Why does interoperability matter?
There’s a lot of media and industry attention on interoperability these days. In general, people in the healthcare space welcome that attention, and applaud government and industry efforts to shine a spotlight on interoperability as a necessary step to help us solve the challenge of making it easier for health information to flow across different information systems.
One key point that we must not lose sight of is why interoperability is important. Interoperability isn’t just about solving a business problem. It isn’t only about the mechanics of connecting one health IT platform to another. Interoperability is about the patient. It’s about giving you, your family, and your loved ones the ability to move your health information securely between providers, regardless of what information system they might be using. At its core, interoperability is about helping providers get a complete picture of that patient’s medical history regardless of where they received treatment.
My own personal interoperability story
The lack of interoperability can manifest in many ways, such as the need to gather our children’s immunization records for school or transfer medical records from one physician to another. Sometimes the situations are far more serious and have dire consequences.
A member of my extended family could have (and I say “could have” because there is no way to say with complete certainty) benefitted from a nationwide system of healthcare communication. My young cousin developed a fast-moving infection that required treatment from multiple health systems across multiple states. The care that he received was excellent, but it was simply not coordinated or communicated in a way that caught the problem in time to successfully treat the infection. Unfortunately, it was not contained in time and my cousin passed away.
I’m sure we’ve all experienced a situation where interoperability could have improved the outcome, which is why I am so motivated by the industry’s fight to improve data exchange.
Solving the interoperability challenge
To support the advancement of patient-centered interoperability, Cerner offers solutions that help healthcare organizations securely transfer data within the community and beyond. At the local level, providers have a need for information exchange as they refer patients to other specialists, send information to area laboratories and pharmacies, and communicate with care providers outside the organization. The Cerner Connectivity Hub helps providers connect to their local care community as they collaborate and electronically share patient information, wherever the patient goes.
To advance interoperability on a national level, Cerner collaborated with other healthcare IT companies to establish CommonWell Health Alliance, a not-for-profit trade association with the simple vision that health data should be available to individuals and providers regardless of where care occurs. CommonWell members are committed to building interoperability into their software, so that providers can maximize a trusted network for data exchange while maintaining their existing workflows. Cerner uses the services provided by CommonWell Health Alliance to allow our clients to exchange relevant clinical information with other providers that use CommonWell services.
The Cerner Health Information Exchange solution offers a central clinical data repository for the HIE and its community partners. With Cerner, HIE organizations have access to aggregated patient data to providers via an online portal and viewer embedded in the EHR.
Many HIEs are looking to expand their reach to connect care within a broader geographic region. Bringing together many different organizations to support community health programs takes strong leadership and a vision. One interoperability pioneer HIE organization in Indiana is doing just that.
Interoperability pioneers
The Michiana Health Information Network (MHIN) was established almost 20 years ago, long before interoperability became a buzzword. With the vision to create a shared central data repository with person-focused health histories specific to each patient, MHIN grew into one of the nation’s first and most deeply integrated HIEs.
After almost two decades of improving communication among healthcare professionals, MHIN has helped the Michiana community to become one of the most connected healthcare regions in the country. Today, MHIN supports more than 3,000 providers associated with 14 hospitals across 11 counties in northern Indiana and southern Michigan.
When MHIN was founded, the healthcare tech industry had yet to develop information exchange solutions. The industry was still working to get providers on electronic systems, let alone focused on exchanging those electronic records. Although the industry as a whole wasn’t quite ready for interoperability yet, MHIN recognized the value of data exchange and seized the opportunity to begin connecting providers.
“The Michiana community was very unique. Most of our local providers used Cerner and they all connected to the one independent regional lab, which was also on Cerner,” says Mark Kricheff, M.D., Medical Director, MHIN. “We thought, instead of having everyone on separate Cerner EHR domains, let’s see if we can get all of our providers on the same Cerner EHR domain so that each provider had access to all regional patient’s health history.”
Cerner was tasked with integrating the independent local lab into MHIN’s inpatient records and outpatient EHR. That first step set the stage for MHIN to become an integrated provider.
As the Michiana region experienced organic growth and change, it became clear that not all providers were going to be on the same EHR system. MHIN and Cerner realized they needed a solution to connect all other health IT suppliers. Over the next 20 years, Cerner and MHIN continued to refine their approach to include many different information systems used throughout the region.
Today, MHIN’s approximately 2,000 provider members on various EHR systems share health information through MHIN. The HIE pulls aggregated patient information from a variety of documents into a single, comprehensive view of a person’s medical and health history.
Interoperability’s impact on patient outcomes
Dr. Kricheff has helped MHIN stay at the forefront of interoperability. He also sits on the St. Joseph County Board of Health, practices in a local emergency department (ED), and regularly experiences the benefits of information exchange.
Dr. Kricheff says he is a proponent of interoperability because he experienced firsthand how connected information can make a difference in patient care. He shared the following anecdote on interoperability’s ability to improve outcomes:
“One day, a woman came into the ED with severe chest pain, a headache, high blood pressure, and a very complex medical history,” says Dr. Kricheff. “My first thought was that these symptoms could have related to a subarachnoid hemorrhage, an aortic dissection, or vascular catastrophe.
“Unfortunately, the patient didn’t know her entire health history and couldn’t remember what a different physician from an organization across town treated her for just a couple days prior. Being a Sunday night, I couldn’t call the medical records department to see if they had any background information on her.
“With the Cerner information exchange solutions, I was able to visit the medical exchange platform and look up her health history. I was able to review physician notes, tests, and results from her visit with the doctor across town, which turned out to occur just 48 hours ago.
“Because all of her information was accessible and in one place, I was able to rule out life-threatening catastrophes with just a few clicks. In addition to the time saved for both of us, I was able to prevent the patient from being admitted, having three invasive and costly procedures, and avoided the risk of adverse reactions.
“Access to the office documents with the clinician notes and patient history provided a clear picture of her diagnosis, allergies, medication list, and more. Ultimately, all I had to do for this patient was have her cardiologist adjust her medication and keep her under observation for about two hours. Before having access to Cerner’s information exchange solution, I would have had to subject the patient to thousands of dollars in tests and procedures that she already had done.”
Changing healthcare
As a mature HIE that successfully enables information exchange in its region, MHIN is now working with Cerner to help its members improve the health of their populations through access to information from many different sources.
MHIN is embarking on a groundbreaking journey to start using the data it amassed during the last 20 years to develop a snapshot of the health of its population. They will begin using the Cerner HealtheIntent population health management platform to help analyze data and identify risk for the patient populations covered by its members.
MHIN’s goal for this initiative is to support the population health management structure for individual organizations, like ACO or health systems, but also to help improve the health outcomes for its region. Michiana hopes to develop insight on broad regional public health issues like infant mortality and biosurveillance.
