A generation ago, Alvin Toffler forecast a “future shock” that would envelop much of the industrialized world as technology driven change transforms society and overwhelming amounts of information flood every aspect of daily life.
Few would argue that Mr. Toffler missed the mark. Individuals and organizations are inundated with facts and figures, and struggle simply to wade through available information, much less integrate or ascribe meaning to this wealth of data in any significant way. Healthcare is not immune to this phenomenon. In fact, some would say it is especially susceptible to information overload, embracing innovative technology while being ill-suited to incorporate resulting data in ways that add genuine value to the delivery of patient care.
Healthcare is, without a doubt, an information-rich field. Technology has advanced rapidly with increasingly sophisticated diagnostic and treatment options, and the resultant ever expanding volume of patient medical data. At the same time, patients have become increasingly mobile and rarely see the same doctor from cradle to grave. Instead, they are treated by innumerable care providers over their lifespan. And so, while there is increasing amount of relevant information, it is scattered among various physicians, institutions and health systems, stored in discrete silos.
In other words, Toffler’s future shock has become present shock, and healthcare organizations have accelerated efforts to counter the movement. The industry is actively seeking ways to use technology to gather information into a single, comprehensive record rather than see it isolated among various disparate systems. These efforts will enable healthcare organizations to create a coherent and holistic view of their patients to analyze trends at the point of care, put discrete sets of data and services into a larger context and, ultimately, deliver improved diagnostic and therapeutic services.
Beyond improving the health and wellbeing of the patient population, the integration and availability of this information will reap significant benefits for the healthcare enterprise as a whole. Costs associated with the transfer of information will be reduced. Enhanced care will create a demand for services, increasing the volume of encounters, admissions and procedures – and, consequently, revenues.
The end result? Healthier patients and a healthier bottom line.
All data-sharing options not created equal
At first glance, healthcare organizations appear to have a wide range of options that facilitate greater accessibility of data:
Portals can be constructed so that providers are allowed to view select information. While portals are generally easy to use and offer immediate access, they provide only limited use of the data – portals are unable to actually integrate the data and as such enable only basic usage of the information for presentation purposes. For example, they typically cannot support in-depth analysis across the enterprise. In addition, availability and presentation of information is highly dependent upon the format of the data and typically relies on the implementation of a separate data repository.
Sole-source or monolithic solutions require that a healthcare organization rely upon a single vendor for its health information technology (HIT), usually centered on its electronic medical record (EMR) system. While this enhances connectivity and synchronicity, it requires the replacement of existing and often expensive systems. Likewise, it means that users who have grown adept at using a familiar system must convert to a new application.
Interoperability platforms are fast becoming the technology of choice, because they enable a comprehensive, current medical record – in essence creating a unified record from the various sources generating patient data, no matter what format they are stored in or where they are located. They also offer the benefit of being able to use the data for many applications that reach far beyond that moment of truth when clinicians and patients interact.
Beyond interoperability is semantic interoperability, which many healthcare thought leaders believe holds the greatest promise. Representing the most sophisticated stage of health information exchange technology (HIT), semantic interoperability allows two systems not only to share information, but enables the systems to truly understand and make use of the incoming data while maintaining the original “meaning” of that information even if the data has been created and stored in varying systems and formats. Labs may report results for the same tests using different nomenclatures, for instance. Semantic interoperability, particularly systems based on service oriented architecture (SOA), coalesce the values, and deliver valuable, highly usable information to users.
Improved care and patient safety
The potential benefits that may be achieved by adopting interoperability platforms are considerable.
Leadership at the University of Pittsburgh Medical Center notes that use of the interoperability platform represents a significant step forward, since it actually allows various HIT systems to ‘talk’ to each other.
Top of the list, of course, is improved care. Since an interoperability platform creates a real-time longitudinal medical record, providers can view broad data sets to support their diagnoses and care plans. When measuring diabetic quality markers, for instance, one laboratory system may denote levels as glycohemoglobin within the chemistry panel, another may represent it as an independent test called “HgbA1c” and a third may describe it as using the appropriate LOINC code, namely 4548-4. Semantic interoperability allows systems and applications to recognize each of the three terms as representing the same value (i.e., glucose level). As a result, providers can be given functionality that makes use of the common meaning – generating a trending analysis of glucose readings over time – regardless of the fact the data originated in very different formats.
