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Validation and error correction at the IHE Connectathon

Publication date: Apr 25, 2013

During this years connectathon an enhanced version of the Gazelle testin tool was used - this has an impact on the quality of the test results. The massive testing process also allows for the detection of inconsistencies in the IHE specifications.

This year the IHE European Connectathon (CAT) was organized in Istanbul, Turkey. At this event many healthcare IT vendors come to test their products against the IHE specification, also known as profiles which are part of the technical frameworks that specify how standards (like HL7, DICOM, etc.) are supposed to be implemented to solve use cases jointly defined by systems vendors and healthcare providers. From the Netherlands my colleague André Huisman and I, joined the CAT to act as Monitors (“referees”).

Connectathon Testing

The test process at the CAT is supported by a tool called Gazelle which is developed by IHE. This tool is also used by vendors for pre-Connectathon testing and also integrates other open source test tools e.g. for validating CDA documents. Many changes and improvements were included in the test toolkIt this year. Gazelle has been enhanced to make it possible to validate all messages, such as those defined in the XDW and XPHR profiles, using model based validation (MBV) as well as schematron validation. The test results are more reliable this way and it also makes life easier for the implementors and the monitors, because the tool points out those message parts that are not consistent with IHE documentation.

Robert Breas and Andre Huisman at the Istanbul Connectathon

In my opinion the downside of this is that there’s less interaction with implementors to solve interoperability issues than previous years. The benefits outweigh the disadvantages though because efficiency in the testing process has been increased. This results in more tests being done and verified during the limited time available on the CAT. Another advantage of Gazelle is that better logging is kept and is also done automatically. This logging helps the monitors in fulfilling their duty.

As a monitor my primary focus was on the XDW profile (cross-enterprise document workflow), XDW related workflow profiles and PCC content profiles (a set of CDA R2 implementation guides). One of the biggest problems I encountered monitoring tests of those content profiles was that the technical framework, the content profile supplements and the IHE Wiki contradicted each other on several places, e.g. on the LOINC codes that should be used in CDA documents. This resulted in failed tests and lots of discussion. André Huisman encountered the same problems in the PCC domain.

View of the testing room at the Istanbul Connectathon

We all know that implementers mostly look at the IHE Wiki pages first, and use the technical framework as a secondary source of information. In my opinion the IHE Wiki should have been updated prior to the CAT. On the other hand I know how difficult it is to maintain consistency in documentation, because organisations like IHE are very dependant on the effort invested by volunteers. One of the CAT benefits is that inconsistencies like these are found, recognised and reported for corrections.


A lot of good work was done to improve health care interoperability during the IHE Connectathon in Istanbul. The added value of this work is the identification of inconsistencies and anomalies in the IHE documentation – which can then subsequently be fixed. In the next few years I expect the Gazelle testing tool even more enhanced so that more interoperability testing can be done not only on site, but also through more easily to set up virtual Connectatons.


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Ringholm bv is a group of European experts in the field of messaging standards and systems integration in healthcare IT. We provide the industry's most advanced training courses and consulting on healthcare information exchange standards.
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