implementing IHE at the 2005 Healthcare Integration and Management Systems Society (HIMSS) in Dallas.
Ganiban is with the Washington, DC-based Innovative Health Strategies. Haramati is the chief of radiology and professor of clinical radiology and surgery at the Jack D. Weiler Hospital, Albert Einstein College of Medicine in New York City.
"No single information system can address all the needs in a modern healthcare environment," Haramati noted. "Most healthcare information systems are designed and marketed to serve a core or specialized function. Intersystem connectivity and the capability to easily exchange data have generally required focused and expensive integration efforts by the users."
The first step in bringing IHE systems into a facility is deciding what systems are wanted for the immeadiate future, and to identify which IHE integration profiles are desired, Ganiban said. The integration profiles describe a real-world problem, the context, what systems are involved, the actors, and what they must do, the defined transactions.
Haramati advised that a facility be realistic about which profiles it wants to bring on board near term.
"Decide on what profiles you would like to implement along with the time frame," he said. "Identify your enterprise wish list for IHE penetration in the coming years, and consider future profiles and domains that are still gestating."
Once the specific IHE implementation profiles have been decided and prioritized, a group will need to determine which actor that it wants a particular vendor to provide.
"Make sure that in each profile, every actor that you require is covered in your plan," Ganiban advised.
In addition to IHE-compliant systems and the roles to be filled by particular vendors, a facility needs to identify non-IHE equipment and systems, and map out the manner in which they will be integrated into the IHE environment, Ganiban said.
"It's important to double-check that every transaction related to the relevant actors is adequately covered," he noted.
Once the background work has been accomplished, the practice will now be able to require contractual commitments from each IHE vendor such as PACS, RIS, voice recognition and dictation, and modalities regarding IHE integration and compliance, according to Ganiban. He recommended that contractual commitments for IHE integration profiles be deployed as part of an initial system implementation. In addition, cost allocations for support and maintenance of the initial and future deployment of the IHE integration will need to be agreed upon.
The IHE initiative is a dynamic process, and new profiles are continuing to be added. As such, Ganiban advised that a facility create a standing committee be created for evaluating and deploying modified or future IHE profiles. This group should be comprised of both staff and IHE-savvy vendors, he said.
"The IHE vendors should agree to support modified or future IHE profiles that are relevant to a customer's workflow," he stated. "The customer needs the right and the contractual mechanism to require the IHE vendors to support a modified or future profile if specific criteria are met."
For smaller institutions, Ganiban believes that IHE testing can follow existing protocols for acceptance testing. For larger facilities, with multiple systems and interconnected devices, he advocates establishing an IHE test environment where interoperability can be examined without impacting daily workflow.
"The ability to test upgrades, patches, and other vendor enhancements in a complete test environment ensures uptime performance and reduced potential for errors and failures when these same products are moved to the live, clinical production environment," he said.
Because IHE contract creation is a very new area, Ganiban strongly supports that any IHE-compatibility contract be carefully examined by a practice's lawyer.
"Ensure that every vendor understands and accepts their exact areas of responsibility," Ganiban counseled. "Make sure that your contracts are enforceable with penalties and teeth for nonperformance."
By Jonathan S. Batchelor
AuntMinnie.com staff writer
March 11, 2005
Related Reading
Survey shows IHE compliance reduces costs, February 16, 2005
IHE assists regional health architecture, February 15, 2005
HIPAA security: IHE guidelines help ensure compliance, November 26, 2004
Developing an effective PACS RFP, November 24, 2004
PACS procurement: Three starting points for success, August 17, 2004
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