Health IT

Does interoperability have to be hard?

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The ideal of interoperable electronic health records isn't hard to understand. Data that moves freely across a patient record from multiple points of care means that tests that might have been duplicated in the past get performed only once, it means that doctors get an accurate read on medical history, and patient data can be aggregated for research and analytics, leading to faster advances in diagnostics and treatments.

Congress and the the Office of the National Coordinator for Health Information Technology have put providers on a path to achieving interoperable health records. A bill report from the House Energy and Commerce Committee says that by 2018 "the administration must adopt interoperability standards that allow every health care provider to access and use longitudinal data on the patients they treat to make evidence-based decisions, coordinate care, and improve health outcomes as quickly as possible."

National Coordinator Karen DeSalvo said in February that “We have to ensure that HIT, an interoperable network of information and data flow, connects providers and patients across the continuum."

But things get messy, as they so often do, when reality doesn't match up to the policy road map. Currently the Department of Defense is in the midst of an $11 billion procurement for an electronic health records system that will be interoperable with the systems at the Department of Veterans Affairs and with the private sector. But leading military and VA health officials are the first to acknowledge that making interoperability work is a tough slog.

"Interoperability is a difficult issue," Dr. Terry Cullen, chief medical information officer and director of health informatics at the Veterans Health Administration, said at a July 9 health IT discussion on Capitol Hill. "We have done the best that we can with the resources that we have available to us, and you know what? It's not enough."

Together, the departments of Defense and VA are ahead of the health care industry on what Terry terms the "non-sexy, boring" issues of interoperability – data standards, terminology agreement, data hygiene, data ownership and provenance, and other elements of an interoperability framework. "We really are the cutting edge of the stick," she said.

Lt. Gen. Douglass Robb, a physician and director of the Defense Health Agency, noted that the speed of technological change contributes to moving the goalposts on what is meant by a patient record and what is meant by interoperability. "The problem is, every time we decide what [interoperability] looks like, it has the opportunity to do something else," Robb said. Creating an interoperable continuous record out of patient care might not be that hard, he said, but the game keeps changing. The health record is transforming into "a clinical support tool which is now being used by systems to also be a business support tool. The platform keeps growing new personalities," Robb said.

In her February speech, ONC's DeSalvo defined the problem as one of siloed data. "We need to set it free from its silos and follow the patient where it is needed in a safe, secure, private, and reliable way across accessible networks that are following the proper regulatory framework and in a business environment that allows for this to happen," she said.

The Department of Defense health systems serve a patient population of about 9.6 million, many of whom get at least some of their care through the VA or private providers. The outcome of DOD’s planned electronic health record procurement, and the mandate that it be interoperable with VA systems, is likely going to accelerate the pace of developing interoperability standards, leveraging some of the ground-level data work that Cullen described.

If the effort is successful, the promise for the future of health care for servicemembers, their families, veterans, and the general population is likely to be transformative, according to Dr. Karen Guice, the principal assistant secretary of Defense for health care. "The power of big data, based on comparable data being accrued across two very large federal departments and then being able to use that data to provide better health care for the future or to provide predictive analytics ... is huge from a business perspective," she said. "If you make that easy, the power of that to change policy, the power of it to improve people's lives is just enormous."

About the Author

Adam Mazmanian is executive editor of FCW.

Before joining the editing team, Mazmanian was an FCW staff writer covering Congress, government-wide technology policy and the Department of Veterans Affairs. Prior to joining FCW, Mazmanian was technology correspondent for National Journal and served in a variety of editorial roles at B2B news service SmartBrief. Mazmanian has contributed reviews and articles to the Washington Post, the Washington City Paper, Newsday, New York Press, Architect Magazine and other publications.

Click here for previous articles by Mazmanian. Connect with him on Twitter at @thisismaz.

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Reader comments

Wed, Jul 16, 2014 Hl

I wouldn't think identifying oneself as being from the "Washington DC Metro Area" would be a good idea. Credibility in all things DC is at the lowest I've ever seen in my life. You would seem to be fishing for business here at FCW. DC is basically seen as a joke out here in the hinterlands. So anyway, how much will it cost to do all this and where will the money come from? We seem to be out of money. Can't just make interoperability happen without money.....a LOT of it. Remember, it come from discretionary budgets like defense, not from mandatory spending such as Social Security, Medicare, Medicaid, Obamacare, or the interest on the national debt. Last reading I saw was about $500B deficit added to a monstrous total debt. Don't have any money to do interoperability any more than money to fix our crumbling infrastructure. Nice article with lots of good suggestions for how to do this, but the article does not address the likelihood that something else must get gored to do this. We've overcommitted as a nation. Remember, we're still under the President's sequestration law for several more years so money will be have to be cut from discretionary spending (like freezing federal employees salaries). Interoperability (other than flash points of govt embarrassment like the VA) will not happen due to lack of money. Interoperability is discretionary and not mandatory. It's smart and a good idea, but it is NOT mandatory. As a tax paying citizen for many decades, I do not want my taxes raised beyond where they are to pay for this. Taxes are very likely to go up to pay for what the govt has already implemented. The last thing we need is another costly govt program to "make things better". I'm spent as a taxpayer. STOP with new programs that cost money. When the US is solvent again, then come back asking me for my money. What I'd like to see from FCW is an article that identifies what should be cut to pay for stuff like this, not just another great ideas (which are a dime a dozen). The really great ideas would be one's that make convincing, empirically based arguments what could be cut from the federal budget to pay for a new program.

Tue, Jul 15, 2014 Barry Dickman Washington DC Metro Area

Congress continues to ask the wrong questions of the Federal agencies and vendor community in addressing interoperability. Both need to ensure accountability in addressing interoperability. I hope that ONC, VA & DoD will be promoting the importance of testing for interoperability and standards conformance in the electronic exchange of health information. ONC, VA & DoD have the opportunity to mobilize the community to participate in the building and testing of open source interoperability solutions. Some proposed objectives to consider to ensure the "ideal of interoperable electronic health records include: • Support Automated Platform for Test Case Execution • Document Best Practices for Audits and Work Flow Lifecycle of Testing • Support an Environment for Re-Use of Testing Tools/Test Cases • Promotion Beyond “Happy Path Testing (peer-to-peer), ensure Negative Testing” • Promote Industry Reporting Metrics on how well their products and services ensure interoperability and not vendor lock-in. Respectfully, Barry Dickman Senior Consultant 703-893-6020 Ext: 379, Inc. Powerful Results. Delivered.SM Rated Maturity Level 3 CMMI-DEV and CMMI-SVC+SSD / Certified ISO 9001:2008 Follow us on Twitter: @AEGISnet HIMSS-NCA Board Member, Vice President/President-Elect HIMSS-NCA Programs & Webinar Committee Member

Mon, Jul 14, 2014 utopia27 NoVA

My TV's universal remote isn't (universal...). My camera flash doesn't work with my 2 different camera bodies - and neither do their lenses. Areas where consumers have been deeply motivated for interoperability have been stymied by commercial interests as long as we've thought about interoperability.

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