HITCH is about developing a vision of how interoperability and conformance testing of eHealth systems should be organized in Europe and beyond. This ranges from the analysis of eHealth testing tools, over quality management in interoperability testing, to complete certification and quality labeling scenarios.
If this sounds interesting to you, be sure to learn more about HITCH below!
Today, delivering healthcare to patients includes a multitude of computer systems that collaborate with each other by exchanging patient data. This is necessary, since often many different devices, departments, institutions or even nations are engaged in the treatment of a single patient. All the collected information like medical images (X-Rays, Ultrasound, etc), and medical reports should be available to the patient's physicians in order to permit optimum treatment, therefore avoiding redundant examinations or adverse drug reactions. Also the current trend of having all patient-related data ubiquitously available (e.g. in the patient's holiday resort) requires high interaction between the involved computer systems.
The underlying communication of images, reports and other information is highly complex. Why that? There are many communication standards and protocols used in medicine that in the best case complement but also sometimes compete with each other. These standards altogether (should) cover everything that is needed to express medical knowledge, thus including ways to express medical terms (e.g. anatomical regions, diseases, physical units, medications, pharmaceutics and many more) in a unique and ultimatively defined way as well as communication protocols for transmitting medical data for example into an electronic health record. The final goal would be to have all information shared in a way, that a computer system may "understand" and evaluate it. Also it should be able to provide an understandable presentation to the user utilizing the system, e.g. to a physician or the patient itself.
This only works if all involved systems communicate in an internationally designed, well-known, standardized way. If two systems can talk to each other, then there is "interoperability" between those systems. According to the IEEE Standard Computer Directory Interoperability can be defined as the ability of two or more systems or components to
First, this must be achieved by the conformance harmonisation of eHealth products, i.e. making sure that different systems implement the same standards and communication measures to talk with each other. This is sometimes also referred to as profiling, i.e. selecting (subsets of) standards and options in order to uniquely identify the communication measures to be used. As described, these standards are fairly complex, e.g. the DICOM standard describing the content and communication of medical images spans over 4.000 pages of technical documentation. So, besides describing how the communication should work, it has to be ensured that the different software products actually do what is defined. In this context, two different testing methods are known. On the one hand, testing whether a system conforms to a set of standards is called conformance testing. On the other hand, interoperability testing "just" tests whether two systems are able to exchange information with each other, i.e. aims at testing whether the communication goal is reached regardless of whether both are also conformant to the standards they implement. However, in order to do pass interoperability tests usually a fair amount of conformance testing is also required and involved.
The interoperability definition from IEEE quoted above does not talk about eHealth systems in particular but primarily addresses human's which, finally, are the receivers and beneficiaries of the information. However, this of course presumes that the underlying eHealth systems are interoperable. Thus, HITCH focuses on interoperability testing of eHealth systems, finally aiming at the interoperability between all stakeholders of the medical context.
Interoperability testing in eHealth means that different implementations (practically, different products) are tested whether they can successfully communicate with each other, i.e. whether they are interoperable in the sense of above definition. Since delivering health is a critical application area and non-interoperability of eHealth systems might lead to serious damage or even death of patients, interoperability testing must take place even before products are sold on the market. Vendors themselves are of course highly interested in offering high quality products. The problem is that developing a product isolated in a vendor's lab cannot guarantee that the system is interoperable when it goes live in real world environment since it first is nearly impossible to build bug-free software but second it also common that other vendors might interpret the underlying standards a another way and therefore implement their products slightly different and therefore maybe incompatibly.
Also, if a vendor would actually create a bug-free product, it is common that in a real world scenario there might be actually products that are not. In those cases, being able (where safe) to cope and communicate with buggy systems makes a product much more robust and increases chances to successfully communicate with each other. As a result, systems must undergo interoperability testing in order to provide high quality and value to their customers and therefore, to physicians and finally patients.
As described above, interoperability testing should ensure seamless information exchange between eHealth systems. How is HITCH facilitating interoperability testing? First of all, HITCH does not aim at developing new eHealth communication standards and HITCH does not do Profiling of existing standards. HITCH does instead focus on the organization, performance and quality management of eHealth interoperability testing.
HITCH analyses different aspects of interoperability testing and for each of them on how they should develop in the future to be more complete and effective:
HITCH defines the European Commission's roadmap on eHealth interoperability testing and therefore will provide recommendations to institutions and authorities interested in establishing cross-vendor interoperability testing events but also to vendors that like to implement an in-house interoperability testing Quality Management System. Additionally, HITCH provides a vision on how a future eHealth quality labelling or certification could look like in Europe. The quality of the roadmap should be guaranteed by the HITCH partners that are already deeply involved in those topics.
The HITCH partners are coming from different countries and are well-established in the world of interoperability testing. IHE Europe for example, organises each year a large eHealth interoperability testing event called Connectathon where dozens of companies (small, medium and large) come together to test more than 100 products against each other. At the end, they may receive a quality label from IHE in order to promote successful testing. Another HITCH partner, EuroRec from Belgium, offers quality labelling of Electronic Health Records (EHRs) in many European countries. So far, they are focussing on functional testing (ie. they are more working with declarative, functional statements that the products are tested for) while IHE does more technical interoperability testing; both complement each other very well. MedCom from Denmark joins HITCH because of their expertise in testing eHealth applications in Denmark. MedCom is a co-operative venture between authorities, organisations and private firms linked to the Danish healthcare sector. They are devoted to the development, testing, dissemination and quality assurance of electronic communication and information in the healthcare sector with a view to supporting good patient progression. OFFIS from Germany has contributed test software to IHE and currently also runs a DICOM CD certification project in Germany which is open to vendors world-wide. Furthermore, HITCH partner INRIA from France has done much work in developing the IHE Connectathon test management tool and to organize the European Connectathon over the last years. Finally, ETSI from the same country is well-known for their expertise in communication system testing and therefore also bring valuable knowledge into the project.
Overall, the HITCH project includes the top European institutions that are dealing with (eHealth) interoperability testing and joins their forces in this project to streamline and consolidate their complementing efforts. If you want to learn more about the partners involved in HITCH, check the their short partner profiles.
Of course, there are other European projects working on issues being connected to HITCH. HITCH keeps in touch with these projects, ensuring that HITCH aligns to the other projects' efforts and vice versa. The same is true for health organizations and Standard Developing Organizations (SDOs) which all are linked to eHealth interoperability testing.
eHealth markets and their vendors, but also customers are of course highly affected by the results of the HITCH project. Therefore, HITCH communicates with them and makes sure that all results will be practically relevant. This is also achieved by evaluating HITCH results directly in the IHE European Connectathon which involves dozens of companies of all sizes and usually is run by neutral "monitors" that verify the Connectathon tests, coming from different health organizations world-wide. The figure below summarizes the the overall setting of the HITCH project: