West Health director explains why you should care about interoperability
TORREY PINES — Text messages, photos, even videos flow between billions of people every day, and it usually makes no difference who manufactured the smartphone that is sending and receiving the data.
Not so for medical devices. While technology in the consumer world grows more connected every day, that has not been the case with the high-tech tools used to care for patients.
“You would think that health care would be a first-order need, but we’re kind of the last in the queue to have seamless sharing of information. In some instances, we’re still using fax machines,” said Dr. Joseph Smith, chief medical and science officer at the West Health Institute.
The nonprofit medical research organization in Torrey Pines is leading a nationwide push to create and implement a common language for medical devices. This ability to “interoperate” would not only be safer for patients, but also potentially save $30 billion, according to the institute.
With a $10 million grant from the Gary and Mary West Foundation, the group established the Center for Medical Interoperability.
It formed a board of directors that includes some of the largest names in health care, including Vanderbilt University, the Cedars-Sinai Health System, Ascension Health and Hospital Corporation of America. Locally, Scripps Health CEO Chris Van Gorder is a board member, along with Smith and West Health Institute CEO Nick Valeriani.
Age: 58
Family: Wife, Ann; two sons, ages 17 and 18
Position: Chief medical and science officer, West Health Institute; board member for Center for Medical Interoperability
Career: Former vice president of emerging technologies for Johnson & Johnson, chief medical officer of Guidant/Boston Scientific’s cardiac rhythm management program, two decades of practicing cardiology at Brigham and Women’s Hospital in Boston, Washington University in St. Louis and the Arrhythmia Institute in Virginia
Education: Medical doctorate from Harvard Medical School; Ph.D. in medical engineering and physics from Harvard-MIT Division of Health Sciences and Technology
Smith recently explained the interoperability concept during an interview with The San Diego Union-Tribune. The following is an edited transcript:
Q: What does this interoperability problem look like at the bedside in a hospital?
A: Imagine you’re in an intensive-care unit where you’re surrounded by half a dozen, maybe even a dozen, smart medical devices. You’ll have a couple infusion pumps that are busy giving you medicine. You’ll have a blood-pressure monitor. You might have an oximeter to measure the amount of oxygen in your blood. You have a bed that’s capable of inflating and deflating to try to keep you from getting blood clots. You may be intubated. You may have continuous glucose monitoring if you’re diabetic.
Each of those devices is optimized to work as if it’s alone.
We ask health care providers — nurses, doctors, technicians — to look at all of those individual instruments, integrate their information and make a decision.
For example: Let’s say one of those infusion pumps is delivering blood-pressure medicine, but your heart monitor shows that the dose you’re receiving is not enough to control your blood pressure. Wouldn’t you want that pump to be able to adjust the dose within pre-established safe parameters? Of course you would, but we haven’t. We ask the nurses to do that. We force that delay and introduce the potential for mistakes by having a person in the middle.
Q: Do you think a fear of technology and a desire to have people ultimately in direct control of medical decisions, like real-time medication adjustment, has held back interoperability?
A: I’m not sure about that. We have many other situations in our daily lives where computers very swiftly make decisions, based on data they collect, to save lives. I’ve spent half of my life designing and implanting cardiac defibrillators that make a decision to deliver a shock within seconds or it’s too late. They save lives every day and they do so autonomously. Pacemakers do the same thing every day.
We’ve gotten comfortable with automatic measurement and automatic control, when there are no other options, and it’s been wildly successful.
Q: What is the biggest force holding back greater interoperability in the wider health care world?
A: We’ve been successful, like the airline industry, in areas where everything is controlled by one vendor. Boeing controls every system in the aircraft it manufactures in the same way that everything inside a pacemaker is controlled by the company that made it. But once you get inside a hospital, you’re dealing with many vendors. We have not yet found a way to make those different vendors all speak the same language, so that they can communicate.
One of the big issues is that vendors are held responsible for the performance of their devices by the U.S. Food and Drug Administration. There is a big open question about how you make sure that the information you’re taking in from other sources, which you did not design and do not control, is accurate and reliable.
Q: What is the Center for Medical Interoperability doing to bring about better communication across vendors?
A: We’ve asked the FDA to issue draft guidelines on what interoperability should look like. They’ve said they would, and at this point, they’re about six months late. There are vendors who see that interoperability is the way things have to go, and they are starting to integrate their own product lines.
But trying to communicate with someone else’s product line is still challenging. Also, vendors in some ways do not have a business interest in talking to each other. If a manufacturer has a dominant share in the market, they have to use my proprietary network, and that can provide a competitive advantage.
Q: What, then, will get vendors talking to each other?
A: In order to make real progress, the purchasing community has to ask for integration. It has to become a user requirement. That’s why we’re working with large health systems very closely.
We’ve been working in the C suites of hospital systems to educate executives that there is money to be saved, switching costs to be avoided and that patient safety can be increased. If the big systems start saying, “We’ll only buy stuff if it interoperates,” then you will start to see change happen more rapidly.