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Beyond Interoperability: A Solution That Builds Bridges Between Incompatible Systems (HIMSS Convention Related News)
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Feb 8, 2010 - 11:49:09 AM

Beyond Interoperability: A Solution That Builds Bridges Between Incompatible Systems

(HealthNewsDigest.com) - Interoperability means the transparent and secure sharing of patient information among all stakeholders involved in ensuring that an individual receives the most efficient and effective care possible. According to the American College of Physicians (ACP), “health care information interoperability will help bring a higher standard of quality to the U.S. healthcare system, making care safer and less costly…interoperability is a goal well worth the effort, one which will require much careful planning and consensus building, and the dedicated input and commitment of every player in the healthcare marketplace.”1

The benefits of interoperability include better care coordination among providers, reduction in medical errors and duplicate tests, better patient engagement, improved clinical decision-making, enhanced capture of codes and charges, and an overall improvement in the quality of care. Ancillary benefits include less time spent in the hospital for patients, elimination of paper records leading to administrative savings, better patient compliance through automated health reminders, and, according to the ACP, a 53 percent reduction in rejected claims.2 Integrating the Healthcare Enterprise (IHE) now standardizes this so users are able to design systems to share information back and forth.

Despite this, adoption has been slow among health care providers. Some key barriers include: low adoption rate of EMR/EHR systems; lack of standards for exchanging complex clinical data, and limited number of EMR/EHR products that can support the prevailing standards. While significant progress has been made by IHE and other standards bodies in developing technology frameworks and corresponding standards that allow health care solutions to securely share information across health care settings, wide-scale adoption within the timeframes set forward ARRA remains a daunting challenge. What is needed is a bridge that allows participants with new, standards-based systems to coexist and collaborate with participants with older systems and participants with no system at all.

A Solution That Brings Physicians and Patients Together

The point of interoperability is to provide caregivers with a complete view of a patient’s health status, allow them to effectively utilize that information in the care delivery process, and enable seamless care coordination with the patient and other caregivers. That level of knowledge affects approaches to care and allows for more personalized options.

While simple in concept, this goal is beset with a number of obstacles. Limited EMR/EHR adoption and the lack of implemented standards are well-documented challenges. Additionally, the realities of current care delivery with physicians providing care in multiple environments and chronic disease patients receiving care from three to four providers on average further complicate the ability of providers to consistently deliver patient-centric care.

Finally, these realities often present a “Catch-22” scenario. In order for providers to benefit from interoperability, they need widespread participation, but widespread participation is difficult due to the wide disparity of existing capabilities. In order to break this negative spiral, communities need to adopt solutions that effectively allow for broad participation in spite of the system disparities that exist.

Building Compatibility: Critical Considerations

In order to achieve universal data interoperability among disparate systems it’s important that the bridging solution meet a variety of requirements so that early adopters are able to achieve maximum benefit and ease of data transfer among all stakeholders, whether they share the same technology solution or not.

Data Co-Existence

First, a community solution must be able to collect both structured, patient-centered data types such as CCR and CCD XML documents and traditional event/result based data elements such as HL7 ADT, scheduling, labs, medications, progress notes, and so on. Given the importance of completeness, the solution needs to be able to handle structured and unstructured data-types and support standard and non-standard interfaces. While comprehensive collection is important, it is not enough to bridge the gap between IHE-compliant environments and legacy environments. This bridge requires the ability to combine data extracted from CCD documents with similar data derived from traditional sources and the ability to organize data from traditional sources into a patient-centered data-type such as CCD.

The ability to de-construct CCD documents into their component parts and combine those data elements with related data collected from traditional data sources allows providers to access an organized, longitudinal view of the patient regardless of where the data derived from.

Likewise, the ability to re-construct data collected from traditional sources into a standards-based CCD document allows that data be interchanged with external systems in a standards-based protocol.

Multiple Mechanisms

While data co-existence provides the building blocks for widespread interoperability, it is ultimately how caregivers and patients are able to use this data that determines the scale of adoption. And it is the scale of adoption that ultimately drives the value of interoperability. In order to account for the wide disparity of current capabilities, it is important that a community solution allow for multiple mechanisms for accessing and utilizing patient information.

From a caregiver perspective, the community solution needs to support providers with newer, IHE-compliant systems that can incorporate CCD formatted patient information and provide portal solutions for providers that either have no system or have systems that limit their ability to utilize external patient information. This portal capability needs to provide enough functional depth to be useful at the point of care and enough flexibility to co-exist with other clinical applications that may be used in a caregiver’s current workflow.

From a broader perspective, the community solution should also provide capabilities that work across or can be shared by all community providers such as bio-surveillance capabilities and public health interoperability.

Practical Approach

Finally, a community solution needs to allow participants to effectively collaborate and coordinate care with other participants regardless of how that particular caregiver is utilizing the community solution. For example, a hospital providing an emergency department summary message through an IHE-compliant interface needs to have confidence that the information will be effectively utilized by the receiving provider regardless of whether or not that provider is able to receive the CCD-based summary into their EMR/HER -- or whether they are accessing the information through a portal.

This kind of flexible solution keeps everyone connected while giving slow adopters an opportunity to stay up-to-date with the patient and participate in coordinating care while allowing fast adopters to take full advantage of the technology investments they have made.

Case Study: MidSouth eHealth Alliance

Informatics Corporation of America’s (ICA) has piloted a program that creates an aggregated database environment that is accessible at the point-of-care for all participants in the MidSouth eHealth Alliance (MSeHA) in Tennessee via a secure, two factor authenticated, Web-based portal. It allows a consolidated, longitudinal patient record to be created from across the individual, secure data vaults.

Using its CareAlign™ Suite – which was designed by physicians and IT specialists at Vanderbilt Medical Center -- ICA hosts the environment in a secure facility and maintains all aspects of the application’s operations, including network connectivity, firewalls, physical security, maintenance, data backup, and failover capabilities, as well as disaster-recovery preparedness and business continuity.

As a result, an aggregated longitudinal medical record is available at all 14 of the MSeHA’s emergency departments and all participating primary-care locations. Other results include:

The aggregated database now exceeds 3+ years of data.
Data is now readily available for use by approved MSeHA members when treating/caring for patients.
Current statistics include more than 2.1 million total records contained in the MSeHA database; 3.9 million encounters (140,000/month); 1,050,000 total patients; 370,000 monthly ICD-9 discharge codes; and 2.4 million monthly lab results.

About Informatics Corporation of America (ICA)

Informatics Corporation of America (ICA) was established to take innovative technology developed by practicing physicians and informatics professionals at Vanderbilt Medical Center to the broader healthcare market. Its flexible architecture integrates legacy systems to provide a comprehensive clinical view of patient records within Integrated Delivery Systems and Health Information Exchanges/Regional Health Information Organizations. Today, ICA is unmatched in its ability to deliver a cost-effective, proven solution that not only leverages complete data across clinical settings to aid decision-making and improve patient outcomes, but also utilizes real-time clinical information when and where it is needed.

Booth #:8309 - ICA will be performing interoperability demonstrations along with Kathy Huddle of Sevocity at booth # 8309 at the 2010 HIMSS show.

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