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Interoperability: a Four Letter Word?

September 14, 2012
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The press regarding Vice President Biden’s recent campaign speech in which he referred to “jobs” as a “three-letter word” inspired me to refer to “interoperability” as a four letter word!  Why would I say this?  I was intrigued by several recent items and conversations that caught my attention with regard to health information systems and their ability to interoperate.

In a recent press release (, Surescripts announced that they are working with Epic to connect Epic’s Care Everywhere interoperability platform to Surescripts’ Clinical Interoperability Network.  The connectivity will allow Epic users to securely send and receive information between practices and health systems.  This is a good thing for enhancing interoperability between facilities, but it really does not address interoperability within a facility.

Another item I ran across (, addresses Allscripts and an effort to promote “open architecture.”  The article notes that Allscripts “is not so arrogant as to believe it will figure out every aspect of the integration puzzle, but will work with other major players to interoperate with their systems.”  The author notes that “Allscripts is notmoving toward open source systems, but uses some open source applications in its products, as do many other vendors.”  The open source products are meant to improve the interoperability between systems.  Another differentiation is made on the basis of the benefits of a singular database versus having data in multiple spots, raising the question of whether true integration requires a single database.  Allscripts CEO Glen Tullman is quoted as saying “Our whole strategy has been on open, and open is common in every other industry.” 

Herein lays the crux of whether interoperability is in fact a four-letter word!  Regardless of approach (singular database or multiple data sources), the goal should be the same: enabling patient information accessibility both within and between facilities.  How difficult this is will determine if it is a four-letter word!

In a recent conversation with Jeff Soble, MD, Cardiologist at Rush University Medical Center and President of ASCEND HiT, Dr. Soble stressed the importance of “streamlined workflows and comprehensive systems that enhance the productivity of physicians.”  Dr. Soble stressed the importance of the hidden costs of EHR consolidation, referring to the cost of system integration to achieve a viable system workflow including both data acquisition and data management in the EHR.  For example, in the case of a cardiac catheterization lab, a significant amount of information is acquired during an exam across a number of different systems.  From Dr. Soble’s perspective, understanding the workflow will determine how best for these systems to interoperate, whether that be by consolidation into a single system or by integration of a number of systems.  The downside of the inability of systems to interoperate may be either duplicate data entry, or the complication of unproductively entering different data into multiple systems during the procedure.

The crux of the matter is the need for facilities to start with a clear idea of their needs for data accessibility – both internal and external, and to develop strategies around achieving such workflow in both a technologically and economically viable manner.  A consolidated EHR database may offer certain advantages in terms of unified patient information access for both intra and inter facility applications, but the cost and method of getting the data into the EHR should also be considered.  A well-constructed plan will make interoperability a sixteen-letter, not a four-letter word!



Dr. Soble hit a "nail" on the proverbial head when he said "understanding the workflow will determine how best for these systems to interoperate, whether that be by consolidation into a single system or by integration of a number of systems. ".
But it is not only workflow in the various departments (including admissions, nursing, housekeeping, dietary etc.) but also patient "flow" and attending physician flow as well.
I myself would prefer a host system (a traffic cop so to speak) which could allow a user to access other systems for information and a back end function which would retrieve all information and put it into a colsolidated medical record for archiving. This record would have to be retrievable when needed.
The technology side should not be insurmountable but the expense might be. For instance if a physician wishes to see lab results, images or anything else at the same time would require very large screens. That technology is here but expensive as
the archival system would also be. Allowing external access to a hospitals data/archival system or accessing external systems (e.g. Doctors office, OPD lab work etc.)for data is another question altogether. The first would probbaly be the easiest but the hospital would have to have a system in place.
After 31 years in Hospital Information Technology, (I am retired now), 7 of which were in hospitals across the US as a consultant,I am truly aware of the problems (and have solved some) with integration. I know all of the problems need to be solved before the EHR will be a reality.