Interoperability: How close are we?

To date, the concept of exchanging patient health data-interoperability-is more vision than reality. While existing in pockets across the healthcare landscape, there is still no true electronic information highway for enabling physicians to share patient data efficiently.

Recently, Medical Economics convened a panel of experts to discuss the current state of interoperability and how to move closer to a goal of truly connected patient data. The panel consisted of:

• Russell P. Branzell, FCHIME, president and CEO, College of Healthcare Information Executives (CHIME);

• Leigh C. Burchell, chair, HIMSS EHR Association (EHRA) and vice president, government affairs & public policy for health IT vendor Allscripts;

• John D. Halamka, MD, a professor of medicine at Harvard Medical School, chief information officer of Beth Israel Deaconess Medical Center (Boston, Massachusetts);

• Michael J. McCoy, MD, chief health information officer (CHIO) in the Office of the National Coordinator for Health Information Technology (ONC); and

• Robert Rowley, MD, a practicing family physician, health IT consultant, and entrepreneur.

Is interoperability a feasible goal?

Michael J. McCoy: Well, I think first of all the question has to be ‘what is the definition of interoperability?’ I think that, as in many other industries, there are pockets of what would be considered interoperability now. But if you put the focus [on a definition as] the movement of data that’s relevant and important for patients, so that it’s usable by clinicians wherever they may reside and whatever the setting is, that to me is the most important definition of interoperability. And you get beyond the general, technical framework of what is interoperability, to the “what does it really mean?” in use. Yes, I think interoperability is a reasonable goal when you focus it on the movement of data that’s required for taking care of patients.

If you broaden that to research, to population health, again, I think that there are still some priority data elements that ONC and our federal advisory committees have pointed out as the crux of the most important information that needs to be moved around. We’re making great progress in that area as well.

John D. Halamka: I think Mike is exactly right, the definition of interoperability is so key. I was editing an article last night where an author was lamenting that if they in their practice referred to another practice, a patient for say, cardiac care, but they in the future, had no idea if that patient ever went or was treated, that that is an interoperability problem. So of course, if we describe this as a closed loop referral workflow, is that interoperability?

Related:The debate over healthcare interoperability

Or I was testifying to a group and I said exactly what Mike said, ‘Interoperability is the exchange of defined elements, such as problems, meds, allergies, notes, labs, diet, care plan, [etc.].’ They said, ‘No it is everything, for every purpose, for everyone!’ And I said, “Well, if you define interoperability that way, you are never going to achieve your goal.” Because you want hair color and toenail length? … So let us cleanly define interoperability.

Leigh C. Burchell: It’s true that healthcare is arguably the most complex industry in which to create an interoperable data exchange environment. But other industries have done it and they’ve done it well. I think there are some parties who sometimes let their impatience for the end goal get the best of them and have some urgency to figure this out. But we’re well on our way.

There are a number of metrics that provide encouraging news in this area. From the percent of healthcare organizations that now use robust electronic health records and I think that matters in the context of interoperability, because it’s a fundamental requirement for electronic data exchange.

The number of hospitals exchanging data with providers outside of their walls has increased rapidly. There has been exponential growth in the utilization of Direct protocols for example, [and] the rapidly increasing volume of primary care physicians who are submitting electronic immunization to local public health agencies. All of those have increased very rapidly in the last several years.

 

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