Information technology standards and profiles are the hallmark of VISUS. It is even doubtful if the company would exist at all without DICOM. But are standards really always the best and most practical solution – especially in times of exploding amounts of data? Absolutely! The more complex data and information structures are, the more important it is, in fact, to reflect on uniform handling.
After all, there was a good reason for the fact that DICOM was launched nearly 30 years ago. In the 1980s, CT and MRI images could be viewed and processed only on the device on which they were created. For the user, this was never really satisfactory, and medical technology companies also sought a solution to make their images archivable and readable over the long term. This motivation led both groups to promote the development of an authoritative “image language” from which the DICOM standard arose in the 1990s. This also opened the world of radiological image data management to those who had had nothing to do with the image acquisition – companies such as VISUS, for example.
The standard as a success factor
To this day, no one whose business model concerns the handling of (radiological) image data can ignore DICOM. Other standards had less of a sweeping impact. Today, HL7 version 2.x is, for example, frequently used in an inpatient setting but in some cases, it is also proprietarily modified. IHE profiles are practical but they are not a must and were therefore slow to appear in clinical practice. Nonetheless, VISUS has systematically established the further development of JiveX Enterprise PACS in a standards-based manner, from JiveX Integrated Imaging to the JiveX Healthcare Content Management system (HCM). In the case of image management, for example, the patient data and order communication, which is important for clear patient allocation, was set up on HL7 ORM, among others. If documents in the HCM are concerned, HL7 MDM is used, for example, and the communication of diagnostic data from the RIS is set up on HL7 ORU. And when the topic of data exchange between institutions became current, it was rapidly evident that the IHE XDS profile is best suited to this task.
The list of examples of the extent to which standards have played a part in the success story of VISUS could go on and on. In brief, each development focused on communicating and evaluating data neatly and cleanly. For a long time, not all providers were following this logic. Contrary to the philosophy of products which are as standardized and thus as interoperable and flexible as possible, the concept of monolithic systems, which was developed in the early 2000s, initially had a large and loyal following. Yet at least since the time when the bony structures in healthcare institutions were broken and successful medicine became a question of interdisciplinarity, technical transparency, and the transfer of knowledge, data silos have been considered to be yesterday's technology. What is more: with a view to section 291d of the E-Health Act which took effect in 2015, there is currently discussion regarding the fact that all clinical systems used in an inpatient setting need a changeover interface so that a system change can be conducted more easily. Thus by now, the use of standards is also a question of legal security and therefore also of economic survival.
So it continues
As things stand today, it is still not entirely clear which standards will prevail for the next large IT challenge in the healthcare field. However, what is clear is the fact that what are referred to as lightweight standards will increasingly catch on. This is because one task will be to include the patient via his or her so-called smart devices – smartphones, smart watches – in medical care, to evaluate large amounts of data using AI, or to make data retrievable at any time for specialized expert systems – for example, for diagnostic support or therapy planning.
Currently the HL7 FHIR standard best complies with these requirements which must be met for this. FHIR also accordingly plays a role at VISUS – even if currently primarily within the scope of pilot projects. One of these concerns the retrieval of demographic patient data via the IHE PDQm profile (Patient Demographics Query for mobile) which also allows mobile applications or those which run directly in the browser to retrieve data from JiveX. The other works with the IHE MHD profile (Mobile Access to Health Documents), a mixture of FHIR and IHE XDS. The profile ensures that devices with limited resources can also access IHE-XDS networks (AffinityDomains). It is still not possible today to predict whether FHIR will ultimately prevail as the sole standard, or be one of many standards, or not catch on at all. However, what is important for VISUS is evaluating all potential standards with an eye towards customer requirements and the further development of the product portfolio. And this is a task which never ends.