Many in the healthcare industry struggle over the true definition of interoperability. According to University of Texas Health School of Biomedical Informatics professor Dean F. Sittig, Ph.D., oftentimes, when people talk about interoperability, they’re talking about it from their own point of view or their own use case that they’re interested in.
As such, Sittig, who is also a member of the Houston-based UT-Memorial Hermann Center for Healthcare Quality and Safety, thought it was time to write a definition on what an open electronic health record (EHR) was. Sittig has promptly indentified five use cases for open EHR technology and health IT interoperability under the acronym of EXTREME: EXtract: extract patient records while maintaining granularity of structured data; TRansmit: authorized users transmit patient records to other clinicians without losing structured data; Exchange: exchange enables organizations to participate in health information exchanges (HIEs) regardless of which EHR they use; Move: move enables organizations to switch EHRs without incurring extraordinary data extraction and conversion costs; and Embed: embed enables organizations to develop new EHR features of functionality and incorporate it into clinicians’ workflow.
The idea of this EXTREME model is to talk about five of the key stakeholders in healthcare interoperability: patients, clinicians, researchers, developers, and administrators, and from each of their standpoints, try to understand or say what interoperability means to them, Sittig says. From there, Sitting and others wrote down different requirements that systems would have to do to meet these cases, as well as the questions that would be raised from them.
Sittig says that some of these use cases are happening in patient care organizations around the nation, and others aren’t. For the ones that aren’t, people are clamoring for them to occur, he says. One such use case that’s not happening too often is that an organization should move their patient records from one EHR to another, he notes. “Say you bought a new system and you want to export all of your records from one to another, right now that’s not an easy thing to do. That would be a huge process and cost a lot of money. But there are people who are moving from one EHR to another, especially now that small EHR vendors are not meeting advanced meaningful use criteria. Physicians are moving to more robust EHRs,” he says.
Dean F. Sittig, Ph.D.
What’s more, Sittig says that with interoperability and health IT in general, there is a “socio-technical” problem, meaning there are legal, organizational, and people constraints on IT systems just as much as there are technical limitations. “A lot of people focus on the technical limitations and say we’re not achieving the interoperability we want because of those. I’d say that’s not the case at all. In a lot of cases the healthcare delivery systems don’t want to exchange data with their competitors. They blame it on a technical reason, either big or small, because they don’t want to do it anyway,” he says. Sittig gives an example of two hospitals that are currently trying to merge and they’re arguing about whether they’re going to let the nurses in the other system see the data. “It’s not a question of technical capabilities, but instead one of giving them log-ins or not,” he says.
To this end, speaking of an Office of the National Coordinator for Health IT (ONC) report released last month on health information blocking, Sittig says the blocking is coming more from the healthcare providers than from the vendors. “It’s happening and it would be better for the patients if it wasn’t happening, but there is a huge business around this. It’s not completely about patient care,” he says. “These are multi-billion dollar businesses,” he continues. “If we shared all the data that people want us to share, we would lose a significant amount of revenue, so much so that it would make us a lot smaller, maybe even put us out of business. Until that changes, and there are federal laws that people are talking about now, we won’t have interoperability,” Sittig says.
David McCallie, M.D., senior vice president of medical informatics at the Kansas City-based EHR vendor Cerner, is surprised at the degree of concern expressed by Sittig when it comes to information sharing. In addition to his Cerner job, McCallie wears several different hats when it comes to interoperability, as he was integral in the creation of Direct and the CommonWell Health Alliance. McCallie says that the first step to stopping information blocking is greater transparency. “What’s actually happening? Is data blocking occurring? We know it is, so the next questions are where and why? The government needs to ensure there’s transparency, and that will fix a bunch of problems right on the spot,” he says.