February 19, 2007

IT Systems Attempt to Connect at Connectathon
By Neil Versel
For The Record
Vol. 19 No. 4 P. 12

If the Interoperability Showcase—meant to simulate data interchange among regional health information organizations (RHIOs)—at this year’s HIMSS conference is impressive, thank the 77 companies and organizations who spent one week in January making sure everything would work just right.

Stretched out on long tables that filled all five segments of a large Chicago hotel ballroom, technology from those entities underwent five days of rigorous testing during the eighth annual Integrating the Healthcare Enterprise (IHE) Connectathon.

IHE is an international project that, in the United States and Canada, is led by HIMSS, the American College of Cardiology, and the Radiological Society of North America (RSNA). Its primary goal is to promote the coordinated implementation of multiple, established HIT standards to address specific clinical needs.

During the Connectathon, IT systems are expected to complete electronic transactions with similar systems from other vendors based on predefined clinical use cases, testing the usefulness of data standards and looking for—and finding ways around—roadblocks to integration and interoperability.

“We’re trying to do the dry run of what people are doing at the [HIMSS] showcase,” IHE director Didi Davis explained. “We will be simulating four RHIOs and transfer of care across those RHIOs at HIMSS.”

The Connectathon is part of a series of IHE development activities, which also include the concept of use cases and technical framework for testing, as well as public comment periods to refine the framework. Demonstrations such as the Interoperability Showcase fall under deployment, which should lead to actual purchases of tested technology, according to Davis.

This year, IHE opened the event to outside organizations for the first time. The Council for Affordable Quality Healthcare (CAQH), a payer-driven coalition, tested interoperability for financial transactions, while the Clinical Data Interchange Standards Consortium took the opportunity to examine ways of integrating electronic health record workflows into the life sciences. “CAQH is filling a void we’ve always been asked about,” Davis said.

One day before the Connectathon ended, Davis reported that this year’s event had so far been the smoothest one to date. “All the vendors are much further along than they were last year,” she said.

Just from the venue, it was clear the Connectathon had come a long way from its early days, when it was held in the parking garage at RSNA headquarters outside Chicago. Davis says the Interoperability Showcase will involve 67 participating organizations—an increase from 37 one year ago—and take up 9,000 square feet of the HIMSS show floor at the Ernest N. Morial Convention Center in New Orleans.

This year, IHE created frameworks for cardiology, IT infrastructure, laboratory, coordination of patient care, medical devices, and radiology.

In cardiac care, participants were required to track patient data flow from home to primary care physician to cardiologist to hospital emergency department (ED) with a personal health record on a USB thumb drive serving as the conduit of information and the link to each physician’s electronic medical record.

Another scenario tested interoperability with radiology when an emergency physician electronically ordered a chest x-ray. The order should lead to digital images then documentation in a picture archiving and communication system. Finally, the images should be made available to a RHIO.

For device connectivity, participants tested the movement of ED vitals to the intensive care unit, where the patient was started on intravenous fluids delivered by a smart pump. The next day, the patient was moved to an operating room for a coronary artery bypass graft and placed on a monitor and ventilator. Values from all the devices should appear on the operating room computer dashboard.

Testing of care coordination focused on follow-up to a hospitalization. For this, the patient was given an electrocardiogram prior to being discharged. Images and a discharge summary went into what IHE calls an XDS repository, shorthand for cross-enterprise document sharing. At home, the patient checks blood pressure and sends the readings to the same repository, which the cardiologist can access during a post-op office visit.

Similar-use cases were tested for trauma care of an unknown patient and will be on display at HIMSS. In the meantime, testing results are available at www.ihe.net or through individual vendors. Each participating vendor publishes an IHE integration statement, spelling out which integration profiles their products support. IHE encourages healthcare providers to reference the profiles in requests for proposals.

To get credit, vendors have to test interoperability with three other participants per profile to prove their products actually follow established standards. “We don’t do certification testing,” Davis said. “We do compliance testing.”

The weeklong Connectathon is actually the culmination of one year’s worth of work. Shortly after the annual event, IHE engages clinicians and IT professionals to identify common barriers to interoperability, taking into consideration access to information, clinical workflow, and administrative processes. IT experts then look for relevant standards to address these problems and develop integration profiles, or clinical use cases, around which to build a testing framework.

Each June, technology vendors and other interested parties attend a five-day educational workshop to learn about the new profiles. “It gives them a chance to review these [profiles] during the development of the framework,” said Davis. After a public comment period on proposed profiles, IHE publishes the use cases in mid-August and participants have until September to determine the domains in which they will test.

Vendors spend the early part of the fall adding the appropriate functionality to their products, then undergo what Davis called an “open-book test” from November 15 to December 15 in preparation for the Connectathon.

Results of the Connectathon were published on the IHE Web site approximately one week after the event ended.

— Neil Versel is a journalist in Chicago specializing in HIT.