In an annual report to Congress last month, the Office of the National Coordinator (ONC) touted an enhanced focus on healthcare interoperability, citing the 10-year road map currently under development. Although the industry has made strides in recent years, ONC acknowledged in the report that “electronic health information is not yet sufficiently standardized to allow seamless interoperability, as it is still inconsistently expressed through technical and medical vocabulary, structure, and format, thereby limiting the potential uses of the information to improve health and care.”
In a shifting landscape to a pay-for-performance model, getting immediate access to health information is as important as ever. Yet most healthcare organizations see interoperability as a daunting challenge; a recent survey conducted by the Charlotte, N.C.-based Premier, Inc. and the eHealth Initiative found that 90 percent of accountable care organizations (ACOs) see the lack of it as a significant concern.
According to Mark Pasquale, CEO of Missouri Health Connection (MHC), a state-designated health information exchange (HIE) organization, a big reason why “true interoperability” has not been achieved in healthcare yet is because most electronic medical record (EMR) vendors have settled on the IHE USA standard for interoperability. The IHE (Integrating the Healthcare Enterprise) is an initiative to improve the way computer systems in healthcare share information, encouraging the use of established interoperability standards such as HL7 and DICOM. IHE offers a common framework for vendors and IT departments to understand and address clinical integration needs.
Pasquale says the way the IHE standards are interpreted vary from vendor to vendor, even though they’re all very close. “An example of this is that in one of the elements sections, we generally pass what’s called a uniqueID. It’s specified that it has to be a unique ID, but it doesn’t seem to say how it needs to be constructed. Different EMR vendors will construct the uniqueID in different ways. So while the uniqueID may exist, it might not be recognizable or process-able by multiple EMRs,” Pasquale explains.
Pasquale does note that he is a big proponent of the IHE standard. “The folks that put that put that standard together did a great job. I believe that to date, it’s the best standard we have to achieve interoperability, whether it’s EMR to EMR, EMR to HIE, or HIE to HIE,” he says. “The guidelines they provide are excellent, very thorough, and easy to understand and implement. But there is variability when you go to implement it. With any standard interpreted by multiple organizations, you’re going to have that happen.”
MHC realized that there was a need to eliminate that variability, and when there was variability, it needed to be standardized, Pasquale says. As such, thanks to a recent partnership between MHC, the Horsham, Pa.-based EMR and HIE vendor NextGen, and the Camebridge, Mass.-based InterSystems, healthcare organizations connected to MHC can now deploy the necessary software for aggregating patient data by using a uniform user interface that enables providers to store and retrieve data from multiple noncontiguous databases with a single query in real time. Healthcare organizations connected to MHC include: Jordan Valley Community Health Center in Springfield, Mo.; Family Health Center in Columbia; and Esse Health and Grace Hill Health Centers in St. Louis.
To demonstrate cross-vendor interoperability, InterSystems and NextGen teams recently used their respective products to perform on-demand data sharing. This type of “federated data sharing” helps create a more connected, interoperable health system that aims to lead to coordinated treatment plans and optimized patient outcomes. And through this level of interoperability, NextGen Healthcare clients can communicate and share important clinical information via a secure and integrated messaging service with any provider connected to the MHC, regardless of their healthcare information technology vendor, according to officials from the organizations.
MHC relies on the InterSystems HealthShare informatics platform to provide strategic interoperability by delivering shared medical information across a complex array of data sources, applications and users. By gathering and normalizing data of multiple types and sources, the platform also enables analytics based on real-time operational data, driving meaningful actions at the point of care, officials say.