Health IT, Hospitals, MedCity Influencers

The art of interoperability in improving patient experience

Healthcare professionals and vendors all around the world can all agree that interoperability is important. But how to address it and properly improve it are the biggest challenges. The following are frameworks, ideas and initiatives that are critical when it comes to improving interoperability.

interoperability, rope, braid

Healthcare is an industry known for its remarkable innovation and talented workforce, but why is it that we consistently fall short when it comes to improving interoperability and patient experience?

A recent survey from the Center for Connected Medicine revealed that fewer than 40 percent of healthcare leaders feel they can successfully share healthcare data with other systems. One bright spot in the survey — a majority of respondents are answering this challenge by aligning their tech with interoperability in mind.

First, let’s call out one point where healthcare professionals and vendors all around the world can all agree: Interoperability is important. But how to address it and properly improve it are the biggest challenges.

The following are frameworks, ideas and initiatives that are critical when it comes to improving interoperability.

Strengthening the data-sharing need among health systems One-third of hospital IT and business leaders say their hospitals’ and health systems’ data-sharing efforts are insufficient, according to the GE survey, shining light on a critical aspect of today’s healthcare IT challenges: Sharing and making use of information.

Today we’re seeing health systems launch extensive integration efforts of their hospitals, clinics and primary care physician (PCP) offices. When set up to operate within a single electronic medical record (EMR) system, this integration, though far reaching, is straight forward. However, as we all know, patients seek care outside their health system, walking into hospital that have no details about their condition or medical history. Without integration across disparate health systems, patient care suffers and becomes much more costly. A health information exchange (HIE) is one solution to support this level of integration but can be costly for health systems already struggling to streamline operations and reduce costs.

Understanding what true interoperability means within a health system

Interoperability within a health system is also a challenge. In addition to the exchange of information between disparate systems within the health system’s network, (chief information officers) CIOs are also being asked to establish some level of interoperability between EMRs and medical devices within their institution. One such example of interoperability in the infusion pump space is using barcode medication administration (BCMA) software within the EMR to automatically program a pump by scanning the barcode on the medication, the patient and the pump. Once programmed, the pump sends information back to the EMR, enabling the automatic documentation of the infusion therapy. This level of interoperability reduces the chance of programming errors while improving the documentation associated with these infused medications and solutions.

Solving the chicken-and-egg dilemma in interoperability
Though both hospitals and vendors would like to do more in the area of interoperability, progress tends to be limited until two or more vendors agree on the interface(s) needed to make that interoperability possible. As vendors consider their R&D investments each year, interface development doesn’t always make the cut unless an interfacing standard already exists and all involved parties have compatible interfaces available. Without some level of innovation and forward-thinking amongst the vendors, these interfaces may never come to be and many healthcare institutions may not even be aware that these types of solutions are even possible. 

Articulating the ROI of becoming interoperable
Under constant pressure to drive down the cost of care, most health systems carefully scrutinize and prioritize investments they make each year based on an expected value or rate of return. Over the past decade, most of healthcare systems’ investments have been around the rollout of new EMR systems across their institutions. Because interoperability often centers around the EMR, it is, at a minimum, a second or third priority after its rollout. However, the cost and complexity of some of these interfaces cause some institutions to hesitate before putting them in place.

Take, for example, the BCMA interface mentioned above. The automatic programming of the infusion from the medication order has been known to significantly reduce programming errors, making infusions much safer. The automatic documentation of the infusion details not only reduces the amount of manual documentation required, but can significantly improve reimbursements by capturing previously undocumented information about the infusion. Despite this, adoption of this solution has been slow as CIOs continue to assess whether the value is worth the investment and weigh this initiative against our priorities. For the CIO, the cost of such a solution includes the cost of the EMR and pump interface and the cost to set up, test and maintain the interface over its lifetime. In addition, implementing interfaces in a hospital requires integration expertise within the hospital IT team. This expertise is needed not only to assist in the setup of the interface but also to support and update it as the interface evolves over time.

Healthcare integration is a unique skillset. Integration engineers often require knowledge of the Health Level 7 (HL7) standard, as well as those specific standards used to manage the transfer of various pieces of data. It also typically requires knowledge of middleware known as Integration Engines, which, like the HIEs mentioned above, are used to translate data sets from one system so that they match those of another. All of this creates an inertia when hospitals consider implementing interfaces between disparate systems and devices.

Addressing the increasing risk of cyberattacks
As medical systems and devices exchange more data over the hospital network, the risk of cyberattacks grows. Unlike other technology investments that vendors make, cybersecurity is something that continues to evolve over time. Like a chess game, vendors and hospitals must continue to pivot and evolve their solutions as new threats are uncovered.

Though complex in its execution, a cybersecurity strategy typically involves three basic tactics. These include using technology that helps prevent attacks, detecting when an attack has occurred and ensuring you have the means of recovering quickly from any attack. Until recently, cybersecurity was an afterthought of most medical device vendors, adding to the risk and long-term cost of implementing interoperable solutions with these devices. As more secure devices become available, these risks and costs will become much more manageable.

Planning and deploying intelligent medical devices
Intelligent medical devices will become a reality over the next decade, using readily available patient information and artificial intelligence capabilities to guide care as it is being delivered.

The first step in making this possible is the establishment of high-value applications capable of integrating information from disparate systems and using this information at the point of care to improve care and reduce costs. Innovation must come from partnerships between vendors and care providers and must include secure interfacing and informatics standards that enable the low-cost integration of disparate systems and the ability to transform disparate data sets into actionable information.

As with other industries, standards will drive down the cost of integration. More secure systems and devices will contribute to that as well. However, the driving force will be the value of the information and its ability to drive care improvements while continuing to drive down the cost of that care.


George Gray

Bio: George Gray, CTO and VP of research & development at Ivenix, has more than three decades of healthcare experience in clinical information systems, clinical analytics and patient monitoring.

Prior to joining Ivenix, George was a senior architect at Philips Healthcare for both the Intellivue Clinical Information Portfolio and Intellivue Information Center. He also founded Envision Solutions Inc., a provider of clinical analytics and data integration solutions. Previous to this, George was the engineering manager for Hewlett Packard’s Systems Integration Organization and held various engineering leadership positions in the development of HP CareVue 9000 Clinical Information System.

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