The open development methods produced by IHE-Europe creates new challenges in standardized formats, from endoscopic examinations to a patient's electronic health record. The lack of endoscopy integration systems in IT domains makes image processing tricky.

In the past, IHE has not had difficulties with interoperability in radiology systems. More recently, they have successfully worked with laboratory reporting, along with the contrasting healthcare systems developed among 23 European Union countries.

The other obstacle is not well known to software engineers. It involves carrying images using the visible light sources of endoscopes into records, which typically handle foreign imaging sources such as X-rays, magnetic resonance and ultrasound.

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IHE will integrate new standards in order to comply with the visible light by DICOM Working Group 13. The new formalities reward a well-advanced technical framework drafted by the Japanese Association of Healthcare Information Systems (JAHIS). IHE-Europe expects the final draft for the Technical Framework to be ready in 2013.

The new course of action will require staff to reevaluate the IHE documentations based on the existing ones.

"Images from cameras with visible eye sensors are new objects for Digital
Imaging and Communications in Medicine (DICOM) standards and require new transfer formats," explained Emmanuel Cordonnier, a software developer for Etiam.

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Only the report from the surgeon matters for patient care in most cases, as an image is not required as a result of the operation.

"Diagnosis is the end product of the radiology workflow but it is the first step after ordering the procedure in endoscopy," Cordonnier said, adding that each procedure for the surgeon will be in real-time, as the surgeon examines and processes images right away to create a report for themselves.