During this past week, there were multiple news items and announcements related to the topics of interoperability and health information exchange. This caught my attention because, even though interoperability has been one of my areas of focus for a several years, I can’t recall a similar timeframe when the topic was so visible in the headlines. One not-so-surprising announcement was that clinicians want access to health information so that they can meet the needs of the patients they serve.
This week, a survey published by the Bipartisan Policy Center Health Information Technology Initiative, Clinician Perspectives on Electronic Health Information Sharing for Transitions of Care, reported that 70 percent of clinicians believe that lack of interoperability and an exchange infrastructure, and the cost associated with both, are major barriers to electronic information sharing.
The survey also found that a majority of clinicians believe electronic exchange of health information will have a positive impact on healthcare. This Clinician Survey confirmed the 2011 HIMSS Nursing Informatics Workforce Survey results which found that lack of integration/interoperability was the top barrier to success.
According to survey results, health IT can play a critical role in supporting high-quality, patient-centered, cost-effective care. The report also states that, “the newly emerging, coordinated, accountable, patient-centered models of care require IT that can facilitate the efficient and safe exchange of health information across multiple clinicians and provider organizations.” This exchange of information is especially important during transitions of care, when responsibility for a patient’s care is “handed off” from one clinician to another.
Another news item released this week shows that we are, at least, pressing on the interoperability accelerator to make forward progress.
A newly formed public-private partnership of states, public agencies, federally funded health information exchanges and health IT companies, called eHealth Exchange, announced it has established a program to test and certify electronic health records and other health IT to enable reliable transfer of data within and across organizational and state boundaries.
According to the news release, “this coalition of 15 states, 37 technology vendors and 34 HIEs, representing more than 50 percent of the U.S. population, has created a robust, highly automated testing program to verify that, once tested, a system is capable of exchanging health information with many other systems. With this testing, a single set of standardized, easy-to-implement connections can support communication among systems.” This effort intends to build on and accelerate consensus on national standards, adopting EHR certification criteria and testing procedures as relevant and finalized for Meaningful Use Stage 2.
From a practical perspective, an increasing number of vendors and healthcare organizations are focused on achieving interoperability that will support the long-term vision of care transitions and care coordination.
As an example, over 110 health IT companies and research organizations participated in the 2012 Integrating the Healthcare Enterprise (IHE) North American Connectathon, successfully testing more than 180 health IT systems for cross-vendor information exchange. This represents an increase of more than 20 percent over the 2011 event and indicates expanded recognition of the value of standards-based interoperability to enable effective and secure sharing of health data.
During the 2013 IHE Connectathon to be held in January, participants will test the interoperability of transitions of care using the HL7 Implementation Guide for CDA® Release 2: IHE Health Story Consolidation, as recently adopted in the Meaningful Use Stage 2 Standards and Certification Criteria Final Rule.
For an example of how important this is, one only needs to turn to the recent Wall Street Journal article in which we learned that the CDC and state health officials scrambled last week and over the weekend to track down patients who received contaminated steroid injections to see if they had become sick, and to warn them to watch for possible symptoms of meningitis. It seems clear that if CDC health officials lack access to critical public health data, electronic exchange of health information is NOT having a positive impact on health- care today.
In composite, the interoperability efforts I’ve noted above can enable health information to follow the consumer, be available for clinical decision-making, and support appropriate use of health information beyond direct patient care, to improve population health.
But, are we truly making progress, or are we simply stalled in neutral, while forming new groups and coalitions, and funding new organizations and efforts that will take more time and resources to get us further down the road? Only time will tell, but in the meantime, interoperability is top of mind, and that is definitely where it needs to be.
Are you involved with any of these evolving interoperability activities?
If so, what are your thoughts on their potential impact?
Do you think we are making progress, and if not, what will it take to get us to the electronic exchange of health information that has a positive impact on health care?
I welcome your thoughts and look forward to our ongoing dialogue.
I believe that interoperability is somewhat overrated, albeit one of the attributes of EHR-enabled healthcare.
