By Tim Kaschinske

In my last blog I discussed the avalanche of unstructured data sweeping through healthcare organizations and the data management challenges it is creating.  In this article, I will introduce an organization that is working to resolve these issues in healthcare: Integrating the Healthcare Enterprise” or “IHE” for short.

Coordinated primarily by the RSNA and HIMSS organizations, IHE consists of vendors and customers working together to define how applications interact. IHE uses existing standards in the healthcare market and optimizes their use by applications. It defines and publishes technical frameworks containing integration profiles that describe how applications should interact using these standards.

Healthcare vendors implement these IHE standards by following the specifications contained in the technical frameworks, and then test their implementations at IHE hosted “connectathons.”  After successful testing of the integration profiles, the technical frameworks are then published for use by all vendors and customers in healthcare.  Finally, IHE works with customers to help them specify integration profile functionality within their tenders.

IHE Domains

IHE separates their work into several functional domains within healthcare.  Radiology was the first domain, specifying integration frameworks for Scheduled Work Flow (SWF), Patient Information Reconciliation (PIR), and Portable Data for Imaging (PDI) among others.  Several other domains, such as cardiology and radiation oncology, have been added since the initial work done in radiology.


  • Scheduled Work Flow (SWF)
  • Patient Information Reconciliation (PIR)
  • Cross Enterprise Document Sharing – Imaging (XDS-I)


  • Cardiac Catheterization Workflow (CATH)
  • Echocardiography Workflow (ECHO)

Radiation Oncology

  • Basic Radiation Therapy Objects (BRTO)
  • Advanced Radiation Therapy objects Interoperability (ARTI)

The IT Infrastructure domain defines integration profiles that serve as the core infrastructure for other domains, including Consistent Time (CT), Enterprise User Authentication (EAU), Audit Trail and Node Authentication (ATNA), Cross Enterprise Document Sharing (XDS), and many others.  These integration profiles serve as building blocks to improve application integration within healthcare.

IT Infrastructure

  • Patient ID Cross Reference (PIX)
  • Patient Demographic Query (PDQ)
  • Cross Enterprise Document Sharing (XDS)

Scheduled Work Flow (SWF) in radiology was one of the first integration profiles defined and is also one of the most successful integration profiles.  Many radiology environments implement all or at least part of the specification for Scheduled Work Flow.  Scheduled Work Flow defines how the HL7 and DICOM standards are used to ensure that the correct patient data flows from order entry, to scheduling and to image acquisition, archive and review.  Applications are defined by actors within the integration profile, and transactions are defined using HL7 and DICOM to exchange patient data between the actors.  Implementation of the HL7 and DICOM transactions by the actors ensures the consistency of patient data across all of the actors within the integration profile.

By its nature, IHE defines the desired future state where all applications implement the appropriate actors and transactions that make the integration profile work successfully.  But today’s reality in healthcare is often far from this future state.  Actors and transactions are often implemented in newer versions of applications, requiring that customers have a plan for upgrading to the new applications with support for the integration framework in order to achieve the desired future state.  In some cases, such as radiology, this has been fairly straightforward leading to many successful implementations in radiology departments.  In other cases this is not as straightforward.  Cross Enterprise Document Sharing, or XDS, is an example of an integration profile with wide support from both vendors and customers that has had few implementations due to the difficulty in getting from today’s reality to the desired future state that is defined by the XDS integration framework.

So the good news is that IHE is hard at work coming up with solutions to the data explosion rocking healthcare.  In my next blog, I will describe how this is playing out today in relation to patient visits and the resulting problems of access to patient data.