Guest author Uwe Porwollik presents a four-part series of the worldwide initiative IHE Integrating the Healthcare Enterprise . In the fourth blog post you will learn what the IHE Cookbook is and how an international methodology is being adapted to the German health sector.


IHE brings light into the darkness!

Overcoming sectoral boundaries has become the biggest problem in health IT over the last few decades, with system boundaries within institutions posing almost insurmountable hurdles. The most promising current approach to solve this problem is the international initiative Integrating the Healthcare Enterprise (IHE). As explained in the previous posts, the interoperability cycle ensures that devices and software are developed that can be integrated into a wide variety of application landscapes independently of the manufacturer and without interface problems. Plug and play instead of expensive interface problems!

Medical procedures are the same everywhere.

A wound is a wound and a syringe is a syringe! There is agreement in modern industrial nations as to how wounds are disinfected and tended effectively, and how syringes feed a serum into the body via a cannula. The processes are largely the same. It gets more difficult with the diagnoses. There are classifications such as the ICD 10, which defines, for example, a cut or a bite wound, but there are also national differences. Establishing semantic interoperability remains a challenge. For this reason, the IHE devises the solution approaches from the process and defines profiles in the IT infrastructure and in the medical departments. Only in this way can technical and technological interoperability be established. But here, too, it is important to note national particularities. Here’s how the IHE Cookbook handles the following three basic areas:

  • Legal framework conditions,
  • IHE profiles and other standards, and
  • Types of inter-institutional electronic patient records.

The IHE Germany does not identify this “nationalization” as a contradiction to an international approach; it sees it as a process-inherent necessity for the creation of international interoperability. Similarly to a cookbook, ingredients are listed and procedures explained that enable a successful adaptation of international standards to German conditions.

Legal framework conditions

In the first step, the IHE Cookbook deals with the legal prerequisites that must be observed in Germany for the intersectoral exchange of information. These include the legal texts governing the handling of personal data: the Federal Data Protection Act, the Social Code, as well as telemedicine and the Data Protection Act. For example, no digital information processing can be performed without the patient consenting to the process. And in the best case, this takes place digitally. This section is the standard guide that every IHE project in Germany should follow.

IHE profiles and other standards

Which IHE profiles need to be considered if health information is to “flow”? In this section, the IHE Cookbook describes how documents are exchanged, what actors and transactions are, how server times are synchronized, and how access rights and authentication processes are organized. In this respect, it is the ABC of the basic technological prerequisites.

Inter-institutional patient records (“ePA/PePa/eFA”)

In Germany there are three main concepts for the architecture of inter-institutional patient records. These include the “ePA,” the electronic patient record, in which the health information of a patient is recorded across institutions and in a time-linear manner (longitudinally). This model is a doctor-led record that brings together the information of the institutions involved in the treatment. Conversely, the “PePA” is a personal electronic patient record kept by the patient. Essentially, it differs from the “ePA” in that the authorizations are granted solely by the patient or an agent authorized by the patient. This is the most comprehensive form of an electronic patient record – it gives the patient full control over their health information. The third relevant record in Germany is the “eFA,” the electronic case record. It is a special form of inter-institutional patient records, as it “only” serves the purpose of bringing together more information about a patient in a treatment case. Like the “ePA,” the “eFA” is a doctor-led digital document in which the involvement of the patient is limited to one-time consent. If the treatment case is completed, the record is also closed.
In addition, the IHE Cookbook describes a complete solution architecture that can be used to plan and perform the implementation of a platform for sharing patient information. The IHE Cookbook is an “open” document that, like the progressive differentiation of IHE profiles, is subject to constant adjustments and optimizations. Anyone interested is invited to get involved in the IHE and help to develop the “cookbook” for interoperability in Germany.


The series:

About the author:
Uwe Porwollik, Partner eHealth.Business, sales and project success in the health sector.