Health IT leaders discussed and debated the different trends and challenges around interoperability, and what the future holds at the IHT2 Health IT Summit in Atlanta on Dec. 2.
The panel session, “Driving Interoperability Across Systems,” at the iHT2 Health IT Summit (the Institute for Health Technology Transformation is a sister organization to Healthcare Informatics under the joint umbrella of the Vendome Group, LLC), was moderated by Denise Hines, CEO of Georgia’s eHealth Services Group and executive of the Georgia Health Information Network (GaHIN). Joining Hines on the panel were: Donna Lynch, vice president, clinical informatics, Covenant Health (Knoxville, Tenn.); David Dull, M.D., chief medical officer, St. John’s Health System in the greater Detroit, Mich. area; Jeff Gartland, vice president at RelayHealth (the Alpharetta, Ga.-based McKesson business unit which focused on clinical connectivity); and Steve Rushing, director of health initiatives, Enterprise Innovation Institute, Georgia Tech. Below are excerpts of the panel discussion on interoperability at the Omni Atlanta Hotel at CNN Center, with the questions being asked by Hines.
What are your definitions of interoperability?
Lynch: To me, interoperability means you have a patient-centric tool and process so you can provide the right information to the right provider at the right time so they can make intelligent decisions to improve care. The key is that the patient has to be at the center of it. We have disparate systems and we need to get that information aggregated for the clinical decision support aspect. Whoever that healthcare professional may be, they need the information to improve care.
Gartland: We call it person-centered interoperability. The information needs to follow the patient and the care team regardless of what system they’re in. It’s not about any one system or a given interface or standard. It’s about ensuring that you drive that outcome and empower the patient.
Dull: When I look at interoperability from a clinician’s [standpoint], it has a different nuance. It has to meet the needs of the patient, but as clinician, I need to have all the information in a way I can look at. All of the relevant information to care for the patient needs to be in a form that is usable, functionable, and easy for whoever is the caregiver at that time. When we had paper records, I would get information faxed to me on a form that looked pretty good and was standardized. The quality wasn’t great, but at least it was on a sheet of paper 8.5 x 11. Now, the [other organization] most likely doesn't have a fax machine, and if it does, it's poor quality. The state of interoperability is actually worse than it was when we were on paper.
How are these definitions being applied to your organization’s infrastructure?
Rushing: Id love to see a day when we stop talking about interoperability, but instead intra-operability. There are new organizational enterprises focused on patient-centered care. There is a future in which you might be wearing a part of your clinician's clinic. We are doing work at Georgia Tech where wearables are real, and we are turning that into information that's vital. You cannot afford to buy everyone like we have been doing over past six or seven years. How do we get that intra-operability working in a fashion where we can improve quality and cost?
Gartland: When we succeed in this space, conversations won’t be about the bits and bites of interoperability, but about outcomes. You look at the World Wide Web as an example—that wasn’t an overnight success. You don’t think about standards, protocols, or other things going on behind the scenes when you call Uber, look at a website, or send an email. We will get there.
When you talk about FHIR [Fast Healthcare Interoperability Resources], it’s a model past the one of sending around meaningful use-era type documents. It actually gets into granular detail. Using CommonWell as an example since they leverage FHIR: you don’t have to leave your EHR [electronic health record] or RIS [radiology information system]—it’s within the workflow. The complication is that the package in between those workflows is a meaningful use-level document, which most people don't want to hunt and peck through. If you want a medication list only, you don’t want to hunt through all that other stuff. FHIR lets you grab the information that’s important. We had Cerner, athenahealth, and McKesson working together to demonstrate the ability to pass those granular FHIR resources. This way, you can send just the problem or medication, for example, from one system to another.
Lynch: One of the things I hear frequently from our clinicians, as we moved into the EHR world, was that they lost the story of the patient. They don’t know what happened on the last shift. The data is there, but they have to really dig through it. Often they have to ask nurses, who are all overworked anyway. As a result, we’re doing interesting things with natural language processing at Covenant.
Rushing: We are huge supporters of FHIR; we use it in our lab in several projects. It breaks down the barrier of usability that’s been present for so long. It enables people to go back to best-of-breed. We spent a lot of time in the early days doing best-of-breed, and then moved to enterprise systems. Now, when you look at start-ups and around the academia world, we are starting to see best-of-breed. We need to stop thinking about hospitals being walls and quarters—that’s the old economics of scale. Now, its how can we use data to improve outcomes. EHR vendors need to function in that new world.