Integrating images into PHRs often requires complex work-arounds

Lack of vendor support for the complex task of integrating radiology images into personal health records may be holding back wider health information exchange, if the experience of one German hospital is any indication. "We have a very highly complex, message-based interaction between several systems...but it's currently highly dependent on local conditions and not as generic as we originally intended," Oliver Heinze of the Department of Information Technology and Medical Engineering at Heidelberg University Hospital said at the recent European Congress of Radiology meeting, reports.

Heidelberg University is testing PHRs as part of the Integrating the Healthcare Enterprise initiative, moving data between its 1,800-bed flagship institution, another 400-bed hospital and one primary-care practice. Like so many similar projects in the U.S., the PHRs have languished because they aren't able to import data automatically from other systems like each hospital's EMR.

Heidelberg University Hospital is trying to solve this problem by building HL7 interfaces for admission, discharge and transfer messaging and for medical document management. But to add images to the PHRs, the IT department first tried an IHE protocol called the XDS-I Cross-enterprise Document Sharing for Imaging integration profile. "However, this won't work at the moment because many of the different vendors don't support the needed profiles," Heinze said.

Instead, Heinze's team tried a "pull" strategy that combines HL7 and DICOM messaging with a centralized DICOM Web Access to DICOM Persistent Objects (WADO) module in the PHR. "This is, of course, a highly complex flow of data, and we have to establish two different kinds of HL7 interfaces in order to get the patient identification and other information [as well as] the accession number of the case," Heinze said. "This information has to be there at the WADO, and then the WADO can do the DICOM request and finally register the document in the record."

Such an approach may not be replicable in other locales, however.

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