Becker's Hospital Review

16 Special Section: Health Information Technology If Interoperability is the Future of Healthcare, What's the Delay? By Kathleen Roney I n order for the healthcare industry to move toward preventive care and population health management, clinical information needs to flow freely across networks and between hospitals and physicians. For this reason, healthcare organizations need interoperability — efficient yet secure means for IT systems and software applications to communicate and exchange patient data. is another major barrier toward reaching interoperability within the healthcare industry and across providers. For instance, one system might call a heart attack a myocardial infarction in its EHR, and another might call it a heart attack. While clinicians know that means heart attack, unless the system is digitized with that standard, it may not recognize the two classifications as one and the same. While CMS focused the latest stage of its meaningful use program on measures and objectives to encourage interoperability, the effect of that will not be seen until later in 2013 and early 2014 when providers begin to incorporate those measures and objectives into their clinical work. Semantic interoperability is interoperability at the highest level because it involves the structure of the data exchange and the codification of the data so a receiving IT system can interpret the data. This will become more important as providers go to risk-based payment models and attempt to manage populations. According to Mr. Caldwell, when data is brought into a data analytics tool or shared via health information exchange, it needs to be standardized as either a myocardial infarction or heart attack, not both. At a hearing on electronic health records and interoperability in November, Farzad Mostashari, MD, National Coordinator for Health Information Technology, and Mark Probst, CIO and vice president of information services for Intermountain Healthcare in Salt Lake City and a member of the Health Information Technology Policy Committee, discussed the need for standardized exchange capabilities, which should help foster interoperability across the entire healthcare industry. "We must set a clear road map and support an exchange infrastructure and the adoption of standards that will make it easier to share health information, so clinicians and patients have the information in the form and time they need it to make appropriate healthcare decisions," said Mr. Probst. "Presently, we lack a shared infrastructure and long-term plan to make this possible."  Due to a lack of shared infrastructure among hospital IT and EHR systems, the healthcare industry has not reached the widespread interoperability it needs to foster preventive care and effective population health management. To correct this issue, there are barriers and issues that must be addressed. 1. Executives need to educate themselves on IT options. Moving forward, hospital executives need to educate themselves on systems, products and vendors that will help them reach interoperability; they need to be educated consumers of IT. According to Patricia Katzman, director of interoperability and CDS marketing and strategy at Philips Healthcare, executives need to be asking about standards and profiles for interoperability when they make IT purchases, and about more than just their hospital's needs. Without knowledge of industry norms for products and systems, executives could agree to purchasing systems that do not offer the capabilities they need. "It takes time to learn, but it is worth the effort. Demands for standardsbased interoperability systems from purchases can make a difference in vendors supplying truly interoperable systems," says Ms. Katzman. "If this is a problem while sharing information, it won't be the straw that breaks the camel's back. However, when providers move to population health management, it will be crucial," says Mr. Caldwell. 3. Products and software need to be developed to fit existing infrastructure and systems. Strong infrastructure within a hospital is necessary for interoperability, and Ms. Katzman believes that strong interoperability stems from product and system compatibility. Since interoperability relies heavily on IT infrastructure, if software products cannot be integrated into existing infrastructure, hospitals may have more difficulty exchanging data. Some products are easier than others to fit into a hospital's IT environment — some have a smooth fit and others require extensive customization. As vendors develop products, they need to develop them with the hospital's environment in mind, says Ms. Katzman. According to Jason Martin, senior director of integration, interoperability and database information and information technology for The Mount Sinai Medical Center in New York City, the industry needs to be focused on more plug-and-play capabilities between disparate systems — leveraging the existing standards and focusing on quick solutions to enable data exchange. "[Vendors] need to play well together to augment an environment conducive to information exchange. There are multiple interpretations of data needs and it differs from vendor to vendor," says Ms. Katzman. "When implementations of vendor systems require over-customization such that data meanings must be constantly interpreted for machine-to-machine communication, it adds cost and complexity to the implementation without adding value to the healthcare industry." Dave Caldwell, chief of marketing and sales of Certify Data Systems, argues that executives need to be thoroughly educated so they have the knowledge to discern technology that will deliver on interoperability rather than just promise it. Kumar Chatani, senior vice president of information technology and CIO of The Mount Sinai Medical Center, agrees. "I believe that EMR vendors need to make it easy to exchange data between the various systems. This should be standards-driven and inexpensive like electronic data interchange transactions," says Mr. Chatani. "The message is buyer beware. Make sure you fully understand all the aspects of the technology and what it can do for you. Don't take suppliers on face value. They can mislead healthcare executives when they are trying to make a sale," says Mr. Caldwell 4. Hospitals need to distinguish data types to strengthen internal interoperability. "Some may think interoperability is just about sharing information, but it is important to note where and to what systems [providers and hospitals] are sharing data," says Ms. Katzman. 2. Interoperability needs to include semantics. Many IT products and software are not semantically interoperable with each other, which Information from a variety of levels within a hospital — point-of-care, departmental or enterprise — can be shared. Departmental level data may

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