In order for the healthcare industry to move toward preventive care and population health management, clinical information needs to flow freely across networks and between hospitals and physicians. For this reason, healthcare organizations need interoperability amongst their technology. However, the industry remains well behind others when it comes to seamlessly and securely communicating and exchanging data.
While the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) has focused the latter stages of its meaningful use program on greater interoperability, recent criticism has suggested that electronic health record (EHR) systems certified for use in Stage 2 of the program are often incapable of exchanging patient health information with other EHR systems, IT vendors and healthcare industry representatives.
As such, although interoperability is poised to radically transform the healthcare system, achieving it poses unique challenges. To discuss these challenges as well as ways the industry can become more interoperable, Joyce Sensmeier, vice president of informatics for the Healthcare Information and Management Systems Society (HIMSS), recently spoke with HCI Associate Editor Rajiv Leventhal. Sensmeier is also president of IHE (Integrating the Healthcare Enterprise) —a national deployment committee of IHE International—an organization that facilitates efforts for fostering the national adoption of a consistent set of information standards to enable interoperability of health IT systems. Below are excerpts of that interview.
What do you think of the recent criticism pouring in concerning interoperability in healthcare?
Right now, provider organizations just aren’t getting much assurance with products. But I think that’s the next wave. If we can provide those products with the capability inside to be interoperable, and the providers that purchase those products can be assured and realize that it works—that it’s more or less plug-and-play—that’s a huge step forward. Our end goal is that every clinician, patient, and person has access they need to their healthcare where they need it. And of course that it’s secure and private.
So is the onus mainly on the vendors?
It’s a shared responsibility—we all have a role. The government has a role, vendors have a role, professional societies have a role, and standards developments organizations have a role. We haven’t all been working together on the same goals—that is what has been missing. Right now, there are too many siloed efforts. We need a restart and figure out how to achieve this working together. That’s not done by reinventing the wheel, but by working together and figuring out what’s there and how we can leverage it.
What are the biggest barriers that are holding the industry back from becoming more interoperable?
Well, agendas get in the way. Each of those groups I mentioned has their own agenda. While meaningful use has been a driver, it has also created a big challenge because when the government says, ‘This is what needs to happen’ and creates incentives for that, of course that will attract everyone’s attention. As a result, a lot of resources and effort go towards accomplishing those goals. HIMSS responds, the vendors responds, the providers respond, but Stage 2 is still such a subset for where we need to go. In my opinion, a lot of effort is being put forward for such a small piece.
I would love to see the government be the coordinator and convener of the different groups—not just setting the agenda themselves, but getting input from everyone. I want them to say, ‘Here is the vision, so what can we do and how can we work together to accomplish that?’ And then groups can respond by defining their role.
I think the vendors will eventually align. They have been getting hit with criticism that they’re not working towards interoperability, but I have to disagree. IHE USA sponsors Connectathon (a cross-vendor live testing event) as a piece of the testing process. Epic has been very active in coming to Connectathon and making systems interoperable with others. They have made efforts; they are an example of the vendors trying. Of course they want to sell their products, but if priorities are identified and if providers can help with that pull, that will align things much more effectively across the vendor organizations.
You have to remember, physicians didn’t get into the industry to be administrators, but rather to do good patient care and move medicine forward. So it is difficult for them. However, surveys have found that 70 percent of providers see interoperability as their biggest challenge. They understand why it’s needed and they want it—it’s just a matter of getting through the painful process to get to that point.
Are vendors working together to accomplish this goal?
I see them working together, and one of the reasons our Connectathon has been successful is that it gives them a place to come together in a neutral forum. And it’s not the marketing and sales people who are present, it’s the engineers who really do want to solve these tough problems and figure out how to work together how to do it. But you need that neutral convener, and I think the government should take more of a role there. Vendors will be seen as part of this advancement; there is an incentive to work together, so they can share information appropriately.
Why do you think healthcare is so behind other industries when it comes to interoperability?
Healthcare is extremely complex. Even one domain area has multiple systems, processes, and ways of doing things. It’s not as simple as finance, for example. In addition, people’s lives are at stake, so there is significant risk there. When I worked in a hospital (with my nursing background), we felt like we could design our computer system, and every organization thinks they can do it their way. We are trying to change that over time, and certainly the consolidation in the industry is affecting things too. If you think about the number of hospitals in the U.S., that is a lot of individualization that needs to be re-engineered. Systems also just now understand what they have to do to live in the new environment.
But if you want to have accountable care, you need interoperability. And it’s not just Stage 2—it’s giving clinicians access to information and having that clinical integration that organizations need to have In place to understand the impact on outcomes. If your data is not standardized, if you can’t pull it out in a way that gives you meaningful information, you won’t be able to do accountable care.
How important is it that different systems speak the same language?
We have to be using the same terminologies. The national guidance is SNOMED CT and LOINC, and within nursing we are mapping some of our own terminologies to that. We have to be naming things consistently to get to the interoperability that we need, though. We had 12 different terminologies in nursing that were approved by the American Nurses Association (ANA), but that won’t get us to where we need to go. You can implement the same Cerner system in three different hospitals and those systems are not necessarily interoperable if they haven’t been configured in the same way or if the organization is using a different terminology.
What did you think about ONC’s recent interoperability roadmap?
I’m excited about the changes that are occurring at ONC. Dr. Karen DeSalvo is doing a good job re-evaluating where things are heading and thinking about what is the right direction moving forward. But I think the Standards and Interoperability (S&I) Framework has been too heavy in development rather than be a convener of current efforts. I would like to see more of an exchange of conversation, and ONC can take a lead role in coordinating and bring the right players to the table to help this move forward—those players being standards developments organizations such as HL7 and IHE. So far, it hasn’t been coordinated in relation to priorities and division of work and collaboration.
So what is your ideal timeframe for when we might see “true interoperability” in healthcare?
If the government can take on a convening and coordinating role, and get groups aligned to identify and share priorities, I think in another six years we can see some really good progress. And you’re going to see other innovations, around mobile, that will be attractive to people, but we can’t just throw the baby out with the bath water. Things that come along will be exciting, but we still need to move the “Big Kahuna” of interoperability forward, building on what we have accomplished so far.
