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.
This example of cross-vendor interoperability seems to be unique to the industry, but according to Pasquale, it might just be due to bad timing. A challenge for EMR vendors has been to make sure that their applications have been meeting the meaningful use guidelines for certifications, he says. “There has never been a time where healthcare organizations have had more demand and less capacity, so they have to apply that capacity to what’s strategically important to them at the time,” he notes. “Vendors have put the meaningful use ability first. We have seen a lot of our customers make sure they could do Stage 2 Year 1 while there was only a 90-day reporting requirement [rather than a full year]. Now that they’re mostly through with that, vendors are working to make their EMRs IHE-compatible as well. Not just outbound with continuity of care documents, but bi-directional, using the cross-community access (XCA) protocols—part of the IHE standard to achieve interoperability.”
Another barrier, says Pasquale, is that some healthcare organizations, “for whatever reason,” run an acute care application on one end and an ambulatory outpatient system on the other end. This is compared to large integrated delivery networks (IDNs) that get standardized on one platform, he says. Large IDNs have selected one vendor, and they have implemented that vendor in both their ambulatory and acute care environments, he explains. “They’re getting a level of integration within their own IDN that meets a fairly large percentage of what they need for interoperability. It doesn’t really stretch outside their IDN.” But the other groups’ level of integration is definitely not as much as the single solution, Pasquale continues, adding that they may have additional requirements that the larger IDNs that selected one platform do not have.
Going forward, Pasquale does have confidence in the industry being able to achieve true interoperability. “The vendors are working hard—I see it more and more on a regular basis,” he says. “All of the vendors we’re working with either have IHE up and running or they’re very close. I believe that as organizations continue to work to facilitate interoperability, the standards will continue to be hardened. I also believe that Stage 3 will play an important part in the march towards true interoperability. That will be a real positive for our industry.”