Tele-Radiology

Role of IT in Integrating e-Health

IT plays a dual role in the e-healthcare and integration segment

Dr Sunita Maheswari Director Teleradiology Solutions Private Limited

The World Health Organisation (WHO) defines e-Health as 'the combined use of electronic communication and information technology in the health sector or it is the use, in the health sector, of digital data- transmitted, stored and retrieved electronically, for clinical, educational and administrative purposes, both at the local site and at a distance.'

So far so good, as far as the text book definition is concerned, but let's now take a look at how this applies to the constantly and rapidly evolving real life healthcare scenario.

Today's ultra-modern world has generated a multitude of healthcare-related parameters and factors, chief among them being shortage of medical staff , speedy development of computerised healthcare solutions and the blurring of countries' borders due to the internet. All these have contributed to a situation where e-Health systems across the globe need to mandatorily talk to and interact with each other.

Patients visit several institutions, starting from their neighbourhood general physician all the way up to a specific organ specialist with several other specialists thrown in to preclude particular ailments. Often, these patients travel across countries or like in the teleradiology/ telemedicine scenario, at least their data continuously does.

In such a situation of dynamic medical data flux, transferring patient information automatically between care sites leads to efficient healthcare and reduces duplicate testing and prescribing. This in turn reduces errors, improves productivity and benefits patient care tremendously.

All this has made e-Health integration an urgent necessity across the spectrum of medical solutions and across different locations.

Role of IT

IT plays a dual role in the e-healthcare and integration segment. Firstly, it has the let's-call-it 'traditional' role which applies to any secure transaction or data transmission domain which depends on IT or in which IT is a key enabler. This traditional role involves setup and configuration of typical IT hardware and software components like routers, firewalls, secure transmission through Virtual Private Networks (VPN) or hypertext transfer protocol secure (https), storage devices, high-performance servers, data centre and network monitoring and management .

Depending on the criticality of the operation or commercial model , this also involves having multiple redundancies like additional internet bandwidth lines with automatic or manual switchover in case one goes down, multiple servers and firewalls for the same reason and power backups.

On a more specific role relevant to healthcare, IT has also to actively address many areas and its components. DICOM protocol which is both a protocol as well as a standard specific to transmission of radiology data across medical centres. This protocol allows the patient data information to be 'tagged' and transmitted along with the patient images as header information. The standard thus precludes any mix-up of patient image and corresponding patient data if they are kept separate in the virtual storage space.

Healthcare integration standards like Health Level 7 (HL7) which is basically a 'neutral' format allowing different healthcare databases like Hospital Information System (HIS), RIS and PACS to talk to each other and allow data to flow back and forth.

Retrieve Information for Display (RID) standards specified by the IHE

[Integrating the healthcare enterprise organisation]. Medical Markup Language (MML), which is a standard actively followed by the Japanese.

Healthcare images transmission issues like optimal compression of images so as to strike a balance between speed of data transfer and image quality.

This second role of IT has also thrown up expertise areas specific to healthcare like PACS administration which differ from conventional IT. In fact, it has given birth to the so-called 'Healthcare IT.'

Conclusion

In conclusion, integration of E-health data is now a necessity in which IT plays a vital role, unfortunately due to different methods of collating and disseminating patient data in hospitals, availability of different solutions from multiple vendors for archiving and transmitting healthcare information, availability of several 'non-standard' standards across the globe, the phenomenon though happening vigorously in pockets, still has a long way to go.

Among the standards that play an important role, HL7 and DICOM SR standards seem to have an edge, but others like Electronic Health Record Communication (EHRcom), IHE RID or even the Japanese MML have their own advantages and geographical location-specific usage.

Though companies like IBM, Intel and Microsoft who can make a significant impact are very much aligning themselves in this domain, for these initiatives to succeed, there is a need for a more comprehensive embracing of open source tools by IT vendors and developers. This would enable entire communities worldwide to examine, tweak and improve integration standards and parameters for an overall advance and implementation of e-Health IT specific integration.