The idea for this article hit me so suddenly I was concerned that I might have uttered the title out loud in the middle of someone else’s presentation! I was attending an ITAC Health workshop on healthcare interoperability and was listening to Trevor Hodge, Executive Vice-President at Canada Health Infoway, introduce Infoway’s clinical interoperability strategy. When Mr. Hodge cited the Alberta NetCare Viewer as a highly successful example of interoperability that met clinicians’ needs, I realized that interoperability could take many forms and that a pragmatic approach may be the most appropriate short-term strategy.
Check out the remainder of this article at Technology for Doctors.
Posted in Uncategorized
Tagged Alberta NetCare, Brockville General Hospital, Canada Health Infoway, Eastern Ontario Clinical Data Repository, Infoway, interoperability, John Halamka, Quinte Health Care, Rowland Taylor, Todd Dafoe, Trevor Hodge
This article originally appeared in Healthcare Information Management & Communications Management magazine:
Call me a “fan boy” but I couldn’t wait to get my hands on Apple’s iPhone 6. Having written about the disruptive potential of digital health platforms, I was eager to play with apps designed for the new HealthKit platform (and that took advantage of the iPhone 6’s many built-in sensors). Even before I began to explore the functionality of the first HealthKit enabled app that I installed, I was struck by how it easyit is to share data among these apps. I simply indicated during the installation process which data elements I wanted to read from and write to the HealthKit repository and I was done. If only the sharing of my personal health data across the various health IT systems in which it is stored was so easy!
Interoperability, like innovation, is one of those words that has become so overused that it risks oblivion in buzzword hell. Equally concerning, it is a term that few people outside the health IT community use and care very little about. Yet, interoperability (or, perhaps, more correctly, lack of interoperability) has proven to be a major impediment to realizing the full potential of health IT.
Karen DeSalvo, Director of the Office National Coordinator for Health Information Technology (often referred to as the ONC) in the United States, has made impassioned pleas about the interoperability imperative at various events since she was appointed less than a year ago. At the annual HIMSS conference, held this year in Orlando, Ms. DeSalvo told attendees:
“We have made impressive progress on our infrastructure, but we have not reached our shared vision of having this interoperable system where data can be exchanged and meaningfully used to improve care.”
A similar situation exists in Canada. In a brochure advertising an interoperability workshop scheduled to take place in October 2014 (before this article is published), ITAC Health offers the following summary:
“For years the Health ICT industry in Canada has struggled with the challenge of interoperability. Application developers are faced with a dizzying array of standards, jurisdictional requirements and legacy environments.”
At the annual American Health Information Management Association (AHIMA) conference held this year in San Diego, Ms. DeSalvo observed that healthcare data “must be plug-and-play. It’s not helpful if it just sits there idle.”
I was intrigued by Ms. DeSalvo’s choice of words. To be useful, Ms. DeSalvo contends, healthcare data must be able to move to where it is needed. This notion of data liquidity, which the Institute of Medicine defines as “the rapid, seamless, secure exchange of useful, standards- based information among authorized individual and institutional senders and recipients”, captures the essence of what we are trying to achieve when we talk about interoperability.
So, how do we achieve data liquidity? Dr. Doug Fridsma, Chief Scientist at the ONC (and soon to be President and Chief Executive Officer for the American Medial Informatics Association (AMIA)), contends that tackling this challenge “from the top down isn’t going to work.”
In a HealthITBuzz (the ONC’s blog) post earlier this year, Dr. Fridsma offered insights on how to achieve interoperability on a large scale. These insights were gleaned from a Software Engineering Institute report entitled “Ultra-Large Scale Systems: The Software Challenge of the Future.” He notes that the characteristics of ultra-large-scale systems described in the SEI report have “an eerie similarity to the challenges we face in the overall health IT industry.”
“Ultra-large scale systems are not about a single software application, or a couple of applications working together, but rather an ‘ecosystem’ of interacting software systems,” notes Dr. Fridsma. These systems “cannot be managed ‘top down’ in a monolithic way, but will require a coordinated, decentralized way of meeting local needs, while keeping all of the systems working together.”
This notion of ecosystem is reflected in the ONC’s 10-year vision for an interoperable health IT infrastructure. This vision is based on what the ONC refers to as “five critical building blocks”
- Core technical standards and functions
- Certification to support adoption and optimization of health IT products and services
- Privacy and security protections for health information
- Supportive business, clinical, cultural, and regulatory environments
- Rules of engagement and governance
These building blocks are similar to the key enablers that Canada Health Infoway lists in its Pan-Canadian Digital Health Strategic Plan.
Ken Stevens, VP, Healthcare Solutions, Intelliware Development
Inc. and Co-Chair of the ITAC Health Interoperability and Standards Committee, offers what I think is perhaps the best summary of the interoperability imperative. Commenting on one of my posts on the eHealth Musings blog, Ken writes:
“Interoperability and data mobility have a huge impact on whether innovation is even possible …. Wherever valuable data is accessible through simple open standards, innovation will flourish.”
What are your thoughts on the interoperability imperative? How can we achieve data liquidity? What needs to change?
I love fall! Not only for the changing colours and cool, crisp days but also for the many conferences and trade shows that take place this time of year. At the recent HealthAchieve conference, organized by the Ontario Hospital Association, for example, I learned that there is a growing trend in Canadian hospitals towards a single, enterprise-wide electronic medical record system. Experience elsewhere in the world suggests that this preference for single vendor systems over best of breed environments is fraught with challenges and runs counter to the trend in other industries.
Check out the rest of this Technology for Doctors articles here.
For years one of the major complaints about healthcare IT systems has been the closed and proprietary nature of most vendor offerings. As we move to improve “information liquidity” (a cool term I read about it a Deloitte study, I believe) across the continuum of care. announcements such as the following are most welcome:
Of particular note in the press release is the statement:
The Microsoft agreement is part of Eclipsys’ open platform initiative, by which Eclipsys plans to expand its reach by working collaboratively with other industry participants to enhance interoperability, and enabling third parties to develop new applications that work natively with Eclipsys solutions.
I added the bold to emphasize Eclipsys’ intent to support third party applications. Taking a page from Internet pioneers and giants Amazon, Facebook, and Google, Eclipsys is creating the conditions for an ecosystem in which they do not try to be all things to their customer. By allowing third parties to add value to their core platform they will make this platform more valuable and more attractive to current and prospective customers.
I hope that other vendors, particularly Canadian EMR vendors, take note of the Eclipsys strategy. Opening up your platform so that other vendors can develop applications that make use of the information stored in your systems is good for the customer, good for our health system, and good for your bottom line.