The rush to implement electronic health record strategies has fueled a proliferation of solutions. But systems, like people, need to work together seamlessly to deliver their maximum value. Easier said than done. So why hasn't the promise of interoperability with all the various systems — electronic health records, monitors, labs, finance, and so forth — been realized?
To answer that question, let's look at the past decade or so. As hospitals and health systems invested in EHRs to collect and store data, they didn't always do so with an eye on the future.
The Rise of Silos
EHR systems evolved organically as silos of information, because leaders weren't thinking ahead enough about how the collected data could impact decisions and processes for the entire health system.
A large health care delivery system might have 90 or 100 point-to-point interfaces over which information is shared between systems, often with a core EHR serving as the primary data repository. If you were to draw the information model of the average health care system, it would look like a spider web with links stretching off in all directions: an extremely complex informatics infrastructure, with enormous maintenance requirements and hundreds of potential points of failure. Clearly, this is not a sustainable model.
Forward-looking health system leaders have recognized this problem and are now trying to get disparate systems to interoperate reliably and sustainably. Initially, they focused on how to get data from source systems into the central EHR repository.
Now, health system leaders are focused on achieving bidirectional communication among the EHR, the clinicians and other systems. They recognize that the EHR is just one part of a health information technology system. The goal is not only to simplify how providers bring data into the EHR, but how clinicians get data out of the EHR to help them make effective decisions.
The government is promoting this shift by developing new regulations requiring EHR vendors to share data with other systems. This includes financial, medication, patient observation and demographic data, as well as data associated with clinical quality measures, among others. That's good news for interoperability advocates.
Changing the Mindset
Of course, that step forward doesn't mean there aren't challenges in sharing information across systems from multiple vendors — there are. In fact, many institutions are looking for solutions that simplify interoperability and provide the most flexible and least complex approach. Having a single source for all the data — EHR, imaging, monitoring and mobility — can help to simplify and unify the infrastructure to make interoperability a lot easier and more effective.
A key part of the puzzle is to find informatics partners who not only can handle the technical aspects of data integration, but who also know how clinicians think, work and care for their patients. Clinicians don't just sit at a desk with a screen in front of them. They're on the move, working with colleagues, caring for patients and talking with families.
C-suite clinical and IT leaders will play a critical role in bringing about infrastructural and cultural changes. Having a chief medical informatics officer for hospital systems is certainly a step in the right direction. These clinical and informatics leaders will help to develop the hospital of the future, in which virtual presence, mobility and interconnected informatics systems enable better, more timely and effective care.
But it's not just about systems, data and technologies — it's also about people. Finding informatics partners who help health systems along their journey to an interconnected environment is the most important step in realizing the full promise of interoperability.
Interoperability holds tremendous promise in the use of data derived from patient care. Retrospective data (information from insurance claims or medical records) will be extremely powerful when combined with real-time data, as they will enable predictive analytics and decision support at the point of care. At the same time, this volume of data can be overwhelming to health care providers. The challenge will be to present only the information that clinicians need to make better decisions.
Advances in gene sequencing and bioinformatics will provide opportunities to integrate patient genomic information into individual predictive models and enhance decision-making at the bedside. Interoperability among source systems will become even more data-intense and important as providers integrate these new data sources into clinical decision-making.
Finally, the accountable care organization payment model will continue to drive the pace of change when it comes to sharing data and interoperability. The importance of interoperability is growing every day, as is the importance of identifying interoperability partners who understand the needs of health care systems, patients and clinicians alike. With the right focus, the result will be clinical informatics that liberate important data and turn them into knowledge that is readily accessible and delivered to physicians and patients when it matters.
Joseph Frassica, M.D., is the chief medical informatics officer, chief technology officer and vice president at Philips Healthcare in Andover, Mass.