Uniform proposals from Europe

  • Uniform proposals from Europe

The more the medical care market is fragmented, the more important seamless exchange of medical information between institutions, sectors and stakeholders is becoming. And the more standardized processes around such data exchange are coming into focus. The challenges in this respect have already been long known, but satisfactory widespread implementation has unfortunately not yet been achieved. However, the reason does not lie in a lack of good suggestions and concepts. 

Naturally Germany is also making advances in the networking of health facilities. Gematics performs the ordinary work, while the telematics infrastructure offers a good technological basis – albeit one being brought to life much too slowly and in small steps. An example: electronic imaging finding, which as a Medical Information Object (MIO) is supposed to ensure that findings described by text are incorporated into the ePA [electronic patent record] and are also considered in the process of image communication. In actual fact, these should have found their way into medical practice long ago. But until now, radiologists are still waiting for results. It is delays such as these that on the one hand prevent highly efficient care on a digital basis an on the other hand lead to frustration and discontent among the potential users.

Using guidelines and achieving speed

What must be acknowledged about the draft for electronic image finding as an MIO: It is oriented toward the requirements of the "Guideline for electronic exchange of health data according to cross-border Directive 2011/24/EU". What sounds awkward and hard to deal with is actually a truly successful template for uniform standardization of communication pathways in medicine on the basis of the guiding principle of interoperability. The guideline was formulated by the eHealth Network, which at the EU level constitutes a platform for the competent authorities of the member states involved in electronic health services. And these electronic health services are also addressed in the above Directive from 2011, which regulates the exercise of patient rights in cross-border healthcare within the EU.

The guideline of the eHealth-Network from 2022 is directed specifically at the member states of the European Union and applies primarily to implementation of cross-border electronic exchange of health data. However, and this is also anchored in the guideline, the guiding principles are also supposed to be a template for national developments and implementations, in order to permit the use of medical information for public health and for research. And that sounds like a good plan. After all: If regional and national exchange of data is built up on the principles of this guideline, the path to exchange at the European level (which is still in its infancy) has also already been smoothed. 

Thus the guideline could be a good starting point for everyone who now wants to develop pragmatic and long-lasting solutions for the urgently needed digital data exchange in medicine. The deciding criterion for this: interoperability. Thus the guideline also states that it "is intended to support the member states in achieving a minimum degree of interoperability consistent with patient safety and data protection, by defining requirements for communication between their national contacts for electronic health services and interfaces between the national and European levels." And ultimately that's exactly what concerns everyone and what everyone is discussing.

You can download the entire guideline here.

Marc Kämmerer - VISUS


Signs and wonders

It actually seemed inconceivable that the results of task forces within medical IT at the national or even EU level would ever match exactly even to only a partial extent. And nevertheless: Contrary to all probability, that's exactly what has now happened for interoperable exchange of radiological findings in combination with the associated images.

The basis for this is a first draft of the "Guideline Medical images and medical imaging reports", which the eHealth Network drafted in June 2023. And therefore at a time when a start had already been made in Germany to detailed formulation of the image finding MIO for the same application situation. 

Since both the eHealth Network and the MIO task force entitled "eImage Finding" based the studies purely on standards such as DICOM, HL7/HL7-FHIR, LOINC and ISO or DIN standards, the results are either identical or at least complementary in broad sections. 

Due to the use of such standards, differences between the contents of data records, for example, still exist only marginally for the area of application of "Exchange of image findings and image data". And this is the case even though there was no coordination of the committees with one another. The same is true for the use of ontologies for encoding the contents. 

LOINC and SNOWMED CT are applicable in practice for radiological contents and have therefore already found their way into basic standards such as DICOM. In HL7 also, a large number of meaningful definitions or even comprehensive, predefined FIHR resources exists for various application situations.

This shows that standards have finally become policies. A good thing! We are showing you that this is the only right way.

Comments by Dr. Marc Kämmerer
Member of the IHE-Europe Steering Commitees & at VISUS in charge of innovation management