Interoperability in its 'last mile'?

How close healthcare is to true interoperability depends on whom you ask
By Healthcare IT News
12:37 PM
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Michael Nusbaum

The vision back in 2004 was that in 10 years the healthcare industry would have complete interoperability from one provider to the next, from providers to patients to payers and back again. Now those 10 years are almost up. So how close is the industry to the original goal?

It depends whom you ask. Ahead of the IHE North American Connectathon Conference in Chicago Jan. 28-30, participants were sounding very confident that interoperability in some form of practice would indeed be a reality by next year. Others weren't so certain, reserving their judgment until stubborn obstacles can be overcome.

But as far as Michael Nusbaum is concerned, the future is almost here.

"Great progress has been made in the U.S, and around the world," said Nusbaum, president of M.H. Nusbaum & Associates, Victoria, BC, and a key presenter at the Connectathon. "But are we there yet? Definitely not. This is as much a 'journey' as it is a 'destination,' and we continue to struggle with what I would characterize as the 'last mile'  -  adoption and implementation."

As a mainspring for measuring healthcare interoperability, the Connectathon has matured and sharpened its technological capabilities to propel the industry further toward its goal of universal connectivity, Nusbaum says.

"As the event grows, so does its relevance to the healthcare IT industry," he said. "More participants in Connectathon testing means that more vendors are better equipped to offer interoperability to their customers.  And as interoperability becomes more available in product, then purchasers of healthcare IT solutions know to ask for it."

This year's Connectathon has more vendors bringing more systems and testing more IHE integration profiles than ever before, Nusbaum said, which demonstrates the strongest commitment to date for making interoperability a reality. 

"With hundreds of engineers representing hundreds of companies that normally compete fiercely in the marketplace, they are collaborating around providing interoperability in all their products for an intensive week," he said. "These visionaries see interoperability as an expectation, not as a marketing advantage."

HIE 'over-engineered'

Robyn Leone, director of public policy and government initiatives for Austin, Texas-based eMDs, says progress is "getting there," but that various kinks are inhibiting the industry from reaching the juncture where it should be. Specifically, the "over-engineering" of health information exchanges has stalled progress within local and regional groups.

"We need to summon the ability to collectively bring all our practices up to speed on what they will need for stakeholders and partners," she said. "There is a lot to be gained by looking at why some systems work and replicating that across the entire group."

The keys to moving forward at the HIE level, Leone says, is to create commonalities to help providers access data to improve healthcare.

"Those keys are just starting to come to fruition," she says. "We've taken a strong strategic role in making this happen. We have 200 or more HIEs out there and interoperability isn't just about provider-to-provider data flow, but it is where we need to focus. As a vendor we need to align our service offering to connect two exchanges based on the needs of providers to make sure we are aligned with meaningful use and ACOs."

Introspective interoperability

While the overarching focus of the interoperability movement has been on sharing patient data externally between different providers, interoperability within a facility has also been a significant movement that is gaining steam. Specifically, interoperability between a patient's electronic medical record and the operation of medical devices has been an area of heightened interest at Wexner Medical Center at The Ohio State University.

Using an interoperability solution from Panama City, Fla.-based iSirona, Wexner is pulling device-oriented data sources into the EMR automatically as opposed to having the data entered manually by the clinical staff.

Kevin Jones, assistant director for business systems, says the system went live in 2011 and that currently all patient monitors and ventilators house-wide are connected and reporting data in real time. By connecting devices and the EMR, clinicians no longer have to spend time entering that data, saving labor while improving accuracy.

"To date the focus has been on high acuity areas such as the ICU and OR," Jones said. "We are now kicking ahead to anesthesia and eventually on to infusion pumps."

By deploying the calculations from the device, the organization can use the data for best practices and documentation, Jones said. Because the system signals when a patient is headed for problems, he said the staff could intervene before a negative episode can occur.

CIO Phyllis Teater says she is satisfied with Wexner's level of interoperability at this point because it has reached Stage 7 of the HIMSS Analytics EMR Adoption Model, which only 2 percent of organizations have reached to date.

The RTLS connection

Although used by hospitals mainly for asset tracking and temperature monitoring, real time locating systems have a link to interoperability through caregiver tracking and real-time coordination of care with workflow, says Jay Deady, CEO of San Diego-based Awarepoint.

While Deady sees progress occurring with interoperability across the healthcare spectrum, he contends that the real-time delivery of healthcare is where the true impact is and that it is still in the early stages of development.

Awarepoint's solution is focused on using RTLS technology with "a very sophisticated workflow feature" that enables 35 to 40 LEAN and Six Sigma milestones for electronic health records, compared with seven or eight for other modules, Deady said. The system captures caregiver interactions with workflow and coordination of medical equipment.

"What we do is interface with the IT system that automates the environment, capturing information about patient registration, orders and other documentation, while tagging the caregivers and equipment and tracking them against the milestone steps," he said. "While only a small percentage of RTLS systems are being used for this purpose, it is set to explode. That provides a huge opportunity for health systems in the future." n