A Field Guide to Interoperability at HIMSS

Healthcare interoperability has a long way to go, but at HIMSS15, the CommonWell Alliance and others will demonstrate an increasing capability to locate patients and their records across previously incompatible electronic health records systems.

The buzz at the HIMSS15 conference in Chicago April 12 – 15 will be about interoperability, which will join the remaining noise and buzz from last year's HIMSS about population health. The two are linked: No interoperability, and pop health will never scale. Without population health as an outcome, interoperability is just a lot of expensive infrastructure-building without ROI.

The Best Interoperability Game in Town

Healthcare has always had some level of interoperability, but historically it's been expensive and had great difficulty keeping up with changing technology and business demands.

The IEEE defines interoperability which is the capability of systems to work together without special effort on the behalf of the user. In the computing industry, the goal is all about "out-of-the-box" interoperability. Pundits point to TCP/IP, the ubiquitous Internet protocol that comes out of the box in every computer and server, and most mobile devices these days.

Healthcare interoperability has a long way to go before its world-changing TCP/IP-equivalent moment emerges. ONC has a draft 10-year roadmap to get us there, and the 10-year clock hasn't even started ticking yet. Meaningful Use Stage 3 attempts to implement a standard here and there, but falls far short of getting the job done in its current draft form.

Meaningful Use Stage 3 Proposed Rule Detailed

E-prescribing works today. The ROI on e-prescribing was clear, and compared to moving entire medical records around, it was relatively simple to implement. The success of e-prescribing is cause for hope.

Just this week, I successfully linked my HealthVault personal health record to my LabCorp test results. The toughest part was logging into HealthVault, which I normally use on my iPhone, so the login and password information wasn't top of mind. But I can now see two years' worth of lab data next to the readings I enter myself into HealthVault on my iPhone. That's interoperability that works today.

At HIMSS, the CommonWell Alliance will demonstrate an increasing capability to locate patients and their records across previously incompatible EHRs, and will start publicly showing ways to move not just entire records, but discrete pieces of records, without requiring hospital IT to sift through a lengthy document-oriented update that contains the most relevant and valuable nuggets of fresh data about a patient.

Seven geographies across five states are currently implementing CommonWell record locator and patient matching services. Those are the same two services CommonWell demoed at last year's HIMSS, now being deployed at scale for the first time, according to Jitin Asnaani, CommonWell's new executive director.

The new CommonWell demo will show how Fast Interoperability Health Resources (FHIR), the emerging HL7 standard at the center of so many interoperability initiatives, can be used to fetch or push those discrete pieces of data I mentioned, such as a recent immunization or vaccination, between providers. (When I tried to get my flu shot last fall, my doctor was out of the vaccine, so I went down to the local pharmacy to get it. But the fact that I got vaccinated never made its way back to my doctor until I told him, months later.)

Asnaani, who in previous jobs built ONC's Standards and Interoperabilty Framework and Athenahealth's interoperability and population health platforms, envisions the FHIR capability allowing pharmacists to send patient record updates, such as reports that a patient on a heart medication is feeling dizzy.

That is if the physician receiving these updates decides he trusts the word and work of the pharmacist, I pointed out to him.

After we spoke, I also wondered if a day would come that a doctor who chose not to incorporate that report into the record would become liable for his decision not to trust that pharmacist, if it was later found that the dizziness presaged a more serious adverse event.

Technology demos aside, we may have a long way to go before these extended care team members are trusted, and treated as colleagues—if not peers—by doctors who don't know them, unless the organizations involve elect to enter into more formal trust relationships.

A Rare Sight

That's where the traditional calls to action, to make healthcare more like the Internet, run into trouble. The Internet can truly be a wonderful, sharing place. It is also the home of innumerable thieves, con men and predators.

We have yet to see an end to the ways crooks can game systems ranging from Medicare to social security, ably abetted by the latest round of medical identity thefts. And they're not just gaming them as pretend-patients, but also as pretend-providers. It's harder to prove a negative, that interoperability not only works, but can't be spoofed or hoodwinked. At HIMSS, ask how the technology you're seeing demoed takes that into account.

While you're on the lookout for CommonWell sightings, swing by the Intermountain or Cerner booths for a look at the latest work of the Healthcare Interoperability Consortium, or HSPC. There you will see a truly rare sight: data being pulled out of Epic EHRs and into demonstration-modified Cerner EHRs.

Even though Epic is part of HSPC, apparently we won't be treated yet to seeing the opposite happening in Epic's booth at HIMSS. It's still encouraging to see that Epic is on board with this effort, unlike CommonWell.

HSPC magic is not yet out of the box, and it's limited to a few specific applications, such as managing sepsis, but HSPC's interoperability demo offers a potentially very nice complement to the CommonWell services. HSPC is actually building an app store where the apps in question will run on more than one EHR. HSPC apps may also end up in the app stores of Epic, Allscripts or others, and help spread Intermountain's sepsis-fighting protocols to other healthcare systems. Tests employing those protocols have already reduced Intermountain's sepsis mortality rates from around 25% to about 5%.

One other interesting tidbit I just learned: HSPC's new bylaws call for a majority of its board members to be drawn from providers, not vendors. CommonWell may represent more than half the market share of inpatient EHRs in the US today, but it is, foremost, a vendor-led organization.

HIMSS also has a whole exhibit area set aside, the Interoperability Showcase, where a bunch more things will be working together on vendor-neutral ground, accompanied by interesting talks, so check that out too. The HL7 booth will also have many excellent interoperability talks.

So happy hunting at HIMSS for that elusive out-of-the-box interoperability. I look forward to the day when I go to the exhibits and see bits of everyone's technology and data running and being accessed in everyone else's booths.