Rhapsody Health Solutions Team

What is Integrating the Healthcare Enterprise (IHE)?

IHE is a group of health care industry representatives that work to improve the way health care systems share information electronically. The group was formed in 1998 as a cooperative venture by the Healthcare Information and Management Systems Society (HIMSS) and the Radiologic Society of North America (RSNA) with the goal to promote interoperability among imaging and health care information systems. Today, IHE membership includes more than 200 global health care professional associations and health care vendors.

IHE encourages the use of established interoperability standards such as HL7 and DICOM. Systems developed in accordance with IHE communicate with one another better, are easier to implement and help health care providers use information more effectively and, ultimately, provide better patient care.

What can IHE do for Health IT Professionals?
Creating interfaces between systems is a key challenge faced by many health care IT departments. Understanding the differing implementation of standards in various vendor systems and creating a way to share information between those vendors is challenging.

IHE offers a common framework for vendors and IT departments to understand and address clinical integration needs. IHE Profiles, described below, are not just data standards, they describe workflows, which makes them more practical for use by healthcare IT professionals and more applicable to their day-to-day activities.

Because IHE’s membership includes a wide array of end users, it focuses on solving relevant integration issues. These solutions provide vendors with many benefits including:

  • Shorter, less costly implementations.
  • Cross-system dataflow out of the box.
  • Smoother, complete workflows.

IHE Profiles
IHE strives to solve specific integration problems faced by its membership in the real world through Integration Profiles. These profiles define the systems involved (i.e., actors), the specific standards used, and the details needed to implement the solution. Each profile offers developers clear communication standards that have been reviewed and tested by industry partners.

Commonly Used Health IT IHE Profiles for Interoperability

XDM – Cross-enterprise Document Media Interchange
What it’s used for: According to IHE, XDM transfers documents and metadata using CDs, USB memory or email attachments. This profile supports environments with minimal capabilities in terms of using Web Services and generating detailed metadata. This standard is utilized by the Direct Project.

Example: Using secure e-mail, a physician e-mails the patient’s CCD to the patient’s Microsoft Healthvault e-mail account for uploading to the patient’s online PHR.

XDR – Cross-enterprise Document Reliable Interchange
What it’s used for: The exchange of health documents between health enterprises using a web-based, point-to-point push network communication, permitting direct interchange between EHRs, PHRs and other systems without the need for a document repository.

Example: A nurse at Hospital A enters a patient’s information in the local EHR, and then sends the CCD directly to Hospital B’s system.

XDS.b – Cross-enterprise Document Sharing
What it’s used for: The sharing of documents between any health care enterprise, ranging from a private physician office to a clinic to an acute care in-patient facility, through a common registry.  Medical documents can be stored, registered, found and accessed.


  1. Hospital A has a document to store. Hospital A creates a description and metadata for the document and submits it to the HIE Repository.
  2. The HIE Repository accepts the document with metadata. It stores the document and forwards the metadata to the HIE Registry.
  3. The HIE Registry receives a query from Hospital B and identifies the document as a match based on the metadata.
  4. Hospital B retrieves the document from the HIE Repository.

XDS-I.b – Cross-enterprise Document Sharing for Imaging
What it’s used for: The sharing of images, diagnostic reports and related information through a commonregistry.

Example: A radiologist accesses the local HIE, in a similar manner as for XDS.b, to find a MR report conducted and uploaded to the HIE at Hospital A.

PDQ – Patient Demographics Query
What it’s used for: Requesting patient ID’s from a central patient information server based on patient demographic information.  Used when a system has only demographic data for patient identification.

Example: Hospital A admits Patient Y, who has not been at the hospital before. Hospital A submits a request to the local HIE, based on demographic information such as name, birthdate, sex, etc., to obtain the appropriate HIE patient ID for Patient Y.

PIX – Patient Identifier Cross Referencing
What it’s used for: Cross-referencing multiple local patient ID’s between hospitals, sites, health information exchange networks, etc. Used when local patient ID’s have been registered with a PIX manager.

Example: Hospital A transmits Patient D’s ID information to the HIE for cross referencing. Hospital A receives Patient D’s local ID for Hospital B which they can use to request information from Hospital B, based on need.


IHE Integration Profiles provide standards that address specific needs, eliminating ambiguities and ensuring a higher level of practical interoperability. Because it encourages use of established healthcare standards such as HL7 and DICOM, IHE is in a unique position to accelerate the process for implementing standards-based interoperability among electronic health records systems.

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