National Extensions Process

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Scope of National Extensions

National Extensions to the IHE Technical Framework address specific local healthcare needs and facilitate local implementation of the IHE Technical Framework.

They may add requirements to the Technical Framework generally or to specific Profiles, Actors, Transactions, or Content Modules. Since systems must still comply with the original Technical Framework, National Extensions may not relax or introduce conflicting requirements.

For example, it is appropriate for National Extensions to:

  • Require support of character sets and national languages
  • Provide translation of IHE concepts, codes or data fields from English into other national languages
  • Extend institutional information and financial transactions to conform to national health system payment structures and specific local care practices
  • Extend patient or provider information to reflect policies regarding privacy and confidentiality (Can someone provide an example of supporting privacy policies by extending patient/provider information?)
  • (It has been suggested that it can also include a list of Profiles which are "invalid" in that country. Is that appropriate? If so, is the National Extension the best place to communicate that?)

Developing National Extensions

IHE National Committees are responsible for drafting National Extensions. Typically this happens after identifying a specific local healthcare need or implementation issue during the review, selection and promotion of Integration Profiles within their country.

(If IHE Regional Committees find needs that span countries within their region they would follow the same process described here.)

Public Comment

National Extensions are defined in Volume 4 of the Technical Framework of a domain.

National Extension documents are submitted in English to the Technical Committee of the relevant IHE Domain for review.

The National/Regional Committee and the Domain Technical Committee collaborate to resolve ay outstanding issues from the review and both approve the document for Public Comment. The document is then published by IHE International for a 30 day public comment period.

Trial Implementation/Final Text

The National Committee and the Domain Technical Committee collaborate to resolve comments from public comment. Both committees then approve the document and mutually decide whether it needs a period of Trial Implementation or can go straight to Final Text, depending on the scope and complexity of the document. Short extensions that simply add a required character set or a few attributes often do not require Trial Implementation.

When the document is approved for Trial Implementation by both the National Committee and Domain Technical Committee, it is published as a supplement to the Domain Technical Framework according to the maintenance and publication process of the Domain Technical Committee. It then is up to the National Committee to propose to the Domain Technical Committee that the document is ready for Final Text based on the Final Text Process outlined for international profiles with relaxation of the requirement for Connectathon testing in at least two regions.

When the document is approved for Final Text by both the National/Regional Committee and Domain Technical Committee, it is incorporated and published as part of the Domain Technical Framework according to the maintenance and publication process of the Domain Technical Committee.


All maintenance of the Trial Implementation or Final Text document is jointly undertaken by the submitting National Committee and the Domain Technical Committee with both approving any updates. Primary responsibility for editorial work lies with the National Committee.

Submission to multiple domains

When a National Committee would like to submit an extension to multiple Technical Frameworks, they may wish to identify the target Domains, submit the extension to the IHE Domain Coordination Committee and request a joint review of the extension. In this case the affected Technical Committees would work out a plan for a joint review.

Testing National Extensions

The National Extension shall be written with sufficient detail to allow for accurate development and testing.

It is appropriate for Regional Connectathons to include testing of compliance with published National Extensions. It is not appropriate to “fail” systems for not complying with National Extensions that were not approved and published a reasonable time before the Connectathon, as this is unfair to vendors who have implemented their systems in good faith according to the published Technical Framework.

The National Committee should consider organizing sponsorship for tool and test plan development necessary for Connectathon testing of the National Extension.

The National Committee should also consider providing staff to support verification of compliance to the National Extension at the Regional IHE Connectathons.

National Extension Document

National Extensions shall include concise descriptions of the local needs they address. They shall identify the transactions, actors, integration profiles and sections of the Technical Framework to which they apply.

It is highly recommended that National Committees review other existing National Extensions before drafting their own to get a feel for the types of issues addressed, document format and wording. In fact National Committees may find it useful to use a National Extension from another country with similar interests as an initial template.

A template for Volume 4, National Extensions, is located on the ftp site at .