If Interoperability is the Future of Healthcare, What's the Delay?
While CMS focused the latest stage of its meaningful use program on measures and objectives to encourage interoperability, the effect of that will not be seen until later in 2013 and early 2014 when providers begin to incorporate those measures and objectives into their clinical work.
At a hearing on electronic health records and interoperability in November, Farzad Mostashari, MD, National Coordinator for Health Information Technology, and Marc Probst, CIO and vice president of information services for Intermountain Healthcare in Salt Lake City and a member of the Health Information Technology Policy Committee, discussed the need for standardized exchange capabilities, which should help foster interoperability across the entire healthcare industry.
"We must set a clear road map and support an exchange infrastructure and the adoption of standards that will make it easier to share health information, so clinicians and patients have the information in the form and time they need it to make appropriate healthcare decisions," said Mr. Probst. "Presently, we lack a shared infrastructure and long-term plan to make this possible."
Due to a lack of shared infrastructure among hospital IT and EHR systems, the healthcare industry has not reached the widespread interoperability it needs to foster preventive care and effective population health management. To correct this issue, there are barriers and issues that must be addressed.
1. Executives need to educate themselves on IT options. Moving forward, hospital executives need to educate themselves on systems, products and vendors that will help them reach interoperability; they need to be educated consumers of IT.
According to Patricia Katzman, director of interoperability and CDS marketing and strategy at Philips Healthcare, executives need to be asking about standards and profiles for interoperability when they make IT purchases, and about more than just their hospital's needs. Without knowledge of industry norms for products and systems, executives could agree to purchasing systems that do not offer the capabilities they need.
"It takes time to learn, but it is worth the effort. Demands for standards-based interoperability systems from purchases can make a difference in vendors supplying truly interoperable systems," says Ms. Katzman.
Dave Caldwell, chief of marketing and sales for Certify Data Systems, argues that executives need to be thoroughly educated, so they have the knowledge to discern technology that will deliver on interoperability rather than just the promise.
"The message is buyer beware. Make sure you fully understand all the aspects of the technology and what it can do for you. Don't take suppliers on face value. They can mislead healthcare executives when they are trying to make a sale," says Mr. Caldwell
2. Interoperability needs to include semantics. Many IT products and software are not semantically interoperable with each other, which is another major barrier toward reaching interoperability within the healthcare industry and across providers. For instance, one system might call a heart attack a myocardial infarction in its EHR, and another might call it a heart attack. While clinicians know that means heart attack, unless the system is digitized with that standard, it may not recognize the two classifications as one and the same.
Semantic interoperability is interoperability at the highest level because it involves the structure of the data exchange and the codification of the data so a receiving IT system can interpret the data. This will become more important as providers go to risk-based payment models and attempt to manage populations. According to Mr. Caldwell, when data is brought into a data analytics tool or shared via health information exchange, it needs to be standardized as either a myocardial infarction or heart attack, not both.
"If this is a problem while sharing information, it won't be the straw that breaks the camel's back. However, when providers move to population health management, it will be crucial," says Mr. Caldwell.
3. Products and software need to be developed to fit existing infrastructure and systems. Strong infrastructure within a hospital is necessary for interoperability, and Ms. Katzman believes that strong interoperability stems from product and system compatibility.
Since interoperability relies heavily on IT infrastructure, if software products cannot be integrated into existing infrastructure, hospitals may have more difficulty exchanging data.
Some products are easier than others to fit into a hospital's IT environment — some have a smooth fit and others require extensive customization. As vendors develop products, they need to develop them with the hospital's environment in mind, says Ms. Katzman.
According to Jason Martin, senior director of integration, interoperability and database information and information technology for The Mount Sinai Medical Center in New York City, the industry needs to be focused on more plug-and-play capabilities between disparate systems — leveraging the existing standards and focusing on quick solutions to enable data exchange.
"[Vendors] need to play well together to augment an environment conducive to information exchange. There are multiple interpretations of data needs and it differs from vendor to vendor," says Ms. Katzman. "When implementations of vendor systems require over customization such that data meanings must be constantly interpreted for machine to machine communication, it adds cost and complexity to the implementation without adding value to the healthcare industry."
Kumar Chatani, senior vice president of information technology and CIO of The Mount Sinai Medical Center, agrees. "I believe that EMR vendors need to make it easy to exchange data between the various systems. This should be standards-driven and inexpensive like electronic data interchange transactions," says Mr. Chatani.
4. Hospitals need to distinguish data types to strengthen internal interoperability. "Some may think interoperability is just about sharing information, but it is important to note where and to what systems [providers and hospitals] are sharing data," says Ms. Katzman.
Information from a variety of levels within a hospital — point-of-care, departmental or enterprise — can be shared. Departmental level data may have department-specific information as well as patient and clinical diagnostic information. Enterprise-wide data may include this departmental information as well as data from an electronic medical record with a patient's address, phone number or allergies. In order for interoperability within a hospital or health system, the network and infrastructure will need capabilities to collect, aggregate and manage each data type.
According to Mr. Caldwell, hospitals have struggled with internal interoperability — sharing point-of-care, departmental and enterprise data among departments and facilities — for years.
True interoperability involves intelligent bridging — not just connecting — information, according to Ms. Katzman. A hospital's utilization of the information is important as there are different products and systems necessary for sharing data at the point-of-care, departmental and enterprise levels.
5. Hospitals need interoperability with physician groups and the community. While interoperability is not perfect in internal scenarios, Mr. Caldwell believes that hospital executives should place focus on interoperability with partners in the community as well because it is where they have placed the least amount of focus.
"[With all the different IT systems being used], it is like all the physicians in a community are living in different countries, speaking different languages. How do you start to become interoperable when no one is speaking the same language?" asks Mr. Caldwell.
Some organizations that have affiliated with, or even acquired, physician groups can use a single EHR platform across all their facilities. According to Mr. Caldwell, interoperability is easier in those instances because the organization can mandate what type of system its employees use. However, not every hospital or health system owns or employs physician groups. According to Mr. Caldwell, healthcare executives need to pursue technology that offers interoperability not just across their organization's EHR system but across disparate systems as well. "It is the biggest stumbling block" he says.
According to Mike Detjen, vice president of service offerings for Arcadia Solutions, a healthcare consulting company, there are many technical decisions to be made based upon the type of information shared.
"There are multiple layers [of necessary technology] to think about now. You might have to share with an affiliate group of physicians as well as non-affiliated physicians who you are competing with," says Mr. Detjen. "Do you need an enterprise service for this exchange or can you route messages point-to-point? As the data exchange moves further away from the hospital, you need to think purposefully about the network topology."
With interoperability, providers can share information to inform better decisions at the point-of-care as well as analyze and aggregate patient data to inform clinical decisions and population health management initiatives. Information exchange is at the root of interoperability, and without it HIEs, accountable care organizations, risk-based payments and the movement toward higher quality, lower-cost healthcare may not be realized. These issues are currently complicating the industry's path and should be addressed in 2013 if goals set by federal initiatives are to be met.
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