Health information interoperability proving more difficult than once thought

Health information interoperability proving more difficult than once thought

Interoperability of health information systems is a centerpiece of Stage 2 of the federal Meaningful Use incentive program for electronic health records – a phase that began a full year ago for some hospitals – but as the thousands of providers struggling to make the jump from Stage 1 are finding, achieving the vision of an interoperable, nationwide network of EHRs is proving to be elusive.

At a breakout session Tuesday morning at the U.S. News Hospital of Tomorrow conference in Washington, one veteran of health information exchange policy and practice illustrated just how difficult interoperability can be when dealing with an industry as complex as health care.

[WATCH LIVE: The 2014 Hospital of Tomorrow Conference]

Micky Tripathi, founding president and CEO of the Massachusetts eHealth Collaborative, a nonprofit that supports health information “communities,” pulled out an old PowerPoint slide from 2003, when he was the head of the fledgling Indiana Health Information Exchange. Then, HIE was seen as a clean circle of data movement from hospital to clinic to laboratory to payer to patient, with a centralized data repository in the middle.

That “pristine” vision and associated HIE value chain is “getting blown to bits,” Tripathi said. Today, there is a multilayered set of often-competing HIE functions. “The market has a very nasty way of moving and moving and moving in ways you didn’t expect,” Tripathi added.

Direct messaging, point-to-point query, and retrieve and record aggregation/data normalization are all parts of separate value chains, he continued. As for central repositories, “I would argue that these are the dinosaurs that are going to go away,” Tripathi said.

A recent survey of “accountable care organizations” by the eHealth Initiative, a Washington-based coalition of more than 200 groups interested in health IT, found that few ACOs have been able to pull in data from disease registries, state immunization databases, remote patient monitoring devices, patient-reported information or unstructured text files. All are considered important inputs for the kinds of advanced analytics ACOs hope to employ in hopes of delivering safer care at lower cost and improving the health of populations.

Jennifer Covich Bordenick, CEO of eHealth Initiative, said that in this age of social media, people are comfortable with sharing all kinds of information about their lives, but there still is no good way for consumers to tell their health care providers what health-related data they want to share.

Unfortunately, according to Bordenick, the Health Information Technology for Economic and Clinical Health Act, the portion of the 2009 American Recovery and Reinvestment Act that created Meaningful Use, focuses on EHR functionality when it should have concentrated on data usage.

“Nationwide interoperability should be defined in terms of which interoperability functions should be universally available,” she said.

Bordenick also said that there need to be tangible examples of HIE and population health management saving lives, preventing errors or improving outcomes. “I think we need a win,” she said.

Sitting next to Bordenick and Tripathi was one official in charge of administering health IT programs: Steven Posnack, director of the Office of Standards and Technology in the U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology.

Posnack noted that interoperability means different things to different people, but said that people should consider six questions when discussing the topic: For what purpose is the exchange taking place, with whom, with what data, via what infrastructure, by when and toward what expected benefits?

Posnack said he has seen multiple approaches to HIE in recent times, including query-based access, data directed to a “known endpoint” and even consumer-mediated exchange, though the latter still is pretty rare.

Tripathi mentioned others, including direct exchange – usually between organizations using the same EHR vendor – and secure email, such as the Direct Project, though that could fall under direction to known endpoints. “Among the challenges we face are these emerging networks,” Tripathi said. “It hasn’t happened nearly as fast as many of us would have liked.”

What all three panelists said they would like to see is greater availability of application programmer interfaces, which is the norm in many other industries. “Kendall Square and Silicon Valley are laughing at us,” Tripathi said.

This post was originally published on US News & World Report.