Achieving interoperability remains, in many ways, the Holy Grail of healthcare IT. As advancements in technology accelerate, finding effective ways to integrate disparate systems, apps, and programs to enable easy sharing of information remains a key challenge. Still, progress is being made as healthcare providers, vendors, and federal and state agencies work toward improvements.
Compiled by Scott Westcott, Contributing Writer
When announcing the goal of interoperability by 2024, HHS said the flow of information is fundamental. While many share this sentiment, significant barriers remain to improving interoperability at many healthcare organizations.
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Achieving interoperability remains, in many ways, the Holy Grail of healthcare IT. As advancements in technology accelerate, finding effective ways to integrate disparate systems, apps, and programs to enable easy sharing of information remains a key challenge. Still, progress is being made as healthcare providers, vendors, and federal and state agencies work toward improvements.
Recently, ONC released its final 2016 interoperability standards advisory which includes six “informative characteristics” for each standard in hopes of providing more clarity regarding implementation, as well as the ability to better track industry progress toward implementation. Meanwhile, the HHS has announced a goal of nationwide interoperability by 2024 in its Interoperability Roadmap.
Steps toward enhanced interoperability are also being taken by healthcare systems throughout the country. One example is Halifax Regional Medical Center in Roanoke Rapids, NC. Recently, Robert Gordon, senior IT leader at Halifax, discussed the interoperability barriers hospitals face and the clinical benefits interoperability offers.
Q: What currently stands in the way of interoperability?
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A: I see two aspects of interoperability, the first being the integration of medical devices with the EHR. At Halifax we worked with Iatric Systems Inc. to connect our vital sign monitors and telemetry systems with the EHR in various hospital areas. The biggest challenge to completing this was that our vital sign monitors were nearing the end of their lives and needed to be replaced — quite the expense. Medical devices have advanced technologically to be wireless and include gateways to interface with EHRs, but healthcare organizations have to be in a place to undertake the capital expense required to replace the equipment. Another obstacle to interoperability between medical devices and the EHR is the technologies of the two don’t always match. For example, Halifax recently replaced infusion pumps, but the vendor chosen by the nurses can’t interface with EHR. These technologies not lining up have created a delay in achieving our interoperability goals.
The other aspect to interoperability is among different healthcare providers and EHRs. To me, the biggest barrier here is expense, especially when looking at having interfaces with each EHR. I can count about seven or eight different EHRs being used by the physician practices in our area, and for the hospital to interface with each of those would be quite expensive. An additional hindrance to this piece of the interoperability puzzle is that not all providers in our area are ready to do these types of interfaces — the people and the technology have to be at the same place at the same time. Meaningful Use (MU) and CCD (continuity of care document) are there to help bridge this gap, but many doctors I talk to don’t want to use these tools because they don’t include the information they want, such as the other physicians’ notes and impressions. Until these documents go beyond vital sign and demographic information to show the entire patient story, they won’t be truly useful to the physician or in achieving interoperability.
Q: Are clearer standards needed to ensure interoperability?
A: Definitely. As an industry, we need to get further into standards and work more with clinicians to determine what they need and then work with vendors to create solutions based on clinicians’ needs and standards. The goal is, for example, when a patient moves from a family practice to a cardiologist, that the cardiologist be able to automatically and easily access the patient data needed from the family physician. Achieving this will require additional standards industry-wide.
Q: What healthcare sector will ultimately drive this effort forward?
A: When looking at the sharing of medical records and letting medical history follow patients, there’s currently not a driving profit motive. Will a majority of patients change doctors because the current one won’t share medical records? This is a long-winded way of saying the government will have to be the key driver, especially when considering it is one of the biggest payers. Private payers will be the second driver, as they have begun to refuse payment for duplicate tests when providers won’t share information. Both the government and payers will have to get into profit motives, and in a capitalistic society, costs will create the biggest push toward data sharing. There isn’t a big enough benefit to the healthcare provider to be a driver, as sharing information could lead to patients choosing another physician. The government will drive down costs for itself, and payers will have to make it too costly for providers not to embrace interoperability.
Q: Can we be meaningful users or achieve population health without interoperability?
