It was about 25 years ago when John Zaleski, Ph.D., began researching and ushering to market medical devices and products to improve healthcare. Back in the 1990s, Dr. Zaleski, who is the named inventor or co-inventor on seven issued patents related to medical device interoperability—and is now executive vice president and chief informatics officer at Bernoulli, a Milford, Ct.-based medical device integration vendor—assumed that by 2016 medical devices would be able to be integrated seamlessly. “We have come a long way, and we have made improvements, but I would have thought that this [interoperability] problem would have been solved by now,” says Zaleski.
Zaleski is far from alone; while “true” interoperability is taking place in certain pockets of U.S. healthcare, many healthcare leaders, as well as outsiders, are questioning why more progress hasn’t been made given the significant investment put in. As such, provider organizations are collectively—but also individually—embarking on their complex interoperability journeys, and they continue to face several core challenges including but not limited to: insufficient data standards for electronically exchanging information; cost concerns, the lack of a universal patient matching solution; and complex privacy and security challenges.
John Zaleski, Ph.D.
Nonetheless, Zaleski classifies himself as a “glass half full” person when it comes to how far healthcare has progressed in becoming an interoperable industry. “We have come a long way and have made definite improvements, but to achieve the types of data access that are necessary for really doing intelligent action and analytics, we’re still too busy about being worried about the dial tone of getting the data versus having the data and being able to do the really important things such as identifying patients at risk,” he says.
Progress Has Been Made
At the Healthcare Information and Management Systems Society (HIMSS) conference in Las Vegas in February, John Halamka, M.D., CIO of Beth Israel Deaconess Medical Center in Boston, looked at how health IT has evolved over the years, assigning grades to various different industry segments. Halamka gave interoperability a C+ grade, noting that healthcare has made reasonable progress pushing payloads from place to place, but have not built the enabling infrastructure to support pull. “We are better than we have been before, but about half of clinicians feel that data isn’t available when and where they needed it. Maybe the data was there but they were not able to integrate it. So we have work to do,” Halamka said at HIMSS.
John Halamka, M.D.
Indeed, much of the work that needs to be done falls on two sides that directly impact one another—the technology vendors that develop the software and the clinical end users of those products. Both sides would agree on the core goal to help physicians access the patient data they need when they need it. But how they get there—and what it costs to get there—remain significant issues.
To this end, also at HIMSS16, Sylvia Mathews Burwell, the U.S. Secretary of Health and Human Services, announced a major federal initiative that has gathered together industry leaders to advance data-sharing, consumer access to healthcare data, and interoperability. Indeed, companies that provide 90 percent of electronic health records [EHRs] used by hospitals nationwide as well as the top five largest private healthcare systems in the country have agreed to implement these three core commitments, which, if acted out, should have the impact of creating a more open healthcare system.
Similarly, earlier this year, five major health IT vendors—athenahealth, Epic, eClinicalWorks, NextGen Healthcare and Surescripts—signed on to be the first to implement Carequality’s framework for interoperability and data sharing principles. Carequality, a Washington, D.C.-based public-private collaborative and an initiative of The Sequoia Project, released its interoperability framework in December, which consisted of multiple elements, including legal terms, policy requirements, technical specifications, and governance processes. The Framework operationalizes data sharing under the previously-approved principles of trust—the policy foundation for connecting health data sharing networks throughout the U.S.