VIENNA – A drafty former storage barn for streetcars became Austria's hottest Internet hub during a five-day European Connectathon that saw thousands of tests run between health information systems in a marathon event to validate interoperability for exchanging radiology images, lab reports or patient medical summaries.

Sponsored by Integrating the Healthcare Enterprise-Europe (IHE-Europe), the event had an equivalent event run by IHE-North America in Chicago in February.

Some key companies, such as IBM (Armonk, New York), GE Healthcare (Waukesha, Wisconsin) and Siemens (Erlangen, Germany), participated in both events.

New at this year's ninth annual event here was the growing trend for test of document-sharing as e-health moves away from point-to-point interactions toward community access to common documents, such as lab reports or diagnostic images.

Integration profiles developed by IHE for sharing clinical documents overtook the traditionally strong domain of radiology again this year, while the new Cross-Community Access (XCA) profile jumped from a single system test in 2008 to eight companies testing their conformance this time around.

"Considering this is the second year for XCA, this participation might be considered an explosion of interest for an IHE profile," said Eric Poiseau, the IHE-Europe technical manager who organizes and manages Connectathon testing through INRIA, the French national institute for research in computer science and control.

Cross-Enterprise Document Sharing (XDS) profiles were tested by 27 vendors, he reported, with another 10 vendors testing Cross-Enterprise Document Sharing for Imaging (XDSi).

A total of 73 companies registered for Connectathon 2009, with 10 participating for the first time. In all, 94 systems underwent multiple tests with a requirement that each test is validated in an exchange with three different, often competing, partners at the event.

An event sponsor, Telekom Austria, brought in its "A" team, usually deployed for international skiing events, to string 25 kilometers (15 miles) of cable and set up 280 hard-wired workplaces and 11 wireless network hotspots.

The Telekom Austria team set a Connectathon benchmark with only five minutes of downtime during the event.

As the 230 health information system engineers and programmers hunched over laptops for this 'plug-fest,' speakers in a parallel workshop program organized by IHE-Austria highlighted why integration profiles for document access within a medical community, and the more complicated cross-community access, are becoming a priority among e-health vendors and users alike.

Titled "Sharing Clinical Documents and Integrating Workflow," the two days of workshops offered presentations for a primarily Austrian audience of 120 paying participants on best practices in health information system and an update on projects from across Europe.

"We saw the Connectathon as a both a challenge and a chance to teach people about IHE, so we seized the opportunity," said Gabriele Költringer of the University of Applied Sciences (Vienna), who organized the testing marathon on behalf of the host organization, IHE-Austria.

Stefan Sauermann, a founding member of IHE-Austria who organized the workshop program, said that the Austrian government in 2007 formally adopted IHE profiles for XDS as the foundation for architecture being developed for the national electronic health record (EHR), called Arge ELGA (Arbeitsgemeinschaft Elektronische Gesundheitsakte).

IHE frameworks and profiles are now an integral part of the national program that features eight project tracks converging toward an implementation phase in 2013, he said.

"IHE is a must and Connectathon turns up at a lot of places in project ELGA documents," said Sauermann, who is an associated director of studies in biomedical engineering at the University of Applied Sciences Technikum Vienna and leads the working group for Interoperability as part of the Austrian e-health initiative and the EHR ELGA.

Moving from strategy to implementation

"Austria is a late adopter of IHE, but is proving to be a a very fast implementer," said Charles Parisot of GE Healthcare during a presentation. He is widely credited as being the leading advocate for health technology interoperability in Europe.

Parisot said the past year saw "substantial advances" across e-health projects in Europe as regional, national and European-level programs began moving from strategy development to deployment.

He cited as an example the landmark large-scale European e-health project launched last year (MDD, July 28, 2008) that in April began developing a series of work packages that will define shared technical specifications for the 12 participating nations for a broad range of actions, such as structured patient summaries, patient identification and security.

IHE-Europe formally represents a consortium of 30 companies participating in this program, European Patient Smart Open Services (epSOS).

Parisot also described the steady progress of eHealth-INTEROP with the formal adoption of Mandate 403, a definition of a consistent set of standards to be used across Europe to address the now rapidly-evolving field of e-health interoperability.

"Standards for e-health fall into a crack that opens halfway between the European Commission and the 27 Member States," he said, explaining that the commission has no provenance to determine European wide standards and the individual countries need to choose between dozens of different sets of standards used in health information technology.

The concern is that European standards organizations, which do have provenance in this area, might independently issue requirements for member states that create a conflict with standards being used in different countries for their national health information systems, and specifically with the standards adopted for the cross-border project epSOS.

Mandate 403 embraces a specific set of standards and recommends the standards organizations agree, and indirectly endorses the IHE methodology that applies a standard process to adopting standards among vendors and users.

The large-scale epSOS project also has created a pressure to set shared standards and methods for e-prescriptions and the exchange of medication information.

The urgency in Europe to share the highly confidential data across borders as part of the epSOS project has put IHE-Europe in the driver's seat for international development.

In March, IHE-Europe sponsored the publication of a white paper, the first step in formally creating an IHE domain, which is now open for public comment and will see a strong participation from the U.S.

Once adopted as an IHE domain, all countries will conform to the standards and technical specifications set in the IHE Integration Profiles, just as they have agreed to conform to the 10 previously developed domains for international interoperability.

IHE Pharmacy is on a fast-track with the release of the first Integration Profile expected by the end of 2009 and the first tests of systems for validation set for March 2010 at the European Connectathon that will take place in Nice, France.