A: The simple answer is no. We will have to achieve true interoperability with a centralized patient record that everyone involved in patient care can access in order to effectively use population health management tools. An example is how my own mother has a cardiologist, pulmonologist, and a family practice physician, and without a central location where they can all see her records, there will be duplicate records, tests, and possibly even medications. Population health management will only be able to tie all care together once everyone involved can easily access, see, and contribute to the entire patient record. This may mean outsourcing projects for help in connecting all of these systems.
Q: What are some methods of transforming care with interoperability?
A: It seems that population health management and ACOs will be the main aspects of interoperability that will transform how patients are cared for. This goes back to how all interoperability projects have to be clinically driven in order to transform care, especially considering the more clinicians are involved, the more likely they are to adopt a new solution or care process. Additionally, when partnering with external sources, it’s best to find one that not only understands the technology needed, but the clinical processes as well.
Q: What else is inhibiting interoperability?
A: We are consistently overcoming technical challenges related to interoperability, but the main barrier remaining is connectivity. Several questions still need answers when looking at connectivity — the biggest ones being various costs and understanding data governance, specifically related to patients opting in and out, and meeting government regulations regarding who can access patient records. Having standards that go beyond MU and CCD to include the data physicians actually need will be a major catalyst in getting past these challenges. I hear from specialists and surgeons that the mountain of data they receive from primary care physicians takes a while to weed through for the data they can actually use. Physicians need current, accurate data so they can make sound judgments on care processes and next steps. Another challenge is how to support smaller physician practices, which often don’t have the capital or technical expertise needed to connect with hospitals and other practices.
Q: What strategies have you found to be successful for achieving interoperability at your facilities?
A: Clinicians need to be the primary stakeholders in any integration project. When integrating our vital sign monitors and telemetry systems with the EHR, our clinical staff sought devices that could be interfaced with our EHR, and this made for a more successful project, as it was the clinicians’ project. Partnering with an outside company that understood the integration needed, as well as our internal processes, greatly helped in meeting our goals.
Q: What role will patients play in the effort to improve interoperability?
A: The patient aspect of the public sector can help improve interoperability by talking about and insisting on data sharing among their physicians. If they talk about and ask for more interoperability, this will likely mean more to the physicians. Every clinician I know wants to help people, and if their patients insist on this type of technology, they are more likely to look into and accept it.
Q: What advice would you share with providers looking to improve their facilities’ interoperability efforts?
A: Set a goal of having all medical devices and other technologies interface with the EHR. At Halifax, we look for and demand interoperability from all devices and technologies brought into the facility. Secondly, create clinically driven interoperability projects, because it has been proven that connecting medical devices to the EHR helps nurses reduce time spent on data entry and increase time spent with patients. Working with an outside resource that is an integration expert takes the pressure from the internal IT department and better ensures a complete integration. To create better interoperability among facilities, work with other providers to create and connect to HIEs, outsource your IT interoperability work when needed, as well as get involved with the American Hospital Association and other industry groups to help create the standards needed. Achieving the interoperability needed to impact clinical outcomes, the ultimate goal, will take several stakeholders working together to introduce creative thought and out-of-the-box advances.
Achieving interoperability remains, in many ways, the Holy Grail of healthcare IT. As advancements in technology accelerate, finding effective ways to integrate disparate systems, apps, and programs to enable easy sharing of information remains a key challenge. Still, progress is being made as healthcare providers, vendors, and federal and state agencies work toward improvements.
A: I see two aspects of interoperability, the first being the integration of medical devices with the EHR. At Halifax we worked with Iatric Systems Inc. to connect our vital sign monitors and telemetry systems with the EHR in various hospital areas. The biggest challenge to completing this was that our vital sign monitors were nearing the end of their lives and needed to be replaced — quite the expense. Medical devices have advanced technologically to be wireless and include gateways to interface with EHRs, but healthcare organizations have to be in a place to undertake the capital expense required to replace the equipment. Another obstacle to interoperability between medical devices and the EHR is the technologies of the two don’t always match. For example, Halifax recently replaced infusion pumps, but the vendor chosen by the nurses can’t interface with EHR. These technologies not lining up have created a delay in achieving our interoperability goals.
