RSNA: Now's the time for IHE, REM and XDS-I profiles
CHICAGO—With the passage of the American Recovery and Reinvestment Act, IHE (Integrating the Healthcare Enterprise) has “found its moment in time,” said David Mendelson, MD, chief of clinical informatics and director of radiology information systems at Mount Sinai Medical Center in New York City, during a session at the Radiological Society of North America (RSNA) meeting on IHE and integration issues.
IHE is an initiative by healthcare professionals and vendors to improve the way computer systems in healthcare share information by promoting the coordinated use of established standards such as DICOM and HL7.
Mendelson, who is also a member of the RSNA Radiology Informatics Committee and co-chair of IHE International, pointed out that for institutions to achieve EMR meaningful use standards they will have to have “a certified system that has achieved certain standards and it would appear that the standards are going to be the ones defined by HITSP" (Healthcare Information Technology Standards Panel).
“And if you look at the HITSP standards, you will notice that IHE comprises about 40 to 50 percent,” Mendelson added. “This has very real meaning for vendors in the United States.”
Two IHE profiles whose time may be coming over the next year, said Mendelson, include the Radiation Exposure Monitoring (REM) profile and the profile for Cross-enterprise Document Sharing for Imaging (XDS-I).
“Why collect the (radiation dose) numbers?” asked Kevin O’Donnell, a senior manager for systems development at Toshiba who has worked on the REM profile. “If you don’t have that data, everything is anecdotal.” O’Donnell also pointed out that as vendors “we keep changing the technology on you . . .so it’s very difficult to stay on top of where those dose targets should be.”
The profile establishes standards for vendors for the automatic capture of radiation dose exposure information during a procedure and making it part of a patient record in the PACS. According to O’Donnell, that information can be used by radiologists to “look for outliers and trends” and make comparisons on radiation dose exposures from one year to the next, or even from hospital to hospital.
Radiation dose could also be “anonymized,” said O’Donnell, so it could be sent to a central dose registry where it could be analyzed on a broader level.
According to O’Donnell, eight vendors are already working to adopt the REM profile, including Agfa, GE Healthcare, Siemens Healthcare, Krucom, EDL, InfiMed, MedicalCommunications and Softway Medical.
The XDS-I profile is a solution for sharing imaging documents across a network of affiliated enterprises such as radiology departments, private physicians and clinics. As part of that profile, Mendelson said, efforts are going on to help patients maintain control of their imaging information through Personal Health Records (PHR).
“PHRs are in development and no one knows how successful they will be,” said Mendelson. “But I submit that a pretty large segment of our population is going to like that solution. So we’re trying to take that profile and make it work under consumer control.”
What would happen, said Mendelson, is that when a patient undergoes an imaging study the patient would be asked whether he or she wants it to be part of a PHR. If the answer is yes, a central repository would be notified those images are available. After that, for example, a patient would have the ability to easily allow those images to be upload from that repository to an EMR so they could be accessed on a wider basis.
According to Mendelson, RSNA has just received a contract from the National Institutes of Health to construct this kind of image sharing network involving 300,000 patients over the next few years. The hope, said Mendelson, is that the project would provide the business model that could be used across the country.
IHE is an initiative by healthcare professionals and vendors to improve the way computer systems in healthcare share information by promoting the coordinated use of established standards such as DICOM and HL7.
Mendelson, who is also a member of the RSNA Radiology Informatics Committee and co-chair of IHE International, pointed out that for institutions to achieve EMR meaningful use standards they will have to have “a certified system that has achieved certain standards and it would appear that the standards are going to be the ones defined by HITSP" (Healthcare Information Technology Standards Panel).
“And if you look at the HITSP standards, you will notice that IHE comprises about 40 to 50 percent,” Mendelson added. “This has very real meaning for vendors in the United States.”
Two IHE profiles whose time may be coming over the next year, said Mendelson, include the Radiation Exposure Monitoring (REM) profile and the profile for Cross-enterprise Document Sharing for Imaging (XDS-I).
“Why collect the (radiation dose) numbers?” asked Kevin O’Donnell, a senior manager for systems development at Toshiba who has worked on the REM profile. “If you don’t have that data, everything is anecdotal.” O’Donnell also pointed out that as vendors “we keep changing the technology on you . . .so it’s very difficult to stay on top of where those dose targets should be.”
The profile establishes standards for vendors for the automatic capture of radiation dose exposure information during a procedure and making it part of a patient record in the PACS. According to O’Donnell, that information can be used by radiologists to “look for outliers and trends” and make comparisons on radiation dose exposures from one year to the next, or even from hospital to hospital.
Radiation dose could also be “anonymized,” said O’Donnell, so it could be sent to a central dose registry where it could be analyzed on a broader level.
According to O’Donnell, eight vendors are already working to adopt the REM profile, including Agfa, GE Healthcare, Siemens Healthcare, Krucom, EDL, InfiMed, MedicalCommunications and Softway Medical.
The XDS-I profile is a solution for sharing imaging documents across a network of affiliated enterprises such as radiology departments, private physicians and clinics. As part of that profile, Mendelson said, efforts are going on to help patients maintain control of their imaging information through Personal Health Records (PHR).
“PHRs are in development and no one knows how successful they will be,” said Mendelson. “But I submit that a pretty large segment of our population is going to like that solution. So we’re trying to take that profile and make it work under consumer control.”
What would happen, said Mendelson, is that when a patient undergoes an imaging study the patient would be asked whether he or she wants it to be part of a PHR. If the answer is yes, a central repository would be notified those images are available. After that, for example, a patient would have the ability to easily allow those images to be upload from that repository to an EMR so they could be accessed on a wider basis.
According to Mendelson, RSNA has just received a contract from the National Institutes of Health to construct this kind of image sharing network involving 300,000 patients over the next few years. The hope, said Mendelson, is that the project would provide the business model that could be used across the country.