A senior leader of the Indiana Health Information Exchange (IHIE) said at the CHIME (College of Healthcare Information Management Executives) Fall CIO Forum that much of the health IT industry is thinking about interoperability in the wrong way.
Charles “Chuck” Christian, vice president of technology and engagement of the Indiana Health Information Exchange, presented at the CHIME Fall CIO Forum in San Antonio, Texas on current interoperability approaches and challenges—namely how interoperability is not one thing, but rather many things.
Christian noted that the industry has made little progress in achieving interoperability because stakeholders have had trouble defining what exactly it is. “It depends on who you talk to; you may get [several] different definitions. But we’re wasting time and resources in the process. There is no clear understanding of the various national approaches, and there’s an unsupported belief that one approach is the correct one,” he said.
To this point, Christian made note of the many interoperability approaches currently out there—such as the eHealth Exchange, CommonWell, Carequality, Epic’s Care Everywhere, health information exchanges, and SHIEC (the Strategic HIE Collaborative). But Christian said a key issue early on in the process is that people believe these approaches are all physical networks. “That’s a problem,” he said. “But the eHealth Exchange and Carequality are frameworks, not networks. They are based on legal agreements. CommonWell is one physical network to connect EHR [electronic health record] vendors. HIEs don’t aim to connect to the whole country; they aim to connect to the regions it serves,” he explained.
Christian said that HIEs are “one patch of the quilt,” noting how the IHIE has 160 data sources that it houses at a centralized location, and is funded by subscription services from its members. “We don’t live on grants. If we can’t deliver value to our members, they don’t use our services,” he said. He also added that Epic’s Care Everywhere platform works well when data exchange is being done from one Epic shop to another.
But the fundamental point of Christian’s presentation was that there is a core belief—which he feels is heightened by how the press covers interoperability—that a single interoperability approach works for every use case. “I violently disagree,” he said. “Depending on the use case, you need other assets and tools. Interoperability is comprised of many use cases, and every use case encompasses other use cases. You need to take a systematic approach.” He added that different organizations have different interoperability needs, and that the approach depends on key characteristics of the specific organization’s market.
A few attendees brought up the frequently-used comparison of healthcare and banking, asking Christian why patient data exchange can’t follow a similar path that led to the deployment of ATMs worldwide. Christian responded by saying there are 27 ATM networks today, but more than 200 when they first started. “Banks realized that their costs were astronomical, so they [thought about] how they could connect networks and let people get money out wherever they wanted. They figured out the standards and inter-bank transfers, and now I can get my money in Denmark, just like that. Maybe I pay $4 for it,” said Christian, adding that there is a fundamental difference in making a withdrawal and moving patient information from California to Denmark. “And that’s because [healthcare] is not a single network. And also, banks know that if you can’t have the ability to take money out wherever you are, then you will move your money somewhere else,” he said.
Christian was also asked if he thinks there could be one day be a national model for interoperability, another belief he strongly disagreed with. “I don’t believe there is one way of exchanging data or making it available to whoever needs it at that point of time,” he said. “The size of the database needed to keep all patient information in one location would be huge,” he continued, also expressing some skepticism for how blockchain could be leveraged in this sense.
Christian said that his key advice to hospital CIOs would be to create a living interoperability plan that first identifies internal clinical value opportunities (use cases) and then prioritize those. He stressed to address workflow and adoption, and be prepared for clinicians’ apathy or resistance.
He then advised CIOs to identify environmental factors that currently or soon will affect an organization’s needs, such as government programs like ACOs (accountable care organizations), MACRA (the Medicare Access and CHIP Reauthorization Act), or the Comprehensive Care for Joint Replacement (CJR) model. He offered an example of thinking about the importance of CJR patient activity 90 days post-procedure.
Finally, he suggested that CIOs assess interoperability capabilities in their organization, by use case, and determine how data will integrate into their internal systems. And then, align the plan with the overall organization strategy and other IT initiatives. In a sense, Christian said, “Interoperability is kind of like unicorns. Everyone knows what they look like, but has anyone seen one? If you’re confused about interoperability, you’re in a very populated place,” he said.
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