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Interoperability moves beyond mere machinery, leans on data to improve systems

Construction process is revealing more layers of procedure needed to elevate the industry's clinical and business model, experts say.
By John Andrews
11:30 AM
While its achievements may not yet be where they were projected to be a decade ago, connectivity between disparate systems is a reality, electronic health records have made inroads into the healthcare establishment and milestones are being celebrated.

From its conceptual roots in the 1990s to adapting to the present-day issues of value-driven care, the healthcare industry has targeted interoperability as essential in optimizing clinical and fiscal operations. But as more systems become adept and EHR connectivity is widespread, the mission of interoperability is moving away from just the technology at play.

"Up until now the focus has been on the mechanics of interoperability and the time has come to go beyond it," said Rose Higgins, president of SCIO Health Analytics' North America Group in West Hartford, Connecticut. "If we're not informing from the process and adding precision, we're not moving the dial in the right direction."

Likening the interoperability initiative to peeling an onion, Higgins said the construction process is revealing more layers of procedure needed to elevate the industry's clinical and business model.

[See also: Health IT interoperability by example.]

"The most important challenge in establishing more interoperable capacity is not limiting it to clinical workflow," she said. "We have to broaden our horizons and think in terms of economics, viability, how to understand performance and measuring performance. We have to take that data-rich environment and turn it into a narrative."

The key ingredient is the data and she says providers need to consider sources beyond the laboratory, diagnostic tests and clinical metrics.

"It's the behavior patterns of the individual – they have to be engaged in the process," Higgins said. "There are additional complexities to it and you must figure out what the data is telling you."

Proactive patient profiling

Culturally, the healthcare industry is transitioning from reactive to proactive care and proponents say interoperability is the vessel of choice for reaching that goal. At the same time, there are a number of developers out there that are forging solutions designed to fit the proactive approach while tracking the individual behavior patterns Higgins mentioned.

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One such company is Monrovia, California-based NextGate, which plans to introduce a new product at HIMSS16 that uses intuitive technology for patient reporting that can help boost communications between provider partners in accountable care organizations, among others.

NextGate CEO Andy Aroditis has been working on interoperability principles since before the term was even coined and says his company's new iDAS tool encapsulates his methodologies in enterprise master patient index research over the past 20 years.

"What we were doing then has led us to where we are today," he said.

The iDAS, which stands for Intelligent Data Aggregation Server, is an app designed to give providers a holistic view of a patient, creating the most comprehensive profile available, Aroditis said. Intended for care transitions, it uses the same underlying technology as social media and Amazon to "super amplify" EMPI's patient matching ability by "listening in" on common transactions, such as hospital admissions, diagnostic tests and discharge reports.

Through API and SDK interface programs, users can send notifications throughout the caregiver network no matter where they are or what system they use, so providers will know when a patient is admitted and to where they are discharged.

The product borrows from the intuitive aspects of Amazon by gathering information on patients the same way the internet retailer does on shoppers, Aroditis said.

"If you buy a Jeffrey Archer book, they recommend similar authors like John Grisham," he said. "Ours works similarly in that when a patient who was admitted with chest pains is discharged, it makes recommendations on Coumadin or other blood thinners. It is not beyond our grasp anymore."

A 'slow' evolution

Reaching a more enlightened stage of interoperability has been a slow evolution over time. And while gradual steps have moved the industry forward, it hasn't yet reached the level envisioned by the Office of the National Coordinator for Health Information Technology when it was launched back in 2004.

[Also: Interoperability done in 10 years?]

Even so, there are signs that participants are now making up for lost time, said John Zaleski, chief informatics officer at Bernoulli and a longtime expert on interoperability and device integration.

"It has been a slow evolution – sometimes painfully slow – but there has been an acceleration over the past five or six years, with more participants and recognition of the need for interoperability," he said. "Whether due to meaningful use or other initiatives, it has accelerated."

The minutiae of interoperability function now lies in the granularity required for real-time data that is necessary for the critical chronological aspects of patient intervention, Zaleski said.

"Data is how the patient talks to you, which makes it critically important for assessing the care," he said. "It's not just collecting data for a chart, but for events that span 30 seconds or a minute. Anything longer is unacceptable."

Zaleski concedes that the bulk of interoperability effort has been with the bits and bytes and the physics of communication between healthcare entities and acknowledges that the time has come for it to expand into the overall environment.

"Ultimately the level of dialogue must be elevated and it has to a certain extent," he said. "But it needs to go beyond data collection and into a wider range that includes anticipatory medicine and predictive analytics."

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