The goal is to “cut costs for everybody and have healthcare quality improved.” By the same token, “it lowers risk for buyers. Before standardization, buying from the same vendor was the way to access interoperability and thus reduced risks.”

Now, in practical terms, how does it work? Users send proposal for integration profiles to the different IHE committees. These workgroups select the standards that best address the problems. “We then write the technical framework. It defines the standards, but, beyond that, it sets work modalities. It means we narrow down the usage of the standards. For instance, in a given database, the modalities define in which particular field one is supposed to store a given piece of information. We say such field is dedicated to such data, and we make sure it matches with other systems, even if, at the beginning, the field descriptions may be different, as created by different organizations. In fact, this technical framework is a guideline.”

Once published, comes feedback time: a period of public comments followed by the trial implementation. In the end of the process, companies can start integrating. All of this is phase one. Steps two is Connect-a-thon. “Chiefly, it permits us to check if framework is implementable or not. Secondly, we make sure these implementations are the good ones.” Then IHE people gear up for stage three: the demos. “We attend healthcare conferences with poster presentations and demonstrations, setting up the equivalent of a mini-hospital that enables us to show viewers that implementations work in real world and that they better use them in their tenders.” The development committee’s mission is to focus on phase two: organizing the test platform. Connect-a-thon happens once a year (2) but the event “requires six months of preparation”.

Before having all vendors come and test their equipments interoperability with others, IHE has to get the testing procedures and the machines ready. “When vendors deplane, they plug their hardware right away, Poiseau remarks. The systems are up and running, ready for testing, by 11AM the very first day. No way can we afford to loose time in what’s-your-IP? problems. So, we provide a set of communication parameters for each and every equipment (3).”

During Connect-a-thon, it‘s up to vendors to decide by themselves who they want to conduct test with, and when. But, in order to get IHE-validated, they successfully go through a whole list of tests. “Usually, vendors do the testing along friendship or nationality lines. Americans would test together for instance. The Japanese would do the same. On the other hand, we see companies saying: we are associated to submit joint tender, it would be good to test the interoperability of our equipments.” Some functionalities are rare. Conversely, some functions happen to be over-represented. Some products do implement a lot of functions while others embark just a few.

“Our way of working is very much volunteer-based, Poiseau remarks. But vendors rally around. They are interested in seeing this interoperability thing done. The model has worked but it is now facing a change of scale. That's why IHE has entered a process -in which INRIA also participates- of improving its organization and structuring the initiative." The technical team is also being dramatically strengthened, and Eric Poiseau is “on the brink of gathering a whole development team. Within INRIA, a first engineer (4) was recruited last October, and two others are to follow, supplied by IHE (5)."

One of this team’s first missions will be to shape a new generation of tools. “We need a brand new testing base to fit a more global vision, something that we couln’t possibly have predicted in the late 90s, at this early stage, we were only dealing with radiology .” Having said that, “IHE’s purpose is not to impose such or such product. We deal only with functional bricks. We might not have resolved everything. But, say, 80 to 90% of the problems have been taken care of. For most equipments, interoperability works.”

“And most of all, Poiseau points out, we have created a common language between clients and vendors.” There was a time where, depending on the hospital, a patient arrival would be named a “stay”, a “visit”, a “meeting” etc. “Now everybody putting forward a tender use the same reference base. This word base has also become the vernacular language between vendors themselves.”