Build a foundation for true health IT interoperability

Feb. 27, 2018
Razvan Atanasiu
Chief Technology Officer, Enterprise Imaging
Hyland Healthcare
Aaron Truskot
Technical Product Manager,
Hyland Healthcare

At a high level, improving healthcare interoperability continues to be a primary focus for providers, vendors, and policymakers in 2018. However, true interoperability in the industry continues to be elusive even as numerous healthcare interoperability initiatives, health data exchange frameworks, and health IT standards (e.g. HL7, FHIR, XDS, etc.) have vastly improved health information exchange over the past few years.

Several roadblocks to interoperability persist and one of the most notable is provider and vendor inertia. Providers have long been the gatekeepers of patient content and old habits die hard. Many have yet to find adequate motivation to liberate health data so that it can be freely exchanged with patients and other providers. Some actually see the practice as a surrender of intellectual property that makes it easier for patients to cut ties with them.

Vendors too have been slow to embrace interoperability. Many have demonstrated goodwill by participating in interoperability alliances like CommonWell and events such as the annual IHE (Integrating the Healthcare Enterprise) Connectathon and RSNA (Radiological Society of North America) Image Share Validation Program. However, many vendors only test beta versions of software at these events. Few have actually incorporated interoperability specifications into their existing product lines.

Why be interoperable?

As an industry, we need to think longer-term and overcome the challenges involved to truly move the interoperability needle forward. The current and future benefits of interoperability to providers and patients are well documented and it’s worth the time and investment needed to put your organization on a path to interoperability. The following are just a few reasons to start building a foundation for health data interoperability today.

Data liquidity

When interoperability is at the core of your health IT infrastructure, vendors can come and go, and the health data itself remains intact. Moreover, access workflows and security profiles can be retained. The need for costly data migrations is eliminated, saving your organization time and money. This is especially attractive in today’s healthcare environment where provider mergers and acquisitions are pervasive.

Improved patient outcomes

A technology framework based on interoperability facilitates the creation of a comprehensive longitudinal patient record. This health record puts all patient information—structured and unstructured—at the fingertips of a clinician at the point of care, enabling them to make more informed clinical decisions that can improve patient outcomes.

Continuity/transition of care

Health data interoperability facilitates the coordination and transition of care across organizational and system boundaries. When existing data can be shared between systems, providers can avoid duplicate testing, medication errors, and other costly oversights. This also helps to ensure patient safety, care quality, and the efficiency with which care is delivered.

Reduced operational/administrative costs

The healthcare industry is rife with waste. An interoperable technology infrastructure can help eliminate much of it. For example, when existing health data can be exchanged electronically, the need to print, mail, and rescan documents or burn medical images to CD or DVD is eliminated. Furthermore, interoperability makes it easier to centralize data, which reduces the time and effort required by medical staff to locate and access important patient information.

Population health

Interoperable systems are essential when it comes to providing the big data necessary for population health efforts across a health system or geographic region. These efforts have already proven instrumental in identifying health patterns and trends on a large scale, where providers can intervene and improve patient outcomes and wellness.

Interoperability of unstructured content is crucial

When it comes to interoperability in healthcare, most providers focus on the data contained in an EHR. Indeed, this information is extremely important to interoperability efforts, but it’s only a piece of the puzzle. A vast majority of patient data (up to 80% according to analysts at Gartner, Merrill Lynch, and others) is unstructured or semistructured and not natively captured by EHRs. This unstructured information consists of clinical documents (e.g. referrals, consents, etc.) and DICOM and non-DICOM (e.g. JPEGs, TIFFs, MPEGs, etc.) medical images and more.

In most instances, this information is stored in several disparate silos throughout a healthcare organization. For example, clinical documents may be stored locally in both electronic and physical formats in just about every department throughout a health system. Multiple departmental systems are typically used to manage medical images as well. A PACS (Picture Archiving Communications System) and RIS (Radiology Information System) is often leveraged to handle the majority of DICOM-based images (e.g. MRIs, CT Scans, etc.), but many health systems leverage multiple PACS for this effort and they’re often segmented by specialty (e.g. radiology versus cardiology). A wealth of non-DICOM images are also captured and managed by numerous departmental systems throughout a healthcare enterprise (e.g. dermatology, ophthalmology, pathology, gastroenterology, surgery, wound care, etc.).

While PACS is based on the DICOM standard, most vendors wrap non-imaging files in the DICOM format, adding private and proprietary metadata elements that prevent the information from being easily shared with other PACS or enterprise systems like EHRs. Furthermore, these systems don’t easily ingest and manage non-DICOM images, making centralized image management using a PACS-based approach problematic and expensive.

Without interoperability of unstructured content, it’s difficult to connect this information to the EHR and make it available to clinicians and other key stakeholders. A more open, enterprise-based approach to unstructured content management is crucial to building a foundation for interoperability that enables fully informed clinical decision making.

Through true standardized data formatting, enterprise imaging provides organizations with all-encompassing ownership of their imaging information, removing the vendor lock-and-block of proprietary systems. It leverages advanced technologies like enterprise viewing to support the management and sharing of imaging data across the enterprise and beyond, empowering clinicians with near real-time image access and collaboration.

This same principle of leveraging open, enterprise-wide platforms can be applied to document-based content as well.

Lean on vendors to achieve interoperability

Improving healthcare interoperability is an initiative of significant scope. It’s a journey—not a destination. Ensure that any of your current health IT initiatives have interoperability at the core and lean on the vendor community to help get you there. Choose to work with vendors that have invested in interoperability and actually incorporate the specifications and profiles into their existing product management and architectural approaches.

A solid practice is to work with vendors whose products have received an IHE Conformity Assessment. This statement asserts that a specific product version has gone through a rigorous interoperability certification process. When a vendor has already made the commitment to making its products interoperable, it provides a healthcare organization with tremendous value by lowering the cost of implementations and improving the quality of data workflows. Finally, start by taking the steps necessary to combine unstructured patient content with the discrete data stored in your EHR. This effort will provide a foundation for interoperability that will deliver the most immediate operational and clinical benefits.

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