Future of interoperability is here
Hard to believe, but it has been a decade since the George W. Bush administration created the Office of the National Coordinator for Health Information Technology and issued a challenge to the healthcare industry that it should be seamlessly interoperable by the year 2014.
The initiative outlined some bold ideas and served as motivation for an industry that lagged behind in information technology development. And while the initial vision of a completely interoperable healthcare system may have had an off-the-mark time frame, experts agree that it got the machinations spinning in the right direction.
“To me, interoperability should be about that seamless flow of information,” says Joy Huntington, RN, clinical specialist at Roper St. Francis Healthcare in Charleston, S.C. “In reality, we’re not experiencing it at this particular point – we’re still in siloes electronically and gaps still exist. We’re not where the pundits thought we should be, but we can see now that they weren’t realistic in their expectations. That doesn’t mean we haven’t made substantial progress – we have in many ways.”
Currently Roper St. Francis has “a higher degree of interoperability than most,” Huntington says, as the inpatient and outpatient sectors “have some degree of interoperability.” The ER has its own system apart from the enterprise because it operates in its own self-contained environment, she says.
“We needed documentation that was easier to use, more specific and customizable,” Huntington says. “What we managed to do is let clinicians in the enterprise see and share the patient’s information, which they can view and validate.”
Looking back 10 years, Kirk Larson, regional CIO of Healthcare for Sunnyvale, Calif.-based NetApp, says the 2004 initiative helped to push healthcare out of its IT lethargy.
“Before that, organizations were content not to be interoperable,” he says. “That was OK because it was the norm and there was no pressure to change. Now as meaningful use is well into Stage 2, progress is not only encouraged, but mandated.”
If there is one place where interoperability has taken hold, it’s with health information exchanges, Larson says.
“They may not be eloquent, but they achieve the spirit of interoperability,” he says. “They can access data at the point of care and that makes a difference.”
More than EHRs
The impetus for the ONC’s creation and subsequent 10-year interoperability assignment focused on electronic health records and the seamless exchange of patient information among healthcare entities. And though that remains the chief concern, interoperability has various dimensions of functionality, says Zane Schott, vice president of business development for Salt Lake City-based BlueStep.
“You don’t need an EHR to be integrated,” he says. “There are so many organizations in post-acute and long-term care that are still running paper. Even so, they have the ability to be interoperable because with the MDS (Minimum Data Set) they have to produce files that can be sent to CMS electronically. We can lift that piece of information and submit it to an HIE or hospital based off the MDS so that even without an EHR they can be interoperable.”
A key reason why providers in the post-acute sector are still dealing with paper is that they were not included as eligible for ARRA funds and therefore are not involved in the meaningful use push.
“What this means is that, ironically, seniors are being left behind in the interoperability initiative,” he says, “and that is tragically unfair.”
Connectivity with payers is another important aspect of interoperability, which is the bailiwick of Cambridge, Mass.-based Pegasystems. While the company serves most of the major health plans, it also focuses on government agencies, health systems and life sciences.
“It’s a great pollination of ideas from retail verticals to financial services,” says Elizabeth Hart, industry principal for healthcare. “We target the different pain points and verticalize them for the customers we sell to, but also extend from those so that you can start a CRM system and call center and build an enrollment system out of that.”
Hart concedes that despite gains, healthcare is still reliant on 30-year-old legacy systems that don’t have the functionality needed to make interoperability a reality.
“Traction is being made, but it is still not moving at the pace we need,” she says. “A lot of it has to do with the fact that there is more data coming out with in-home monitoring and mobile devices that weren't envisioned from the old systems and existing EHRs. We end up wrapping around those systems to give them the capabilities and capacity they need.”
A new ‘connection’
The hallmark event for interoperability is the IHE North American Connectathon, which will be held Jan. 26-30 at the Cleveland Convention Center and HIMSS Innovation Center in Cleveland. The sponsors are enthused with the new venue after 15 years in Chicago.
“Cleveland’s state-of-the-art Convention Center and Global Center for Health Innovation – called ‘The Globe’ by the locals – has provided Cleveland with the opportunity to become an epicenter for healthcare and innovation,” said Celina Roth, HIMSS manager of informatics and staff liaison to the IHE. “Together these two venues are creating a new renaissance in downtown and revitalizing the city.”
The IHE Connectathon is a cross-vendor, live, supervised, and structured testing event with more than 100 participating vendors and 600-plus engineers and IT architects. All these organizations and IT experts converge on-site for one week of interoperability testing and problem resolution. Participants test their products against multiple vendors using real-world clinical scenarios contained in IHE's Integration Profiles.
With implementation of IHE Profiles growing, IHE USA has introduced new programs, such as a new one-day technical program called Connectathon 101. It will be offered on Tuesday, Jan. 27, to help engineers gain a full understanding of the Connectathon testing process, experiment with the testing tools, and work one-on-one with industry experts. Engineers who complete the session leave prepared to participate in next year’s IHE North American Connectathon 2016.
“While EHR usage has increased significantly, the interoperability necessary to achieve continuity of care, population health, patient management and clinical quality improvement is not yet realized,” Roth says. “Interoperable health IT has made strides in many areas like ePrescribing, but widespread progress remains slow.”