Standardization in e-health
A new framework for coordination is defined
A recent workshop, organized jointly by the ITU Telecommunication
Standardization Sector (ITU–T) and the Telecommunication Development Sector
(ITU–D), defined a framework for standardization in e-health and how to take
that forward. The event was held with the participation of the World Health
Organization (WHO), the International Organization for Standardization (ISO),
the International Electrotechnical Commission (IEC) and other
What is e-health?
|Standardization in e-health has long been sought as a key
element in support of traditional healthcare
The term e-health incorporates some elements of telemedicine —
that is, the use of telecommunication tools, coupled with medical expertise, to
deliver diagnostic, therapeutic and educational services to individuals living
some distance from medical facilities. But it is generally agreed that e-health
is more than that. It includes the electronic background tasks that make the
medical world tick, and the technical wizardry that is behind the systems which
allow, for example, the sharing of medical expertise and radiology information.
In short, the term “e-health” encompasses all of the information and
communication technologies (ICT) necessary to make the health system work.
Opening the workshop, Houlin Zhao, Director of the
Telecommunication Standardization Bureau (TSB) said that “…standardization
in e-health has long been sought as a key element in support of traditional
health-care”. There are many generic standards used in e-health applications
for video coding, security, multimedia transmission and languages for instance.
Most of those standards have been developed by ITU–T. However, there is a
perceived lack of coordination in e-health specific standards — a key problem
that the workshop addressed.
Stronger coordination: an imperative
Among the 114 participants from 41 countries (including 25
developing nations) were representatives from telecommunication system
manufacturers, system integrators, end-users and ICT professionals within the
medical profession, international and intergovernmental organizations,
university hospitals, medical associations and non-governmental organizations.
Workshop sessions included a combination of case studies highlighting end-user
requirements and discussion on a number of technical issues and priorities that
needed to be addressed for e-health to prosper. Many speakers agreed that
standardization in e-health is a way to increase levels of interoperability,
but, a number of others also agreed that there are too many standards and that
these are either not deployed or are conflicting, introducing competing
solutions for similar problems. A stronger coordination of the standardization
effort is seen by many as imperative.
A high-end anesthesia workstation
ITU 030078/Siemens AG
ITU–D has been involved in many activities related to
telecommunication in healthcare from the time of the World Telecommunication
Development Conference (WTDC) in 1994. Following that event, several e-health/
telemedicine projects were implemented in developing countries
demonstrating the benefit of such applications. However, many system vendors
were shown to be promoting telemedicine systems of a proprietary nature, meaning
that with no interoperability, medical institutions were often locked into
buying one company’s products. In his opening speech at the event, Hamadoun I.
Toure, Director of the Telecommunication Development Bureau (BDT), likened the
situation to fiefdoms in medieval times.
|“Two nurses were running a
tele-medicine project with European
Union funding in Northern Sweden and Scotland, with the aim of offering better
access to healthcare information and diagnostic and therapeutic advice. They had
one big problem. Every system that they ran used a proprietary means of
communication. Each application took up a whole personal computer (PC), and so
you had this great wall of PCs — none of which could talk to each other.”
Ole Bergsten, Head of the Clinical Engineering Department at the
Copenhagen University Hospital, said: “At the moment, it is possible for me to
want to share information with another hospital and face the possibility that
because they are using equipment based on a different standard I may lose some
quality of definition or other general degradation, and in healthcare that is
not acceptable.” Mr Bergsten, along with many others, believes that a best
practice document outlining the pros and cons of given standards in particular
situations would be a good idea. The problem, however, according to Horst
Siebold, coordinator of international activities at IEC TC 62, is that such a
task would be too big an undertaking for one entity. He says that there are
documents that already go part way to addressing the issue — the German
Government for instance produces guidelines for best practice in e-health — but
these are generally parochial in nature, or not wide reaching enough to cover
all facets of e-health.
Case studies may help create more meaningful standards
Melvin Reynolds, speaker at the event and Vice Convener of ISO
TC215/WG2 (“Messaging and Communications”), argues that standards makers
should, more and more, take into account case studies: “I talked to two nurses
who were running a telemedicine project with European Union funding in Northern
Sweden and Scotland. The aim was to offer better access to healthcare
information and diagnostic and therapeutic advice. They had one big problem.
Every system that they ran used a proprietary means of communication. Each
application took up a whole personal computer (PC), and so you had this great
wall of PCs — none of which could talk to each other.” Most participants
agreed that giving case studies greater attention would lead to the creation of
more meaningful standards.
All agreed that the developing world is an important
consideration in the development of e-health applications and standards. Ousmane
Ly, a doctor from Mali, made a presentation about a telemedicine project in his
country and highlighted the importance of interoperability in the environment of
developing countries, where different underlying technologies may coexist.
Some very robust de facto standards already exist, for example,
DICOM (Digital Imaging and Communications in Medicine) and HL7 (Health Level 7).
Most workshop participants agreed that events that brought together all players
can only help drive future standardization work and give it better focus while
making sure that duplication of effort is kept to a minimum. WHO representative,
Andrei Issakov congratulated ITU for its initiative, pointing out that WHO
considers e-health as a very valuable tool for medical professionals and as an
innovation that will have an important and positive social impact.
Workshop agrees to set up a joint coordination group
|ITU–T Study Group 16 will set up an e-health study project to
look at standardization of multimedia systems to support telemedicine
An important conclusion of the event was the agreement to create
a joint coordination group for standardization in e-health, whose task will be
to increase information exchange about ongoing standards activities in the
respective organizations, avoid duplication and enhance cooperation. Subsequent
to the event, ITU–T Study Group 16 has agreed to set up an e-health study
project, which will look at standardization of multi-media systems to support
telemedicine applications, underlining the importance given by ITU to this new
and exciting area.