University of Missouri Health Care (MU Health Care) is among the first health systems to begin using an interoperability solution from Oracle Health (formerly Cerner) called Seamless Exchange, which works to reconcile new data from external sources, eliminate redundancies and make the new information available directly in the clinician’s workflow. In a recent interview with Healthcare Innovation, Sam Lambson, vice president for interoperability at Oracle Health, spoke about the benefits of the new tool as well as his impressions of progress being made on interoperability industry-wide.
First, I asked Lambson if there were already some tangible benefits that customers could see from the acquisition of Cerner by Oracle, which closed last October.
He said many of Oracle Health’s interoperating solutions are cloud solutions that sit on top of the EHR. “Our interoperability solutions are cloud already and they connect to these outside systems over networks, so the immediate benefit of Oracle Cloud infrastructure, and the associated discipline of cloud management has been phenomenal, and really a true accelerant to our progress,” Lambson added.
“The impact that Oracle has had has been pretty immediate for my team, which means rigid operational discipline, emphasizing observability of our solutions. We want to know everything that's happening in our cloud in a new and focused way. There is a focus on automation of our deployments and support, reliability and uptime,” he said. “As an executive leader, I'm looking at these operational metrics in a way and on a frequency that I never had before, so I'm excited about the way that secure cloud deployment really impacts our interoperability infrastructure.”
Referencing the recent announcement about MU Health Care deploying Seamless Exchange, I asked him how it works and what the value is to customers.
Lambson noted that the industry has had great success with expanding data availability to clinicians with initiatives like the CommonWell Health Alliance. But he added that when you tell physicians that you are making lots more data available to them, the response is more often a grimace than a smile because it represents more work to sift through the data for clinically relevant information.
“Seamless Exchange is our answer to the feedback we've gotten from providers about the deluge of interoperable data,” he explains. It is a cloud solution that sits between the EHR and sources like CommonWell, Direct and other outside clinical data. It pulls that data in through this cloud component, he says, and compares everything that's ever been seen before to the new data coming in and determines what's actually new and what's actually clean and high-quality. There's a lot of duplication and there's a lot of low-quality data, he notes. “We find that the process eliminates nearly 99 percent of the data,” Lambson says, “and the 1 percent of high-quality novel data from the outside that is clinically relevant is all that remains. We also bring it into the EHR in a semantically interoperable way, so whereas before it might have been read-only or copy and paste, we're converting all of this into FHIR as a standard and saying, ‘if you want this data, we can push it into your core medical record.’ We either do it automatically for trusted sources such as an immunization registry. If it's not trusted in the same way, we just want to be able to do a really quick look and do a reconciliation. It is like cloud service de-duplication, and then a really quick reconciliation into the medical records.”
Without a solution like this, many health system EHRs have an outside record viewer that allows a clinician to see this type of data, but to incorporate it would take a lot of copying and pasting.
Both Epic and Oracle Health have been enthusiastic proponents of the shift to the FHIR standard almost from the outset. I asked Lambson if Oracle Health’s approach to FHIR distinguished it from some other EHR vendors.
Lambson recalled that he started working at Cerner just as it was launching FHIR for the first time. “I would say FHIR has come of age — it's an adolescent now. It's not a full-grown adult. I believe what we're doing with Seamless Exchange is probably one of the most advanced applications of FHIR that had been done in the real world,” he said. “Our solution for electronic case reporting, which is another requirement of Promoting Interoperability, is at the back end FHIR talking to FHIR. We are doing a lot of things now in our interoperability space that are direct connections to those FHIR endpoints that we built for 21st Century Cures. What we're finding along the way, however, is that FHIR isn’t everything it's cracked up to be. As we work to do real-world things that are more semantically interoperable or work directly with public health agencies or federal agencies, we're uncovering all kinds of gnarly issues that no one's actually seeing yet because they're not fully using it. It is making us truly accelerate into a standards-based, API world.”
That led me to ask him if he felt the roadmap that ONC is following around EHR certification and other interoperability requirements is developing at the right pace.
He said it is easy to point to things that ONC has pushed that are really positive, including the work toward the adoption of the FHIR standard. But he added that Oracle Health also hears from a lot of its customers that some things are burdening them that aren't necessarily tied to the overall priorities. “The idea of having time to move into this new API-centric world without an annual update that's going to push us to reallocate resources would give us the opportunity to actually do innovations like Seamless Exchange and like what we're doing with case reporting,” he explained. “It is a trade-off, and there is give and take, but from an overall outcomes perspective, we're really happy with where things are today, and we're supportive of ONC’s agenda.”
Since Epic chose to be to apply to be one of the first Qualified Health Information Networks (QHINs) under TEFCA, I asked Lambson if it would make sense for Oracle Health to become a QHIN in the future.
“I think there's a fundamental difference, which is that we have been operating in a QHIN-like environment for 10 years, with the CommonWell Health Alliance. That was foundationally the framework that's been followed for TEFCA,” he said. “So it's a natural thing for us to continue that strategy of leveraging a 501(c)(3) industry trade group that everyone else can participate in as our core QHIN strategy. It's like asking me if I want to be the power company. I don't need to be that. I'm very comfortable with having a very strong backbone with CommonWell and then innovating on top on top of it.”
Since Oracle's working closely on upgrading the military and VA health IT systems, I asked if there are features that come from those new systems to enhance interoperability within VA, DoD or between those and external partners?
He said one of the best things about this project to date is the federal Joint Health Information Exchange. Lambson said previously there were little HIEs in each department, but when Cerner came in, it made HIE the first enterprise-wide cross-departmental piece of technology that's managed at the collective federal organizational level.
Today it is connecting every user of all of those legacy and new Millennium systems together with a longitudinal patient record for all servicemen and veterans — across Vista, across the core system and it's connected to CommonWell as well. “It's the most comprehensive connective tissue for a single healthcare organization in the country,” he stressed, and it's the largest trading partner for many health systems that are connected to CommonWell today. “In every market, there's a VA hospital that's connecting to another kind of IDN [integrated delivery network], and those can be some of the most significant interactions between two systems. So the HIE is huge in terms of strategy and importance for Oracle as well as for our for our federal partners.”
Speaking of HIEs, Lambson added that he does see an important but changing role for regional and state HIEs. In working with state government requirements, there are needs that go beyond just data exchange, involving the analytical layer and the data that drives state Medicaid and public health objectives, he said. “You really need a data service that's going to support those state-driven objectives and even regional objectives when there's a multi-state opportunity.” He added that the State of Missouri has current legislation calling for the creation of a health data utility. “Who's going to step into those roles? I think it's these regional HIE s that will step up.”