Is the current lack of interoperability among the data resources for electronic health records (EHRs) a major obstacle to the effective exchange of health information? According to a recent white paper written by the JASON initiative within the McLean, Va.-based Mitre Corp., an organization that operates federally-funded research and development centers, the answer to that question is yes.
JASON—an independent group of scientists that advise the government on matters of science and technology—wrote its report in November 2013 (funded by the Agency for Healthcare Research and Quality), stating that interoperability issues need to be solved going forward, or else the entire health data infrastructure will be crippled.
One route to an interoperable solution, the report conveyed, is via the adoption of a common mark-up language for storing EHRs, a step already being undertaken by the Office of the National Coordinator for Health IT (ONC) and other groups. However, simply moving to a common mark-up language will not suffice, the report stated. It is equally necessary that there be published application program interfaces (APIs) that allow third-party programmers (and hence, users) to bridge from existing systems to a future software ecosystem that will be built on top of the stored data, it said.
Further, the white paper says that the criteria for Stage 1 and Stage 2 of meaningful use, “while surpassing the 2013 goals set forth by HHS for EHR adoption, fall short of achieving meaningful use in any practical sense. At present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records. Most patients still cannot gain electronic access to their health information. Rational access to EHRs for clinical care and biomedical research does not exist outside the boundaries of individual organizations.” The paper recommends that CMS embrace Stage 3 meaningful use as an opportunity to break free from the status quo and embark upon the creation of a truly interoperable health data infrastructure.
Dereesa Reid, CEO of the Irvine, Ca.-based Hoag Orthopedic Institute, an orthopedic hospital with 70 beds and nine operating rooms, is one hospital executive who feels that the claims and suggestions made in the JASON white paper regarding lack of interoperability are completely on point and could serve as a game-changer for the industry. (Reid has no formal connection to the publication of the white paper) Currently, many in the industry are working on their patient portals, and Reid says that while that’s a great thing—as patients should be able to get all of their information in one place—due to the way the industry is in its current state, the portal will just be a bigger silo.
“You may be part of some big health system and your electronic health information might be there, but if you move from the west coast to the east coast, there is no transfer [of data],” she says. “And so, I like to think of it the way the banking industry is today. Perhaps we have money in different banks, and from our home we can log on and look at different bank accounts. It should be the same for healthcare. If we want patients to be empowered and accountable, it would seem like the first step would be to access their information, which is unfortunately in a multitude of silos right now,” Reid says.
Reid—and the white paper—advise the industry to take a step back and look at how the internet became interoperable in the early 1990s. “Think about where we would be today if we had not made the internet have the ability to have standards and communicate,” she says. “Similar to healthcare, you have to have a very high degree of patient privacy and security, but we would be delivering much better healthcare if we were able to federate all that data and be able to look at it across the [continuum of care].”
To that end, Reid points to the newly-formed Industrial Internet Consortium (IIC), which aims to accelerate work on interoperability standards in multiple industries, including healthcare. Formed by AT&T, Cisco, GE, IBM, and Intel, the group focuses on breaking down the barriers of technology silos to support better access to big data with improved integration of the physical and digital worlds. “The main players involved in the IIC understand the connectivity challenges,” says Reid, adding that those companies have a deep learning and have experiences deep success in terms of what they have done with their technology. Specific to healthcare, Reid notes that some EHRs evolved from building off of some small clinical or some billing systems. “You have to start somewhere, but there is a huge wealth of knowledge that the IIC can bring to this industry. It’s such a quantum leap, though,” she says.
Were there an industry-wide vision that, ”We agree on common standards,” then an end-user could quickly leverage that information to deliver care, Reid continues. “What if you didn’t have access to your bank account? It’s the same thing. Thinking back to the mid 1990s, an email sent only went within that contained network, but from then on, you can send an email across the world. Standard protocols are required, and a common platform will change everything,” she says.
However, when asked her thoughts on the success of meaningful use to date, Reid does admit that the program has been positive overall, but that it has reached its limit. “We needed to be able to use technology to improve care, because the industry wasn’t going to do that on its own,” she says. “Kudos to the value-based purchasing program for pushing transparency. I believe that meaningful use has been a good thing, and it had to happen from public policy because it wasn’t going to happen in the private sector,” she says.
But the solutions today don’t solve the whole continuum of care, Reid feels. In an orthopedic hospital, if someone comes in for surgery, he or she has likely seen the primary care provider, an orthopedic surgeon, and has had physical therapy and lab tests done. So while that information is all gathered, it really depends where that patient received his or her care, Reid notes. “If he or she traveled from out of state, the records are in other state. Patient portals and health information exchanges (HIEs) attempt to solve that, but not in a way that is as elegant as it could be. Today, we have interesting new technology being developed, but it’s being bolted on to massive systems with complex integration problems, and they may talk to each other, but not without significant effort,” she says.
The key to making that next big step, Reid continues, is getting the industry to accept change. People probably don’t want to go back to the days where they couldn’t see the internet beyond their specific provider, just as they wouldn’t want to go back to getting bank statements through the mail or writing paper checks only, she says. “And there was fear then too, about security. But we have some of the most intelligent technical minds on the planet. If we get the interoperability platform standardized, we can alleviate those fears.”