However, it takes more than a dramatic increase in adoption of EHR systems to create interoperability, especially in a heterogeneous environment created by mergers or acquisitions. Healthcare facilities must have a strategic plan and the right technology to support health information exchange (HIE) both within the organization and to external providers.
The 2016 Interoperability Standards Advisory notes significant steps have been made: approximately 41 percent of hospitals nationwide routinely have electronic access to necessary clinical information from outside providers or sources when treating a patient; about 78 percent of hospitals electronically sent a summary-of-care document; and 56 percent received a summary-of-care document.
Unfortunately, less than half of hospitals integrate the data they receive into an individual’s record, which represents an area that requires significant improvement. And only a small percentage of ambulatory providers share electronic health information with providers outside their organization, according to the interoperability report.
As the health IT ecosystem pulls structured information out of unstructured narrative to support a variety of analyses and user needs, a format for this metadata will prevent information loss that can hamper the comprehensive view needed for making diagnostic and
treatment decisions.
The ability to efficiently exchange information among systems will equip individuals, families, and healthcare providers to send, receive, find, and use electronic health information in a secure and timely manner. If the right information is available at the right time, patients and care providers can be active partners in healthcare decisions, which can improve decision-making and help deliver better care.
Creating a cohesive view of the patient requires the exchange of both structured and unstructured data. Metadata currently is being used to allow users to communicate this context along with pieces of structured data. As the health IT ecosystem pulls structured information out of unstructured narrative to support a variety of analyses and user needs, a format for this metadata will prevent information loss that can hamper the comprehensive view needed for making diagnostic and treatment decisions.
Next-generation standards enable interoperability
Healthcare organizations need to act now to implement interoperable systems that take advantage of industry standards, protocols, and technologies. While this is a challenging project, achieving greater interoperability is made possible by the IHE (Integrating the Healthcare Enterprise) initiative for improved use of computer systems in healthcare, the standards developed by the international HL7 organization, and the DICOM standard widely used in imaging departments.
These standards and profiles address data capture, storage, integration, discovery, and presentation challenges within a healthcare organization:
- Acquisition and capture: The IHE Web-Based Image Capture (WIC) profile provides a simple, lightweight, mobile-friendly mechanism to encode and send captured images, videos, and evidence documents from the capture device to the platform’s image manager so that these objects can be easily integrated into the rest of the imaging workflow.
- Data formats and protocols: The IHE Cross-Enterprise Document Sharing (XDS) profile provides native support for many different file formats, such as DICOM, CDA, PDF, JPEG, and more. It offers a consistent way to communicate, index, and access data in department-specific formats using standard, secure web services.
- Enterprise data discovery: DICOMweb provides the web-based APIs QIDO-RS, WADO-RS, and STOW-RS to enable query, retrieval, and storage of patient and exam data. These DICOMweb APIs offer a simple way to implement standard methods for data providers and consumers to store, find, and access clinical imaging information without being constrained by incompatible or proprietary systems.
- Cross-enterprise data discovery: The IHE Cross-Community Access (XCA-I) profile provides the means to query and retrieve patient-centered medical data held by multiple facilities and enterprises, enabling a unified patient record to be created and delivered across communities of care. In addition, an IHE Imaging Object Change Management (IOCM) profile can facilitate the synchronization of image data when it’s stored in multiple locations such as a local PACS, an enterprise repository, or the EMR.
- Patient demographic data discovery: The IHE Patient Demographics Query (PDQ) profile provides a very simple means for searching patient demographic information associated with acquisition data. The Patient Demographics Query for Mobile (PDQm) Profile defines an interface to a patient demographics supplier using standard technologies already available to mobile applications and lightweight browser-based applications.
- EHR integration: Fast Healthcare Interoperability Resources (FHIR), the next-generation standard from HL7, enables advanced web capabilities for providing and consuming patient-centric health records. FHIR uses existing logical and theoretical models to offer a consistent, easily implemented method for exchanging data between healthcare applications, such as between the EHR and a vendor-neutral archive.
Achieving efficient data exchange
These standards (and others) will play important roles in achieving efficient data exchange. In the next few years, FHIR will become a crucial standard for bringing diverse and complex systems together under a simple, shared framework, while eliminating many of the implementation challenges and delays that have hampered interoperability projects in the past.
Whether healthcare systems are federated or fully integrated – or whether a combination of the two approaches is used to accommodate the needs of multiple disciplines and facilities – these are the crucial standards to consider when evaluating solutions that promise to deliver clinical data interoperability.
Executives need to select systems providers that can demonstrate their ability to support interoperability by participating in industry “connectathon” events, such as those conducted by IHE and other groups, that promote the use of established standards to address clinical needs and help support delivery of optimal patient care.
Enterprise imaging platforms, vendor-neutral archives, universal clinical viewers, clinical collaboration platforms, and other systems need to support IHE profiles and data-sharing standards that can allow healthcare providers to identify and share diverse patient clinical data to help clinicians make diagnostic and treatment decisions. The goal is to achieve efficient, standards-based sharing of data and images that is agnostic to applications, data formats, protocols, or geography.
Stepping stone to HIE integration
An enterprise imaging strategy using standards-based workflows can be a stepping stone to HIE integration. HIEs can improve care by expediting sharing of patient data among providers, thereby reducing duplicate imaging exams while eliminating the associated costs.
A recent study conducted by the University of Michigan and published in the journal Medical Care1 reported that adoption of an HIE is associated with a decrease in repeat imaging in emergency departments (EDs). Author Eric J. Lammers, Ph.D., and his colleagues looked at data from early adopters of HIE in California and Florida that compared 37 HIE-affiliated EDs with 410 unaffiliated EDs.
When patients had visits at two unaffiliated hospitals that took part in an HIE, they were 59 percent less likely to have a redundant CT scan, 44 percent less likely to get a duplicate ultrasound, and 67 percent less likely to undergo a duplicate chest X-ray.
Lammers and his colleagues suggested that, if all hospital-based EDs in California and Florida participated in HIE, it would result in nearly $3 million in annual savings from potentially unnecessary ED ultrasounds, chest X-rays, and CT scans. Additional savings could come from sharing of data from other departments across the enterprise.
Healthcare executives and managers are acutely aware of the road blocks presented by their current infrastructure of aging departmental systems. Everyone agrees that patient data needs to be efficiently managed, stored, and shared so authorized clinicians can gain a holistic view of a patient’s health. The challenge is to deploy industry standards, protocols, and technologies that equip physicians with all the data needed to accurately assess and treat each patient. Adoption of the latest standards, profiles, and exchange technologies makes this goal attainable.
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