Interoperability: Why is it so hard?

Most everyone agrees that interoperability — enabling healthcare information to flow seamlessly between disparate devices and IT systems — would improve patient care and reduce costs. Yet despite all the new technologies and gadgets, there’s still a disconnect when it comes to actually being able to share health data.

One of the factors driving the interoperability challenge is that the different medical device and health IT manufacturers each have their own proprietary interface technology, so there’s no way to connect the disparate parts, said Kerry McDermott, vice president for public policy and communications at the Center for Medical Interoperability. Without a common interface — something akin to a USB cord — hospitals are forced to spend scarce time and money setting up each technology in a unique way.

Adding to the problem that there is no overarching architecture for creating interoperability. “In healthcare, we don’t have that blueprint for how the different pieces should fit together,” McDermott said.

Another problem has been the lack of standards. Unlike a two-by-four that really never varies, in healthcare you don’t always know what you’re getting. This is beginning to change, though, with groups like Integrating the Healthcare Enterprise. “IHE came up with all these standards and we adopted them,” said Daniel Pettus, vice president for IT sales for BD’s Medical Management Group.

BD has been working with Epic and Cerner to facilitate information flow between its infusion pumps and EHRs. “We haven’t seen any reluctance in the IT community to share information in order to expand the capability” said Pettus. The biggest barrier to interoperability, he said, is alignment — getting devicemakers and IT companies to talk with one another.

Pettus cited, by way of example, a medication order. In the past, clinicians would generate an order in the IT system and that order was filtered down to the nurse who interpreted it based on information in an infusion pump, creating the potential for errors to occur, he explained. With connectivity, every single order that’s generated in the IT system must match the information in the infusion pump. “It’s a wonderful thing when it happens because, for the first time, you can guarantee that the order generated upstream by the doctor really matches” the information at the point of care, he said, adding, “That’s just not the case today.”

EHR vendors have also expressed frustration with the lack of interoperability, made more glaring with the shift to electronic health records. According to one study, 70% of physicians are spending less time with patients because of the demands of electronic record entry. The problem spurred athenahealth to launch a ‘Let Doctors Be Doctors’ campaign last October.

McDermott understands that frustration. “Hospitals and health systems don’t want to pay for things that don’t work together in a plug-and-play way, because it’s not good for patients,” she said. “There are absolute implications for patient safety, clinical care outcomes, clinician fatigue. We’re exhausting our workforce because they have to spend so much time troubleshooting the technology instead of having it function seamlessly in the background.”

CMI spun out of the West Health Institute early last year with the goal of creating a space for health systems and other stakeholders to meet and solve their interoperability challenges. The nonprofit is assembling a technology coalition of providers, devicemakers and IT vendors to develop the reference architecture for an interoperability platform, as well as medical device and enterprise interfaces to the platform.

In addition, CMI is establishing a centralized laboratory where engineers and other technical experts can work on shared challenges around getting medical devices, EHRs and IT systems to work in a plug-and-play way. The lab, located in Nashville, will also test and certify that devices and IT systems conform to the standardized architecture.

The goal is to ensure that the architecture is vendor-neutral and supports real-time one-to-many communications, two-way data exchange, plug-and-play integration of devices and systems, the use of standards and the highest level of security, McDermott said.

“At the end of the day, we’re trying to make it easier and less expensive for devices to talk to each other, for devices to talk to EHRs and to other systems that support patient care and clinical decisionmaking, not to mention consumer access to information,” she said.

For Cerner, interoperability involves working with competitors and industry partners to achieve more “meaningful connectivity using available standards and creating new ones where there are gaps,” said Cerner VIce President of Interoperability Bob Robke. “Our ongoing innovation includes an open platform that strengthens scope and service along the continuum of care, making it easier and faster for developers to create apps that meet the needs of people and their healthcare providers,” he said.​

The federal government has also been involved in the press for greater health interoperability. Last October, the Office of the National Coordinator for Health Information Technology released its final roadmap on interoperability. Guiding it are three overarching themes: the need to move to a value-based healthcare system that enables consumers to access and share personal health data; the need to eliminate obstacles, whether intentional or inadvertent, to data sharing across organizational boundaries; and the need for federally recognized interoperability standards.

And on Jan. 26, the Food and Drug Administration released draft guidance on design considerations for manufacturers of  interoperable medical devices. Testing of devices should focus on the risks associated with interoperability, the potential for misuse and likely scenarios of events that could compromise patient safety.

In addition, the Senate’s Health, education, Labor & Pensions Committee last month unveiled legislation aimed at enhancing overall use and development of health IT. Among its proposals is the creation of a “trusted exchange network” for information sharing across health systems, EHR vendors and consumers. The bill would also create a set of “standardized data elements,” so that information could be easily entered and shared in patient registries.

The Improving Health Information Technology Act, S. 2511, is one of seven bills the Senate plans in answer to the House of Representative’s sweeping 21st Century Cures healthcare reforms bill.

Such initiatives notwithstanding, moving interoperability forward is a slow process and will take a concerted effort by the provider community, EHR vendors and devicemakers working together to tackle the obstacles. CMI hopes to provide that space. “You really need a place for all parties to say we should work with this architecture within the platform it creates, and everyone has access to the data in that platform and we can all compete on top of that,” McDermott said.

Via HealthcareDive »