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Informatics Expert on Interoperability: “We’re in the Dark Ages”

February 24, 2015
by Rajiv Leventhal
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David Avrin, M.D., Ph.D.

For healthcare organizations, challenges to interoperability include getting consistent and timely response from electronic medical record (EMR) vendor interface developers, financial costs of building interfaces, and technical difficulty of building interfaces. Undoubtedly, many have classified the state of interoperability in healthcare immature as vendors and providers continue to try to work together to make all systems interoperate, while the call for more direction from the federal government has been made.

What’s more, medical image exchange across the enterprise presents its own set of challenges, as historically, medical image storage has been under the control of individual picture archive and communications system (PACS) applications, requiring management of that data to be completely reliant upon system functionality. To this end, David Avrin, M.D., Ph.D., vice chairman, informatics, professor of clinical radiology, department of radiology and biomedical imaging at the University of California, San Francisco (UCSF), will be part of an interoperability panel discussion at the iHT2 Health IT Summit in San Francisco on March 3, 2015 (the Institute for Health Technology Transformation, iHT2, is a sister organization of Healthcare Informatics under our corporate parent organization, the Vendome Group LLC).

Dr. Avrin and others will discuss the best practices for data exchange at their respective organizations, addressing how organizations are working with regional health information exchanges (HIEs) and vendors, and what’s on the horizon for interoperability. Click here to register for the San Francisco event. Avrin recently spoke with HCI Associate Editor Rajiv Leventhal about what’s holding the industry back from being more interoperable. Below are excerpts from that interview.

Interoperability is clearly a huge healthcare buzz word these days. Where does your organization stand when it comes to data exchange?

We have been successful with integrating in-house vendor/provider applications. All of our principle apps—our PACS system, radiology system, Epic’s Radiant, and PowerScribe—are tightly integrated. Take abdominal imaging for example, a patient’s medical record at UCSF opens up in a second, and you are one click away from seeing the entire record and notes by date or by category. We have achieved that through a requirements and specifications process, and customer assistance with these vendors. Certain vendors know they need to interoperate. That works well.

Here’s what does not work well: as an academic medical center, we get patients from elsewhere, which might include Sutter Health, Oakland Children’s, Kaiser Permanente in northern California, or whoever.  If you’re dealing Epic to Epic, for example, to Kaiser in northern California, sometimes with the right permissions you can get read-only access into Kaiser’s medical record, but you can’t bring over things like medical lab values automatically.

We also receive patients from community physicians, and in spite of meaningful use, we still have a terrible time with electronic records or any records across care boundaries from the outpatient world into the inpatient world and back again. It’s a mixed world, and it’s getting a little better because customers are insisting more, and vendors know they have to do a certain amount. But it’s far from perfect, far from what many hoped would happen. There’s a lot of finger pointing going around. It’s in the community hospitals’ interest to share data, but data really belongs to the patients, not the hospitals. Vendors say there aren’t well-accepted standards, and they also take advantage of the fact that the neither the customer base nor the government have done a good job with insisting to adherence to Health Level Seven (HL7) Version 3 or Logical Observation Identifiers Names and Codes (LOINC), or whatever. Outside of healthcare, they have had a simple time with electronic data exchange. We are still in the dark ages.

You mention finger pointing, so where does most of the onus lie?

The majority of the onus is still on the community hospitals now for two reasons: they haven’t done a good job of making demands, and also too many community hospitals view patient information as their proprietary property, their marketplace advantage, and are not motivated to share it. Vendors would go along if the customers were more progressive. Another thing is there is no national medical record number for patients. The Veterans Administration (VA) uses social security numbers for patients, yet every other industry does it differently.

Also, meaningful use was a great opportunity for the government to guide the adoption of certain standards and XML cloning of data. I think the federal government blew it with Stage 2, as interoperability was supposed to be a huge part of it. That was not well done. It was a real missed opportunity to force some standards development. HL7 could simply things, and it needs to recoup.