Healthcare IT insiders regard interoperability as the key to effective health information exchange, and some might say, the hardest to pin down thus far. Industry leaders agree there can be no true exchange without interoperability. How can healthcare transformation occur unless doctor A's EHR can process the information received from doctor B's EHR?
John W. Loonsk, MD, chief medical officer at CGI Federal, served as director of interoperability and standards in the Office of the National Coordinator for Health IT (ONC) from 2005 to 2009.
He is among many who pin the "elusive" tag on interoperability.
"For those in the trenches, interoperability is still an uphill grind if not largely elusive," he writes in a recent Healthcare IT News commentary. "They just aren't seeing many health IT systems that can easily process information that other systems provide."
Health information exchange is making some progress, he said, "But without broader exchange and the interoperability needed to process 'foreign' information, health IT can actually act to increase the unnecessary information that a provider has to review rather than help make the provider more efficient."
Loonsk has observed a new degree of pessimism when it comes to interoperability, he says, noting that some have suggested (before Congressional committees) that true interoperability is a decade away.
ONC chief Farzad Mostashari, MD, acknowledges that interoperability has been a tough nut to crack. But, he remains optimistic.
"Most vendors really do see it now as part of their self-interest to be as interoperable as possible," he says, adding that Stage 2 of meaningful use raises the bar. "It's a huge step up," he says, "a huge step up on interoperability."
Mostashari views EHR interoperability as a shared responsibility among the vendors, hospitals and doctors, and the government.
Customers (hospitals and physicians) must demand interoperability, Mostashari says.
"If the vendor doesn't seem committed to interoperability, he advises, "You should look elsewhere because the future of healthcare is going to be the need to coordinate."
Mostashari does not say when interoperability might be achieved, instead quotes his colleague, Doug Fridsma, MD, director of ONC's Office of Science and Technology: "Interoperability is not a destination, it's a journey."
"There's always going to be new needs, new requirements for interoperability," Mostashari explains. "We're going to constantly have to keep stepping up towards greater and greater levels of being able to share information and understand the information once it's shared."
Also, as Fridsma explains in his commentary (see page 29), "There are two parts to the definition of interoperability: the ability of two or more systems to exchange information and the ability of those systems to use the information that has been exchanged."
"Technology is only one obstacle to interoperability," Gilad Kuperman, MD, director of interoperability informatics at New York-Presbyterian Hospital, told attendees at the American Medical Informatics Association Annual Symposium last November in Chicago, where Kuperman moderated a panel about why interoperability is "taking so darn long."
Some of the other reasons, put forth by Kuperman and his panel are: Vendors have built proprietary databases. Not everyone follows the same standards. Health systems fear sharing data with competitors. Policymakers have not focused on health information exchange or EHR usability.
Steps on the HIE-interoperability journey are being taken today to make the exchange of information between systems more easily achievable and easier to understand once it moves to its destination.
As meaningful use Stage 2 gets under way, providers will be required to demonstrate they can exchange clinical care summaries with other providers and with patients using certified EHRs. The information will be structured and coded. The idea is to make it possible for the provider who receives the information to understand it, use it for patient care and make it part of the EHR. That means vendors will be expected to do their part to make that possible for their customers.
The fine points of all of this were discussed at a joint hearing of the Health IT Policy Committee and the Health IT Standards Committee, Jan. 29 in Washington, D.C.
Among the many people who testified was Neal Patterson, chairman and CEO of Cerner, one of the top EHR vendors in the 200-bed-plus market.
When he addressed the two committees, Patterson beat the drum for greater data liquidity.
"For all the promise of new technologies and of consumer-mediated HIEs," he said, "I am here this afternoon to lend my voice to the call for a more aggressive approach to data liquidity and exchange."
As Patterson sees it, cross-vendor data liquidity (one definition is: "the use of common terminologies to enable the seamless, rapid flow of information among individuals and across institutions") is vital for the success of population health management and accountable care organizations.
"Cerner is, for its part, committed to an open healthcare ecosystem," Patterson testified. "We are committed to enabling data liquidity for every product. We are committed to enabling our solutions to send and receive data in a universal manner. We are committed to putting these principles to work for every system in every venue of care."
The interoperability journey that leads to the secure, seamless exchange of information may be a long and difficult one, but Mostashari maintains there have been advances, and there are more to come.
"I believe that we have made more progress in the past two years on interoperability - motivated by the meaningful use incentive program and by collaboration and the open, inclusive process to get to consensus - than the decade before," said Mostashari.
So will it take a decade? "No, not 10 years," he said. "In the nearer term."
