For those of us without expertise, information technology is more readily understood in conceptual terms. As we wire our homes, offices, and hospitals, we spin a web of connectivity that enables us to communicate, compete, and simply carry on more efficiently. And hence, we in the press tend to glamorize it all, the public buys in, and vendors at health information trade shows make promises that look a lot like castles in the air. Remove the hype, and information technology can be boiled down to fiber-optic cables, gateways, silicon, and the software that instructs it. Anyone who has implemented a picture archiving and communications system (PACS) understands this far better than I.
Within the radiology department, we do have our connectivity issues. The acronym DICOM (Digital Imaging and Communications in Medicine) is used fairly loosely, and whether a piece of technology is DICOM compliant, DICOM conformant, or DICOM compatible could mean the difference between ease of implementation and just plain trouble. Connecting to the rest of the hospital is another issue. The most elegant solution to connectivity is a system in which the radiology information system (RIS) can retrieve demographic, identification, and insurance information from the hospital information system (HIS), instruct the PACS, and then transmit back department activity for both medical and billing purposes; a system that could ultimately tolerate and accept from the PACS the transmission of pertinent images, to be stored along with the medical history, with minimal redundancy of information. Huge gaps in understanding between HL-7 and DICOM currently obfuscate this communication.
That is why the Integrating the Healthcare Enterprise (IHE) initiative, the joint project between the Radiological Society of North America (RSNA) and the Healthcare Information and Management Systems Society (HIMSS), has generated so much hope, hopes that were somewhat disappointed in April at the HIMSS meeting. A demonstration by participants revealed that while radiology vendors are indeed on board, the information system (IS) vendors appear to have remained at the station. Many there made the jaded observation that IHE was a charade.
The good news is this: there is a plan, and progress has been made. During the closing session of the Society for Computer Applications in Radiology meeting, on June 6, 2000, a group of radiologists and vendors led by R. Gilbert Jost, MD, offered a detailed historical presentation on the genesis of IHE, what it has accomplished, and where it is headed. The focus during the first year was on reducing redundancy of data and function; closing the information loop between RIS, modalities, and PACS; and improving prefetching efficiencies within the RIS/PACS environment. Imaging vendors are to be commended on their participation in this effort, which helped produce the IHE Technical Framework Standard Version 3.1, available online at www.rsna.org. The standard offers instructions for four modality transactions; five PACS transactions; and five RIS transactions. Be advised that the standard exists, but not all vendors have incorporated it. Radiologists, administrators, and information services personnel must ask: Does the product support the specified DICOM service classes and HL-7 messages according to the IHE Technical Framework Version 3.1?
Now that radiology has its house in order, the IHE widens its scope for year 2 to include image availability, access to radiology information, access to non-radiology information, patient information reconciliation, consistent presentation of images, and report management. Clearly, the ambition of the Year 2 initiative requires greater involvement on the part of the IS vendors. That leaves radiology departments with a job to do: If radiology wants to be connected to the health care enterprise, it needs to sell the information services department on the importance of the IHE. The emperor is indeed clothed; however, only half so.
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