IHEonFHIR


 * IHE on FHIR: **[[image:ihe-australia/FHIRLOGO.png align="right"]]
 * a summary of IHE profiles on FHIR in 2016 **

Peter MacIsaac IHE Australia [1] Chris Lindop IHE Radiology [2]

IHE Australia is the local branch of IHE International, an international health IT standards and development community charged with solving the big issues of how different organisations in the health sector can communicate electronically. The solutions are only partially technical, so in addition to application of existing standards such as HL7, DICOM and Web services, IHE focuses on the social and organisational factors to create a digital health community able to support effective interoperability.

The IHE “trademark” is collaboration between health professional organisations, national IT programs and the health vendors to enable agreement and implementation of standard communication functionality and workflows. Progress in health IT seems to struggle when driven by either top down mandate or bottom up individual vendor or implementer efforts. IHE is an example of the alternative “middle out approach”, a term coined by [|Professor Enrico Coiera] to describe a solution to the way technical change was being adopted in the UK’s NHS health IT reforms.

IHE publishes interoperability **profiles** which define user and vendor agreement on functionality, provide detailed implementation guides to the component standards such as HL7, DICOM, Web services and other sources, and form the basis of conformance testing in regular Connectathons. IHE’s library of profiles supporting many healthcare domains is updated as technology advances, requirements change and standards are updated or emerge. IHE is contributing to the development and implementation of emerging standards, two of which HL7’s FHIR and DICOM’s DICOMweb.

Fast Healthcare Interoperability Resources ( [|FHIR] ) are HL7’s standard implementation of health communication using RESTful Web services. This approach to machine to machine communication is rapidly gaining support in the industry, as being less time consuming and complex to implement, especially on mobile devices with limited computational power. IHE and vendors are moving to embrace FHIR because it helps solve real business problems. Initially IHE’s focus has been on updating existing profiles and providing FHIR as an option applied to existing transactions.

Another emerging IT standard being implemented to support mobile communication is [|DICOMweb], DICOM is the major standard for radiology and image communication and via IHE Scheduled Workflow profile has traditionally been implemented on high speed local networks, and is less suited to the mobile operating environment.

The following diagram provides an overview of how FHIR and DICOMweb are being integrated with existing IHE profiles and support image and information exchange within
 * Share health records – health information exchange
 * Patient identify management
 * Point to point communication
 * Electronic medical records
 * Medical image management

A key strategy adopted by IHE to engage both vendors and the health community is the delivery of testing and demonstration events. IHE Australia is seeking expressions of interest from health vendors to implement IHE profiles at the j2017 IHE Australia Connectathon and the Interoperability @ HIC 17 showcase. Further information can be accessed online.



Figure: IHE profiles adopting FHIR and DICOMweb.


 * IHE Profiles using FHIR and DICOMweb in 2016 **

FHIR itself is still under development, consequently efforts to incorporate FHIR options within existing and developmental IHE profiles are also ‘works in progress”. As yet there are no “final text” profiles and the following examples are out there for testing and trial implementation.


 * 1) ** 1. ** ** Shared Health Records – Health Information Exchange **

[|**Mobile Access to Health Documents (MDH)**] defines a simple web based mobile friendly interface to a health information exchange based on an XDS like environment. Supports store, submit to index, and retrieval of documents

[|**RESTful ATNA Query**] adds the ability to retrieve records from an Audit Registry repository (which is the log trail for interactions in IHE XDS health information exchange)

[|**Reconciliation of electronic clinical information (RECON)**] enables the reconciliation of electronic clinical information from multiple data sources. Usually this is a difficult task involving managing lists of clinical information that are often larger than most users can keep in working memory. This profile enables shared health information to support automation of these reconciliation tasks and clinical workflows.


 * 1) ** 2. ** ** Patient Identify Management and Identity Services **

[|**Patient Demographics Query for Mobile (PDQm)**] provides a RESTful/FHIR interface to a patient demographics leveraging technologies readily available to mobile applications and lightweight browser based applications.

[|**Patient Identifier Cross - reference for Mobile (PIXm)**] provides a FHIR interface for communication between a health application and with identify services to register a person and update local identify management


 * 1) ** 3. ** ** Point to Point Communication **

[|**Mobile Alert Communication Management (mACM)**] is the infrastructure specification needed to send and record outcome of short, unstructured text alerts (e.g. SMS).


 * 1) ** 4. ** ** Electronic Medical Record **

[|**The Guideline Appropriate Ordering Profile (GAO)**] is a mechanism by which EHR and departmental systems can evaluate orders to determine conformance with guidelines.

[|**Clinical Mapping (CMAP) Profile**] supports mapping between clinical terminologies where:
 * • Device generated observations need to be converted to clinical terminologies for use in clinical decision making and record keeping
 * • Clinical terminologies need to be converted to billing compatible terminologies for communicating diagnoses and procedures.


 * 1) ** 5. ** ** Image Management **

[|**Mobile access to health documents for imaging (MHD-I)**] identifies of radiology images accessible through XDS-I health information exchange on mobile devices

[|**The Web-based Image Capture Profile (WIC)**] is a simple, lightweight, mobile-friendly mechanism to encode and send captured images, videos and evidence documents from the mobile device to image management systems.

For further information about IHE on FHIR, other IHE profiles or to explore participation in the process as a vendor or health professional please contact:

Dr. Peter MacIsaac Secretary IHE Australia admin@ihe.net.au

[1] Address for correspondence: peter@macisaacinformatics.org; admin@ihe.net.au [2] Based on a presentation given by Chris Lindop to the Radiological Society of North America 2016 Conference