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Effective sharing of patient information depends on getting different and often disparate systems to exchange data and, at the highest level, process those data.

This requires sturdy bridges between systems, interpretive and compatible algorithms, and integrated strategies for how different systems will be used and will work together.

THE BASICS OF INTEROPERABILITY

CHALLENGES

SOLUTIONS

What is Interoperability?

According to the Healthcare Information and Management Systems Society: interoperability is "the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities." It allows different IT systems and software applications to communicate, exchange data, and use this information.

The data exchanged by these systems may be fundamentally different yet critical to the proper management of the patient. They may be DICOM (CT and MR images) and non-DICOM (digital snapshots of a rash or ECG waveforms); micrographs from pathology; or information drawn from patient histories – vital signs, such as blood pressure; patient allergies; or a list of medications.

With its emphasis on information systems, this common definition, however, leaves out the most important element of a healthcare system – people – the doctors, nurses, and staff who administer care.

To help patients, information exchanged among IT systems must be readily accessible by staff.

Why Interoperability Is Important

Between 2010 and 2013, U.S. hospitals spent $47 billion annually on information technology (HIT), according to the American Hospital Association. In 2014, nearly all (97 percent) of the hospitals tracked by the U.S. government possessed a certified electronic health records systems, according to the Office of the National Coordinator for HIT. But, because patients use multiple providers in multiple locations and these locations may be in hospitals, physician offices, post-acute care facilities, pharmacies, retail clinics, labs and imaging facilities, it is difficult to put all the relevant medical information in the hands of those who need it. Years of IT specialism has spawned disparate systems driven by particular strategies for handling specific types of data. Imaging specialists benefitted first through picture archiving and communications systems. Other specialists and general practitioners followed with electronic medical records systems.

Today, as data are being spread across the enterprise and among specialties, the strategies that guided the acquisition, storage and transmission of specific types of data are being homogenized to allow access to caregivers in multiple departments and across enterprises regardless of the type of department or whether those data were collected in in- or outpatient facilities.

And so they should. Patient health, after all, is the only reason these data are collected. Care coordination facilitates good healthcare and helps keep a lid on costs by optimizing drug expenditures, testing, and billing, according to research published in 2003 by Excerpta Medica.

It makes sense, therefore, that clinical data be acquired and shared interoperably and seamlessly in forms usable by doctors, nurses, nurse practitioners, other staff and patients. This is particularly needed in cardiology, in which patients may be examined and treated at multiple facilities and as both in- and outpatients. This has led some providers to seek out a “single-stack solution” -- a single IT system that handles all facets of diagnosis and treatment.

To serve the patient, data must be accurate. That accuracy must be maintained during the exchange. And the transmission must be quick.

Critically important data must not be held up by methods needed to ensure its security, for example, its encryption and decryption – or because the caregiver doesn’t know the password.

Efficiency is important also for the provider to remain financially viable. Patients must be managed effectively despite continuing reductions in reimbursements as medical practice shifts from fee-based to value-based care.

Effective and efficient data exchange is crucial for the patient to benefit and the provider to survive.

CHALLENGE: Consolidating Healthcare IT Systems

Hospital consolidation is gaining momentum. At the end of 2016, Becker's Hospital Review predicted that this movement toward fewer but larger health systems would continue. Among the drivers are an increased focus on population health, disputes between payers and providers, and lower reimbursement.

This trend has been going on long enough that mega for-profit and not-for-profit provider systems, integrated delivery networks or IDNs (aka integrated health networks or IHNs), have taken root. They have brought with them a plethora of disparate IT systems, each chosen and implemented by once independent hospitals and care facilities. In some instances, this has bred a cacophony of data -- a specialist’s report turns somehow from “English to gibberish,” states the AHA; values appear in the wrong section of a lab report; data are dropped from critical fields in a care summary; inpatient data do not accompany patients transferred to outpatient facilities.

Going to a unified system that establishes a single platform throughout the IDN/IHN might remedy many of the problems but it usually is not economical to do so. Installed IT systems are often viewed as investments. But, as medicine moves from a fee-based to a value-based model, they must be managed to provide efficient and effective patient care.

In a single hospital, the challenge of connecting the various silos, each representing a different specialty, can be formidable. The subspecialties of cardiology may be viewed in much the same way, walled off from each other; patients entering and exiting different silos, data barriers reinforced by disparate IT systems--one for nuclear cardiology, another for echocardiography, another for cardiac cath.

Interoperability is the key to interfacing multiple information technologies throughout cardiology, just as it is the key to unifying IT systems throughout hospitals and the enterprise. And interoperability depends on standards.

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