There has been some buzz lately about how interoperability is a non-issue. I beg to differ.
With increasing pressure from federal initiatives like Meaningful Use Stage 2, there is growing need for information exchange across the industry. As many federal incentive programs will soon come to the end of their reporting period, providers are likely to rely on technology vendors to comply with data exchange and reporting requirements. The need for interoperable systems will grow exponentially.
Providers and technology companies need to gear up to deal with the huge complexities that lie ahead. In fact, achieving interoperability for a wide range of complex data (administration, clinical, financial, lab, radiology, pharmacy etc.) has been one of the healthcare industry’s biggest problems for years, and continues to be so even today.
Key Challenges
Many healthcare settings continue to run a wide proliferation of home-grown and legacy applications, providing functionality across patient and infrastructure management, clinical care, administrative and financial domains. Other than being closed in nature, many of these applications pre-date the introduction of standards for information sharing. Added to this is the fact that, even today, many healthcare providers are reluctant to change from traditional paper-based systems to electronic systems.
Another concern is the lack of specificity of healthcare standards and information sharing protocols that are often general in definition, and subject to region or provider-specific interpretation. Even in cases where data is shared between applications, there are numerous incompatible terminologies and ontologies involved. Semantic interoperability continues to be a major challenge and, if not addressed, will have a serious impact on the quality of care.
These factors together make interoperability one of the biggest hurdles in improving the effectiveness of patient care. The problem is amplified at the state or national level or when health systems attempt to manage a population’s wellness and develop mechanisms to exchange population-level data.
What’s Changed
In the past three to four years, we have seen developments, both from a technology and a standards perspective, that have accelerated the pace of technology adoption for clinical interoperability. Most notable are the interoperability requirements mandated by Meaningful Use, the development of HIEs and HIXs, and the need to transfer financial information using X.12 standards. Because of this, we are now seeing greater emphasis being laid on standards-based representation of information (CDA, CCD, CCDA) and communication (IHE, XDS, Direct Project, PHINMS, eHealth Exchange).
Organizations such as IHE, S&I Framework and a few others have been actively defining standards for interoperability in healthcare. The emerging standards, such as the Direct Project and eHealth Exchange, will allow providers to implement key use cases such as delivering and sharing lab results, transitioning between care providers, sending patient reminders, transferring records between providers, and more. As these standards are implemented and clinical systems start participating in initiatives such as HIEs and ACOs, we will start seeing benefits accrued to patients. The accumulated data will then be structured in a way that will allow analytics—both deductive and predictive—to enable better patient care.
The Road Ahead
The emerging standards today offer a number of opportunities to providers, that even a few years ago were beyond the realms of possibility. We can have the ability to aggregate and share lifelong electronic health records for patients with multiple stakeholders across the continuum of care. There is great potential in using combined clinical data—from EHRs, patient health record systems (PHR) and wireless medical sensor devices—for better decision support and patient care. Areas like clinical research also can benefit greatly from secondary use of EHR data, to analyze trends within patient populations for more effective research, and to evolve evidence-based care protocols.
For all of this to happen a lot of work needs to be done by both providers as well as technology companies. Providers need to view interoperability as not just a regulatory requirement, but as an effective way to improve collaboration between healthcare providers, to reduce the cost of healthcare and dramatically improve the delivery and quality of healthcare. Likewise, healthcare IT vendors must work closely with their customers to build and deploy systems that enable interoperability.
With challenges and opportunities that lie ahead of both providers and technology companies, interoperability cannot be a non-issue.