What is the difference between interfaces and interoperability anyway?
Many in both the healthcare and technology fields apply the terms “interface” and “interoperability” interchangeably – although they are not synonymous. Let’s examine the differences…
An interface engine routes information from one system to another, but stops short of enabling systems to use the data that has been transferred. A common example is an interface between a laboratory system and a billing system. When lab work is performed, the former sends a message to the latter so a claim or bill can be generated.
Systems genuinely capable of interoperability, on the other hand, make data available to be used. Put another way, a system or application can consume and assemble information from the source systems, without those systems having to generate that information in an orchestrated fashion when it is required. Technology that exhibits true interoperability can create a composite list of all lab results associated with a specific patient, for instance, even if the labs reporting the results rely on disparate systems. Even more advanced is semantic interoperability, which allows two systems not only to share information, but enables the receiving system to understand and make use of the incoming data while maintaining the original “meaning” of that data.
Consider also the patient safety ramifications when comprehensive data is available. At the University of Pittsburgh Medical Center (UPMC) the implementation of a semantic interoperability platform represents a significant step forward with the application of this technology actually allowing various HIT systems to “talk” to each other in an integrated and meaningful way – in real, practical terms and not just in theory.
The platform also helps eliminate opportunities for miscommunication and error at UPMC. When patients are discharged from an acute care facility, for instance, it is typical for them to be prescribed new medications or therapies. It is vital that information about these treatment modalities be made available to clinicians who subsequently see the patient in the ambulatory care setting. Rarely do these physicians have access to discharge summaries and other documentation that supports ongoing or follow-up care. Similarly, it’s not uncommon for ambulatory care patients to arrive in urgent care settings where physicians also lack access to history and current therapies. Today that information is being efficiently and effectively conveyed, subsequently transforming the care process.
Reduces waste, streamlines workflow
Interoperability offers benefits beyond the improved care that is facilitated by the availability of information at the point of care. Because up-to-date patient information is at the provider’s fingertips, both money and time can be saved. Patients seen in an ambulatory setting may be referred to the hospital for specialty services. Without the availability of a patient record at the point of care, caregivers may have to spend substantial time – perhaps hours – trying to locate important test results. Faced with delays and frustration, they might simply abandon the search and order the studies again, duplicating the cost.
“The real value is that this advanced approach allows organizations to use the best systems available, now and in the future, and bring them together to create a unified clinical framework that is pervasive and patient-centered.”
– G . Daniel Martich, MD
Chief Medical Information Officer and
Associate Chief Medical Officer at UPMC
UPMC has found that interoperability helps address one of the most significant areas of waste within the system: tracking down information in a timely manner. Recently, quality professionals at UPMC investigated the processes involved as nurses prepared patients for surgery. On average, nurses spent between one and 41 minutes looking for necessary information, says Tami Merryman, Chief Quality Officer at UPMC. Once located, it might take from five minutes to 20 hours before the information was actually in hand. The most frustrating part was that, after this extensive paper chase, 30% of patients still were not ready for their procedure as scheduled. “The interoperability platform virtually eliminates this problem,” Merryman says, “because the full medical record is immediately accessible to the pre-operative and surgical team, even if it is generated by or stored in unrelated data silos.”
Likewise, interoperability enables healthcare organizations to comply with rapidly emerging quality programs and pay-forperformance (P4P) initiatives. CMS is aggressively adding quality measures to its PQRI program each year. Concurrently, the agency is increasing the number of situations it designates as “never events.” To comply with reporting requirements, healthcare organizations have come to realize that manual extraction and reporting is virtually impossible. Stand-alone EMRs simplify the process only slightly. On the other hand, interoperability solutions offer access to data across the care continuum, which streamlines reporting so organizations can more readily participate in P4P.
