Feature | November 06, 2014 | Williette Nyanue

Moving Forward With Interoperability

Meaningful Use incentives as well as a more interactive and connected healthcare industry push interoperability forward

Photo courtesy of Carestream Health

In the healthcare organization of today, picture archive and communication systems (PACS) are a mainstay. Introduced to the healthcare world in the early 1990s, these systems have given providers a solution for storing, viewing and sharing patients’ medical images. In recent years electronic medical records (EMRs) and other health information systems have also gained popularity for storing and transmitting patients’ healthcare information. These systems, for the most part, have been specific to each hospital, practice and even department. As healthcare becomes more interactive and connected, with a focus on efficiency, healthcare organizations around the country are investing in ways to make these systems interoperable within the facility and across the enterprise.

Pressure From Meaningful Use

While PACS have been around in different departments for quite some time, EMRs have recently gained popularity within healthcare organizations, due in part to the rollout and implementation of Meaningful Use criteria. According to “The New Healthcare Enterprise: Leveraging Healthcare IT to Achieve Connected Care, Healthcare Reform,” a survey of 142 healthcare leaders conducted by the Healthcare Information and Management Systems Society (HIMSS) on behalf of Philips, EMRs have been the most widely adopted health information technology. Healthcare organizations across the country are looking to reap the benefits of Stage 1 and 2 Meaningful Use criteria, which provide reimbursements for those facilities that deploy an EMR.1 According to the survey, as of June 2013, the Centers for Medicare and Medicaid Services (CMS) had awarded more than $15.1 million in EMR reimbursements.2 As Stage 2 Meaningful Use comes to completion and Stage 3 begins, further pushing the incentives for the meaningful use of EMRs, healthcare facilities are looking for ways to get the most of their systems. 

The Interoperability Problem

The problem with many health information systems — EMRs, computerized physician order entry (CPOE) and clinical decision support (CDS) systems — in addition to PACS and radiology information systems (RIS), is that the technologies have not been able to communicate with each other outside of a specific hospital, vendor or even department. In addition, the different formats in which medical information is stored — DICOM, nondicom and HL7 — makes sharing information more complex. Cardiologists cannot access radiology images within the same hospital, and referring physicians cannot get access to a patient’s EMR if it is at another clinic. 

A survey by Premier Inc. and the eHealth Initiative recorded that although most accountable care organizations (ACOs) have the health information technology systems that help to improve clinical quality, poor interoperability across systems remains a barrier. “While accountable care organizations are providing quality care for many patients, even more could be accomplished if interoperability issues were addressed,” said Jennifer Covich Bordenick, CEO, eHealth Initiative. 

A big goal of many healthcare facilities throughout the United States is to make health information systems interoperable throughout facilities and across healthcare networks. According to the Phillips survey, interoperability, mobile activity and technologies that drive real-time actionable information at the point of care will be the focus of health information technology investments this year.2

Integration Profiles for Interoperability

John Paganini, senior manager, interoperability initiatives, HIMSS, said that a big part of interoperability is conforming to standards that format data in an industry standard way that allows it to be communicated across systems. 

“IHE (Integrating the Healthcare Enterprise) has what it calls integration profiles that allow organizations to understand what the actual formatting of the data looks like — what the protocol is for, the information to be sent from one system to another, and how it works,” he said. “In order to be interoperable, these integration profiles have to be followed by each vendor’s information system and digital imaging system as well — their PACS.” Paganini said that once both vendors understand the approach to communicating between the two systems, information can be exchanged. 

To help vendors adopt these standards, HIMSS hosts the annual IHE North American (NA) Connectathon Connection. At this event vendors from all over the healthcare enterprise gather together for one week to test their systems for interoperability. “At this point there are more than 100 companies gathering together on a yearly basis, with over 500 engineers total,” said Paganini. The 2015 conference will take place in Cleveland at the HIMSS Innovation Center. 

At the conference, vendors take predefined tests according to the functions and workflow of their systems and the departments in which they operate, including cardiology, eye care or the laboratory. “Based on what you do and what information you need to send and receive, there are certain tests that you will be taking,” Paganini said. “Once you take these tests, you get what is called a conformance statement, which means that you conform to the IHE technical framework, and you actually performed the integration requirements according to the specifications of the test.” 

HIMSS is also starting a program called the Interoperability Accelerator that allows companies to test interoperability throughout the year. “They can actually come to the HIMSS Innovation Center in Cleveland, plug into our environment and we will provide them with the testing tools that they need to test their systems physically,” Paganini explained. 

Emergence of Enterprise Imaging

Not only will interoperability benefit efficiency for physicians, it will also benefit patients. Today, patients want to be actively engaged in their medical treatment. With advances in technology, both patients and physicians now have the ability to access medical records and view images, via smartphones and tablets. This makes it more important that health information systems be able to transmit information regardless of vendor, platform or operating system. Paganini said that enterprise imaging is an emerging approach to allow patients and physicians to look at images from across state boundaries.  

According to the Cleveland Clinic, a multispecialty academic medical center located in Cleveland, an enterprise imaging strategy “addresses the overarching enterprise need for standardization of clinical image acquisition, management, storage and access.”3 Vendor neutral archives (VNAs), a technology that saves medical information in a standard format with a standard interface so that it can be shared with others regardless of vendor, have helped make enterprise imaging possible. 

Atlanta-based Piedmont Healthcare, which performs 1 million diagnostic imaging studies annually, deployed the Perceptive Acuo VNA to consolidate medical image management for radiologists, cardiologists and other clinical users across all hospital and clinic locations. The 2014-15 U.S. News and World Report rankings of the nation’s Best Hospitals reported that 40 percent of the cited top 17 hospitals use the Evercore VNA, which integrates and manages patient-centric clinical content in the clinical and research settings across wide geographies, including standard DICOM objects. TeraMedica states that Evercore possesses the ability to natively manage and distribute beyond DICOM using global standards such as MPG, JPG, PDF and other critical clinical content such as treatment plans for cancer care or vital reports in non-standard formats.

Making Your Systems Interoperable

While VNAs are a viable option to address interoperability within a network via enterprise imaging, Paganini said before an organization deploys a solution, it should ensure that the basics are met. “If you already have a system installed, then one approach would be to look and make sure that they are following the integration profiles specifications,” he explained. “If you’re out there buying a new system, then you should, in you RFP process, request that the vendor adheres to the IHE standards for their integration.”  


1. www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html?redirect=/ehrincentiveprograms/. Accessed Oct. 1, 2014.

2. www.itnonline.com/article/survey-healthcare-executives-reveals-top-priorities-it-investments. Accessed Oct. 1, 2014.

3. http://portals.clevelandclinic.org/mis/MyPracticeImagingSolutions/WhatisanEnterpriseImagingStrategy/tabid/7766/Default.aspx.
Accessed Oct. 1, 2014.

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