As many healthcare organizations with disparate applications and devices have experienced, the lack of interoperability across technologies impedes the quality of patient care and leads to operational inefficiencies. This year’s Healthcare Information and Management Systems Society (HIMSS) conference in Orlando, Florida, featured the highly anticipated Interoperability Showcase, which aimed to demonstrate the potential for interoperability among various EHRs, medical devices, patient portals, data warehouses, and other technologies through real-life use cases with the participation of over 60 organizations. This year’s showcase included use cases such as surgery and recovery, athletic injury, childhood asthma, childbirth, and interoperability using the Fast Healthcare Interoperability Resources interface standard.
A noteworthy demonstration of interoperability followed the medical journey of a young patient who was admitted to a hospital after a severe asthma attack. The demonstration tackled the problem of scattered patient data across disparate systems and capture of data from medical devices into an EHR. The patient had an existing medical record with her primary care physician (PCP), who used the NextGen ambulatory EHR. During her hospital stay, she was monitored by smart sensors and given fluids through a smart pump. These devices were interfaced with an alarm management and clinical surveillance system through interface profiles developed by Integrating the Healthcare Enterprise, an initiative that promotes the aim of providing standardized interfaces for data exchange in healthcare. The information from the smart sensors and smart pump was then interfaced to the Epic inpatient EHR populating the patient’s medical record. Once the patient was discharged, information from her medical record was interfaced to the ambulatory EHR just in time for a follow-up visit with her PCP.
It was clear at the conference that interoperability is a goal that has the healthcare industry’s attention and investment dollars. This is evidenced by the 60 or so organizations in attendance representing vendors, government entities, and patients, as well as by the 34,000 square feet—or nearly two-thirds of a football field—of exhibition space at the Interoperability Showcase. Furthermore, the majority of vendors at the conference highlighted the interoperability of their products in demonstrations, sales pitches, and marketing collateral.
Even though the desire for interoperability is strong, vendors believe there are a couple key obstacles that continue to make meaningful progress toward interoperability difficult:
- Lack of a National Patient Identifier — Due to the absence of a national patient identifier (NPI), patient medical data is scattered across various EHRs, web applications, patient portals, and medical devices. Even if perfect interoperability across various technologies is achieved, reconciling existing patient information from disparate systems will prove to be difficult without an NPI. Use of an NPI would allow for a single, unique identifier for each patient in the United States regardless of the location of care and EHR. The recent collaboration agreement between Carequality and the CommonWell Health Alliance is a positive step toward interoperability and has received buy-in from major EHR vendors. However, the results of this collaboration remain to be seen.
- Collaboration Through Business Associate Agreements — Business associate agreements (BAAs) also present a challenge for interoperability, because some vendors believe that BAAs inhibit the sharing of personal health information (PHI) that can be used for patient care, quality improvement, population health, and other activities. BAAs serve the all-important purpose of protecting PHI under the requirements of the Health Insurance Portability and Accountability Act (HIPAA). The Office of the National Coordinator for Health Information Technology released guidance throughout 2016 clarifying that HIPAA provides pathways for exchanging PHI in support of interoperability through permitted uses and disclosures. These allow covered entities to use and disclose PHI without having to obtain written authorization from patients.
It is clear that there is much progress to be made toward achieving perfect interoperability. Vendors will have to continue to navigate various healthcare interface standards and interoperability alliances toward a more collaborative approach. Furthermore, there needs to be a good faith effort on the part of interoperability initiatives such as Carequality and CommonWell to put aside their differences and pursue true collaboration. Even though perfect interoperability has not been achieved, this year’s Interoperability Showcase demonstrates that vendors and organizations are on the right path. Ultimately, it highlights that stakeholders are willing to work together to achieve interoperability for the benefit of patients and to improve the quality of patient care.