This convenient access to comprehensive data closes the loop and brings healthcare organizations back to their objective of improving quality. Because a longitudinal patient record is easy to obtain, facilities have the tools in hand to conduct genuine analysis and trending. “Interoperability empowers the organization to truly dissect data and clinical outcomes to determine what is working and what is not,” Merryman says. “Leaders have access to tools that will allow them to investigate and correct patient care issues efficiently and effectively.”
Beyond ‘shock:’ Future benefits
While offering great opportunities for enhanced care delivery, interoperability also opens the door for long-term, enterprise-wide benefits.
Organizations can avoid the need to convert to a new monolithic HIT solution, for example, leveraging instead their investment in legacy systems. This allows them to retain best-of-breed technology that precisely meets the distinct requirements of varying departments, units and service lines – and provides flexibility to adopt emerging technologies that offer advanced functionality. “The real value,” observes G. Daniel Martich MD, Chief Medical Information Officer and Associate Chief Medical Officer at UPMC, “is that this advanced approach allows organizations to use the best systems available, now and in the future, and bring them together to create a unified clinical framework that is pervasive and patient-centered.”
The capacity to accommodate different systems and future HIT developments, therefore, will support organizational efforts to scale operations. By adopting an interoperability strategy, UPMC is able to continue increasing its market share while avoiding many of the typical growing pains. Because its systems are interoperable, UPMC is able to function more efficiently and to continue enhancing its “customer service” as it grows. In fact, this platform is paving the way for the smooth integration of a newly acquired facility, whose systems are being fully integrated with UPMC existing systems, eliminating the need to sunset existing technology and invest in new.
Adopting an interoperability platform is not only good for patients, but good for business as well, allowing organizations to achieve an enviable return on their technology investment.
At the same time, interoperability will support healthcare organizations as the trend towards consumerism and transparency grows. Payers increasingly are ranking providers on quality measures – usually based on claims data – and making these lists available to consumers. It’s not unusual for claims data to be incorrect or incomplete, resulting in a less-than-desirable ranking. “With an interoperability platform in place, providers can arm themselves with comprehensive clinical data and demonstrate to payers that they indeed meet established standards, regardless of what the claims seem to indicate,” says William A. Fera, MD, Vice President of Medical Technologies for UPMC. “This ensures the quality of care they provide is accurately reflected and publicized, so that consumers can make effective decisions about where to receive care.”
In short, adopting an interoperability platform is not only good for patients, but good for business as well, allowing organizations to achieve an enviable return on their technology investment. “At UPMC, we had ‘transactional systems’ before,” notes Martich. “Now we have ‘transformational’ systems.”
The ROI case for interoperability
While the importance of sharing clinical data is driving the momentum behind semantic interoperability, healthcare organizations need not overlook the business case for making the transition. Tami Merryman, Chief Quality Officer at the University of Pittsburgh Medical Center, shares her insights on a few of the many benefits:
Contain costs. Interoperability can greatly reduce duplicative testing because it makes lab results, imaging studies and other health data immediately available to providers. Because interoperability significantly diminishes the reliance on manual processes, organizations are able to decrease administrative FTEs.
Re-allocate IT dollars. Use of an advanced interoperability platform means the healthcare enterprise does not need to convert to a single-vendor system, at great cost and disruption. Likewise, it can relieve the burden of building interfaces and developing connectivity from internal IT staff.
Enhance relationships with referring providers. Interoperability represents the perfect tool for communicating with community physicians, sharing information about their patients to support care. Studies have shown that providers are more likely to refer patients to other clinicians when they are assured they will remain in the information loop.
Recruitment and retention. The value of comprehensive, current patient records at the point of care is not lost on physicians – and facilities that can offer this level of access are recognized as desirable practice environments. Hospital admissions are a reoccurring source of revenue, so the recruitment and retention benefits of an interoperable system not only help ensure a highly qualified medical staff, but support revenue growth as well.
There can be no doubt that access to information will continue to be as vital an instrument to healthcare providers as forceps, CT scanners and gamma knives. Semantic interoperability ensures this instrument is placed in the right hands at the right time, allowing organizations to improve care, increase efficiency, support growth and better prepare for any data-centric shock the future may hold.
Elizabeth Willett is a Healthcare IT writer, based in Atlanta, following developments in Healthcare Interoperability and Intelligence.
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