IHE-RO: Addressing interoperability issues in radiation oncology to make our treatments safer and more efficient

Interoperability is a major challenge in radiation oncology due to the technical specialization of our field. Safety and efficiency of clinical care can be compromised when information exchange across software is not seamless. To address this issue, in 2004, ASTRO created Integrating the Healthcare Enterprise–Radiation Oncology (IHE-RO), an initiative that helps to ensure safe, efficient radiation treatments by improving system-to-system connections.

IHE-RO, now operated by the American Association of Physicists in Medicine in collaboration with ASTRO and other organizations, comprises physicists, physicians, software engineers, and others from private practice, academics, and industry, working together to identify and solve connectivity issues in radiation oncology. To assess and prioritize what technical challenges are most pressing to the radiation oncology community, we conduct biannual surveys of ASTRO and AAPM members and use this feedback to develop new use cases, which are the basis for the technical committee to develop industry standards for vendors to improve the system integration of their products, resulting in safer and more efficient patient care. Vendors can meet in annual Connectathons to test the success of product development and their ability to integrate with other hardware and software.

In this biannual survey, 295 responses were submitted by individuals from 6 continents. 67% reported difficulties with specific clinical workflows due to systems not working well together and entered up to 3 specific interoperability issues as free-text. These items were reviewed by the committee and categorized as challenges with oncology information system (rad onc OIS) and health information system interfacing (HIS), challenges with oncology information system and treatment machine integration, and software features of individual products or classes of products. Not surprisingly, common themes and issues emerged. Poor interoperability between radiation oncology and health information systems was noted as a frequent challenge, resulting in potentially degraded quality and efficacy of clinical care. In the past year, IHE-RO has already been defining the problem and developing testing tools, which we anticipate making available in the coming year, so that vendors can initiate software enhancements to facilitate data sharing, supporting ASTRO's Minimum Data Elements initiative.

Based on the most recent survey, new use cases for the coming year include:

1. Information transfer (including dose, shifts, and imaging data) from the treatment machine to the oncology information system for treatment dose verification
2. Radiation simulation scan and spatial dose information transfer to Radiology PACS to assist in tumor response/toxicity assessment and subsequent patient care
3. Beam data file format standardization for more efficient commissioning of treatment planning systems and machines

IHE-RO is a partnership between end users in the clinic and vendors, all working together to advance patient care in a safe and streamlined way. Please share your clinic's interoperability issues with us so that we can help.