"Connectivity" of imaging acquisition systems is a non-negotiable customer expectation. Providers transmit images from their modalities to a variety of imaging information systems, which include stand-alone analysis or review workstations, cluster archiving systems, hardcopy film and paper output devices, and an increasing number of Picture Archiving and Communications Systems. The level of connectivity expected by our providers now reaches well beyond point-to-point image transfer, taking into account increasingly sophisticated workflow processes-a new frontier where GE believes IHE can make a difference.

Several providers wonder why radiology requires more than what DICOM delivers for imaging. It is widely known that DICOM development has been a challenge; however, over the last eight years, GE and other industry leaders have optimized DICOM to provide good interoperability between radiology systems.

Now the "bar of clinical information integration" has been raised. New demands, such as linking images to radiology documents, accessing radiology and other clinical information systems and communicating this data beyond the walls of radiology, requires a broader level of connectivity. And this leads to the challenge of the new decade: increase efficiency and comfort of patient care and decrease the risk of medical errors. To achieve this, the imaging industry needs to reach out to healthcare information vendors to develop a complementary range of connectivity standards, among which HL7 plays a central role.

The combination of IHE-based integration with new technologies, such as GE's advanced direct digital radiography and mammography, multi-slice CT and functional MR, provides unsurpassed productivity and quality of care benefits.

Through the IHE initiative, industry reaches practical agreements on the best use of information technologies and standards to solve real-world clinical problems. This is good for providers who desire flexibility to select "best of breed" imaging systems. Additionally, for vendors it greatly simplifies the design and installation of new equipment and the process to upgrade installed-base equipment.

IHE is about teamwork, and since its inception, GE has been at the forefront with active involvement. Not only is it teamwork between vendors, but also between users and vendors. This is a novel approach to the complex problems of healthcare information systems integration that now has reached maturity in its definition.

The capabilities have been proven through several multi-vendor demonstrations at RSNA 1999 and 2000, and HIMSS 2000 and 2001. During the RSNA 1999 presentation, for example, GE demonstrated a variety of IHE ready products, including the GE Senographe 2000D digital mammography system, Signa MR family, and PathSpeed PACS. At the following year's RSNA, GE demonstrated the CT LightSpeed, eNTEGRA nuclear workstation, GE RadWorks workstation, and the Signa MR family. In fact, GE was the only vendor to demonstrate all seven IHE Integration Profiles at RSNA 2000.

As such, several deployments have taken place, and GE has learned that to achieve integration and successful IHE deployment in healthcare institutions, three specific actions need to be taken:

Along with the guidance of these deployment recommendations, providers not only can achieve radiology workflow productivity, they can help realize true clinical improvements in image quality. IHE's Consistent Presentation of Images Integration Profile ensures that images are consistently displayed on any display system within the institution (film or softcopy). This benefits both the user and the vendor in that images will appear consistent across all calibrated display systems. Users no longer will have to call their local service person to "tweak" the image to make it look like their films.

IHE also is an opportunity for vendors to maintain a simpler dialog with providers in understanding their integration requirements. Additionally, it provides a common framework for vendors to reach agreement on solving provider problems.

It is the hope of the IHE implementers that PACS projects-currently taking months of very complex technical analysis and installation-eventually will be reduced to weeks, while delivering higher levels of functionality. Eventually, IHE will expand the adoption of digital radiology across the entire enterprise by providing significant advancements and efficiencies in radiology workflow productivity.

Charles Parisot, Global Connectivity Center, GE Medical Systems Information Technologies, and Co-Chair of the IHE Technical Committee

GE Medical Systems Information Technologies is leading the digital transformation of healthcare delivery by helping customers improve efficiency and provide consistent quality care to patients. Together with its cardiology, patient monitoring, image management, clinical information systems and performance management services, GE helps healthcare providers make the transformation to an enterprise-wide digital environment. In making this transformation, it is challenging to overcome the barriers to access information across system boundaries. Yet, there is a better approach than the "interface engine" method of data integration, which adds undue complexity, poor maintainability, and higher costs to the institution.

Each individual information system is highly dependent on workflow information from other systems in keeping the provision of radiology services responsive to the entire healthcare institution. In the past, custom ad-hoc integration solutions were viewed insurance policies again losing customers. In reality, they have resulted in limited market growth while stifling technological evolution.

IHE provides a better solution.

In the radiology department, for example, three major forces are converging, which makes IHE a timely initiative. First, the "image factory" is transforming digitally, which opens the door to higher efficiencies and quality of care. The maturity of flat panel X-ray is a most recent example of this. The second force emerges from the dawn of the schizophrenic period, when the image information had to be separated strictly from the clinical and administrative information. Now the rapid adoption of PACS, its linkage to RIS, as well as the Web distribution of images and reports, is reinforcing the need for IT and imaging product vendors to work together. With stronger linkages, the lines of RIS and PACS are being blurred, evolving into a new generation of information systems. These new information systems are compelling radiology leadership to team-up with the chief information officer.

Finally, the third force is the need for efficiency and cost consciousness while at the same time, improving the quality of care and the reduction of medical errors. With this force, the "bar of patient information integration" has been raised. In the paper and film era, links between patient information and the acquired images were a manual process, which was both error-prone and time consuming. In this new era, patient information management becomes an integrated capability of the prescription, acquisition, review and diagnosis of a study.

GE views IHE as a mechanism to enable consistent exchange of clinical information, as well as the ability for healthcare providers to select best of breed information systems that uniquely deliver maximum efficiencies and ease of use.

To that end, three key issues need to be considered to deploy IHE. First, vendors need to promote IHE-ready products, while enhancing and aligning HL7 and DICOM capabilities of their information systems products. In fact, IHE can enable a focus on the design and support of better information systems, such as RIS, PACS, and clinical data repositories. Second, providers need to become an IHE-ready institution. The IHE Buyer's Guide is a useful resource to become familiar with the IHE Integration Profiles. Health care providers should keep in mind that their systems, such as HIS, RIS, PACS and modalities, do not need to be upgraded at once but that implementation can take place in incremental steps. Finally, providers should consider enlisting the help of IHE-ready integrators. These integrators can help analyze the current state and explore new possibilities with the profiles.

Since its inception, GE has been at the forefront of IHE with active involvement and participation at HIMSS and RSNA demonstrations with information systems, such as GE PathSpeed PACS. IHE not only is teamwork between vendors, but it is also teamwork between vendors and users with very efficient leadership from HIMSS and RSNA. This is a novel approach to the complex problems of healthcare information systems integration that now has reached maturity in its definition.

With IHE, the future promises an open environment among the industry-one where all vendors work together and share technologies for the sake of our healthcare providers and the successful digital transformation of the industry.

Vishal Wanchoo, Vice President and General Manager of Radiology Systems, GE Medical Systems Information Technologies

Charles Parisot, Global Connectivity Center, GE Medical Systems Information Technologies, and Co-Chair of the IHE Technical Committee