Integrating the Health Enterprise


One of the standards applicable to the NHS Interoperability Framework is ‘Integrating the Health Enterprise’ (IHE). Before discussing IHE in more detail, I will provide a context.

Patient Records

Patient records are central to the delivery of healthcare and serve a number of functions including the recording of clinical assessments and interventions. Aggregated data is also utilised at a local and national level to inform commissioning.

Electronic Patient Records

The digitisation of patient records offers a number of advantages over paper based records. These advantages include automated backup of records, reduced use of physical storage space (since paper based notes are switched to servers), off-site access to records using mobile devices and the potential to develop analytical clinical support tools which use computers to process clinical data to help improve clinical decisions. Not all healthcare services have electronic patient records but most providers are moving in this direction.

Getting Electronic Patient Records to Talk to Each Other

When patients move between healthcare providers – for instance between primary care and the hospital – they may find that one provider does not have information that the other provider has. There are many providers and many electronic paper record systems. For two systems to talk to each other they have to solve a number of problems. When these problems are solved a patient can move between providers and healthcare information can be accessed by the different providers. A key solution to this problem of health information gaps is the Health Information Exchange (HIE).

The Health Information Exchange

There are many definitions of what a Health Information Exchange is. (Hersh et al, 2015) define a HIE as follows:

Health information exchange (HIE), the electronic sharing of clinical information across the boundaries of health care organizations’

Whilst this definition is simple, the process of sharing clinical information between healthcare organisations is technically complex and encompasses a range of software, hardware and governance issues. The process of helping systems to talk to each other is helped by the development of standards. A set of standards is outlined in the NHS interoperability framework.

The Interoperability Framework

A digital copy of the Interoperability Handbook can be found at the NHS England website (NHS England, 2017). The handbook explains how an interoperability framework can support an interoperability strategy. The Interoperability Framework has three layers – a governance layer, an exchange layer and an interpretation layer.

What is Integrating the Health Enterprise?

Integrating the Health Enterprise is one of the standards that applies to the Interoperability Framework as per Appendix A of the Interoperability Handbook. There is a website for IHE. The website also features a resources page that provides further information (IHE, 2017). IHE is an initiative driven by a combination of the Healthcare and IT industries to improve the sharing of information between healthcare information systems. IHE supports a number of standards (there is an overlap with the other standards that apply to the Interoperability Framework). According to the website, IHE experienced initial success with radiology. IHE provide IHE integration standards and vendors can create IHE integration documents which outline how their systems meet these standards. IHE utilises ebXML which is one of the standards discussed previously. This WHO document outlines how the use of ebXML in IHE has developed with experience.

What is ebXML?

One of the standards that maps onto the framework is ebXML.

So what is ebXML? To answer that we need to look at XML which stands for extensible markup language.

XML is a format for writing documents which can be read by people but can also be processed more easily by software. This is done by using simple code to identify different aspects of a document.

ebXML stands for electronic business using XML.

The website for ebXML references the National Program for IT (NPfIT) in the NHS which used ebXML for messaging.

The Standards Applicable to the Interoperability Framework

Appendix A in the Interoperability Handbook shows how various standards map onto the Interoperability Framework (NHS England, 2017).

Citations, IHE, accessed 9.4.17, accessed 8.4.17

Asuman Dogac, Yildiray Kabak, Tuncay Namli, Alper Okcan, “Collaborative Business Process Support in eHealth: Integrating IHE Profiles Through ebXML Business Process Specification Language”, Information Technology in Biomedicine IEEE Transactions on, vol. 12, pp. 754-762, 2008, ISSN 1089-7771.

Hersh WR, Totten AM, Eden KB, et al. Outcomes From Health Information Exchange: Systematic Review and Future Research Needs. Eysenbach G, ed. JMIR Medical Informatics. 2015;3(4):e39. doi:10.2196/medinform.5215.

There is also an NHS Digital Twitter account here.

Links to Other Posts in the Health Information Exchange Series

General Posts to Date on Health Information Exchanges

Posts on Examples of Health Information Exchanges

SNOMED CT®/ICD Mapping and Harmonisation Posts


ICD 1-10 Posts

ICD-11 Posts

Index: There are indices for the TAWOP site here and here

Twitter: You can follow ‘The Amazing World of Psychiatry’ Twitter by clicking on this link.

TAWOP Channel: You can follow the TAWOP Channel on YouTube by clicking on this link.

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Disclaimer: The comments made here represent the opinions of the author and do not represent the profession or any body/organisation. The comments made here are not meant as a source of medical advice and those seeking medical advice are advised to consult with their own doctor. The author is not responsible for the contents of any external sites that are linked to in this blog.

Conflicts of Interest: *For potential conflicts of interest please see the About section


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