Until we are totally confident we know how to design and deploy EHRs in a manner that will substantially improve healthcare, why would we want to proliferate these expensive systems? The thinking is that EHR interoperability will solve healthcare’s crisis. But ask yourself: Whenever you’ve received inadequate care, what was the root cause? Was it (1) because your doctor couldn’t access a medical record that was in some other doctor’s office? Was it (2) because your doctor did not have access to the clinical knowledge that would have led to accurate diagnosis and/or effective treatment? Or was it (3) because medical science, itself, just does not know enough?
Of those 3 causes for suboptimal healthcare, I believe the first one (lack of EHR interoperability) is actually the least impacting. For most clinical episodes, the treating physician is not truly handicapped by not being able to see what’s in some other physician’s record of your prior care. The second one seems to be considerably more instrumental. No physician can learn all s/he needs to learn, remember all that was learned, and apply it effectively during a brief clinical encounter. So we should clearly enable access to whatever is currently known by medical science, by providing computer-retrievable knowledge at the point of care. Not to do so is just plain foolish…or professionally arrogant.
The third cause, in my opinion, is actually the most significant deficiency in healthcare. Medical science just does not know enough. The reason for this is that healthcare does not learn from its own experiences. No one is retrospectively analyzing all the clinical encounters every day, to determine the early signs of what eventually become definitive diagnoses. No one is evaluating what treatments actually work best for various conditions, and under what circumstances. Medical science only moves forward via controlled clinical studies, which are too targeted and expensive to be our only strategy for advancing the science. We need to mine the data on real-life clinical encounters – nationwide. If you doubt this assertion, think about hormone-replacement therapy. The message here is that data interoperability, attained through a standardized clinical vocabulary, is more critical than operational interoperability.
Once we have determined, through data analyses (while controlling for potentially confounding variables), how to diagnose and treat more effectively, we must convert that learning into a “clinical guidance system”, operational at the point of care. We would monitor outcomes, assuming we can figure out how to measure them, so that the system can be empirically enhanced – thereby establishing continuous quality improvement (CQI) for healthcare. That, along with systematization of healthcare delivery, via processes like triage and rational incentives, is the only way that we can prevent the current crisis from turning into an apocalypse.
We need to conduct pilots of alternative EHR approaches, rigorously analyzing both the financial and clinical outcomes – so that we can learn what truly works best. The point-and-click documentation requirement of most existing EHRs has ironically been demonstrated to decrease the productivity of physicians. That is the last thing we need…particularly if there are no offsetting benefits derived from improved quality and value. Let’s figure out how to do it right: How to make data entry physician-friendly and highly efficient. Let’s bring the best minds together to design and evaluate these systems, which will determine the future of our nation’s healthcare. Let’s not throw money at this devastating problem until we know for sure it will buy the cure.
Kaiser & SETMA have proven conclusively that EHR & interoperability improves health outcomes and reduces the cost of care when done right. The CMS Physicians Quality Reporting Initiatives and the National Quality Forum have best practices to inform a clinical guidance system. Agree that a standardized clinical vocabulary is essential for interoperability, and that is being advanced as we speak. The progress in the public/private accomplishments of Integrating the Healthcare Enterprise at the interoperability connect-a-thon this year is evidence that we are in drive on interoperability.
Do we know if the CDC knows the extent to which Certified EHRs collected the data needed for surveillance? That same question was asked at the time in more detail, here:
http://www.healthcare-informatics.com/blogs/joe-bormel/showtime-meaningful-use-meningitis-outbreak
In your post:
“… we learned that the CDC and state health officials scrambled last week and over the weekend to track down patients who received contaminated steroid injections to see if they had become sick, and to warn them to watch for possible symptoms of meningitis.”
Interoperability, in the case of outbreaks, will be very useful if we know we’re collecting adequate information for case finding and follow up. It will be useless if we’re exchanging information that is not.
Is HIMSS working with the CDC on your question, and mine?