With all the discussion industry-wide around the subject of interoperability, the topic is clearly top-of-mind for many healthcare leaders these days. With that in mind, attendees at the Health IT Summit in Miami, being held at the Ritz-Carlton Coconut Grove Hotel, and sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group corporate umbrella) heard a wide-ranging first panel discussion on Monday, under the heading, “Interoperability: Beyond the Buzzword.”
Gary Ozanich, Ph.D., senior research associate and professor in the Center for Applied Informatics in the College of Informatics at Northern Kentucky University, led a distinguished panel of industry leaders in a very broad and probing discussion of the topic. With him in discussion were William H. Morris, M.D., associate CIO, Cleveland Clinic; John Santangelo, senior director, information technology, Cleveland Clinic Florida; David C. Kibbe, M.D., president and CEO, DirectTrust; and Karl Norris, CTO, founder, DUOLARK LLC.
(l. to r.) panelists Ozanich, Santangelo, Morris, Norris, Kibbe
Among the numerous subtopics discussed, early on, discussion emerged around how much real progress is being made towards interoperability in the U.S. healthcare industry right now. Dr. Morris of Cleveland Clinic said, “Certainly, we’re seeing advances with Smart on FHIR. On the geek side, which I oversee, there are definitely exciting things happening. But clinically, operationally, it still feels pretty glacially slow,” he conceded.
Santangelo of Cleveland Clinic Florida, immediately responded, “What he said! You know,” he continued, “we as a healthcare community are figuring out ways to interact with each other, to exchange information. HIEs [health information exchanges] are not the answer, obviously. Based on the transition of our healthcare organizations, we’re finding ways to make interoperability work around HIEs and other infrastructures that really aren’t working. I think we’re definitely making progress, but it’s not going to be run by the state or government, it’s going to be run by ourselves.”
Ozanich asked his fellow panelists, is the attempt to exchange patient record summaries and to be able to move away from having to exchange very large patient record data sets, becoming real yet?
“Things are getting better,” Dr. Kibbe testified. “I recently had an appointment with my internist in a rural place in North Carolina. And I asked, can you get my records from Mayo Clinic? I recently received care there. And they said, ‘Sure, what’s their DIRECT address?’ And this was not an IT person asking that question. And my CDA went the next day. So it is happening,” he said. “ But there are problems. Neither FHIR nor APIs have fully worked out standards. But it’s doable; we’ve done it with DIRECT exchange.”
Meanwhile, Kibbe said, “There are two other FHIR problems. One, if you’re pushing (data), you know someone’s address, but there are problems you have to deal with. First, there’s the patient matching issue: am I getting the right patient? Second, do I have the right consents in place? And once you’re beginning to do server-to-server exchange, you won’t have the people to help facilitate those issues. That’s one of the reasons we’ll see much more intra-exchange inside patient care organizations before we see much inter exchange.”
Norris noted that, “Here in South Florida, what we’ve done is to design a method to communicate downstream, from the hospital to the SNF [skilled nursing facility] to long-term care. A lot of the time, it’s just paper records. And we basically set up a way to get all these different organizations to be interoperable, using tools like FHIR as a standard but also normalizing the way people do business and track the encounter. Within CJR, each provider gets reimbursed. And the first year, it’s all designed for benefit. We’re making sure that information on a patient tracks down through all these different entities for quality control and cost management. We have to track the individual, the episode, the encounter, and the cost, so these folks get reimbursed. And 67 metro areas across the US are mandated on this for knee replacements,” he said, referring to new mandates coming out of the Medicare program around joint replacement procedures. “And by year three, if you don’t use this system, by year three, I believe, you’re cut out of Medicare payment. So those kinds of developments are moving things forward.
Later in the discussion, the subject turned to the development of APIs, and whether that ongoing evolution would help the U.S. healthcare industry move forward on interoperability. “APIs are a tool,” Cleveland Clinic’s Morris said. “They’re not a panacea. With regard to what David [Kibbe] said about the evolution of how you use these tools, a couple of points. We need not be so innovative; we can be imitative, and look to [the developers of tools at individual, pioneering organizations], to see how to use tools appropriately. Internally, there are plenty of opportunities to get your feet wet with APIs and with FHIR. Internally, as we move from volume to value in our organizations, how do we use predictive models?”
Critically, Morris said, “Physicians are seeing that their computers can be not just repositories of records, but rather, that they can help guide them in patient care delivery; and that’s what we need. Using predictive models is one great concrete example; another is visualization. That’s all really centered around how you take data and make knowledge.”