Is interoperability a challenge at your hospital? Do the frank opinions of hospital CIOs matter to you?
If so, you might be interested in the thoughts and perspectives shared in a focus group at HIMSS16. The topic: Defining Interoperability Challenges, Priorities, and Solutions for 2016. About 18 CIOs attended, representing hospitals, public health agencies, and similar organizations.
Here are the key takeaways:
Interoperability with HIEs
Much of the discussion focused on interoperability challenges with hospital systems and health information exchanges (HIEs). CIOs described a number of hurdles including different generations of HIEs, standards implemented in different ways, vendors complying to varying degrees, and conflicts with hospital workflows and culture.
In this volatile environment, most CIOs are simply trying to do the best they can to make sure data gets to where it needs to be. However, a few themes stand out:
For some CIOs, interoperability mainly means a lot of work so the organization can meet a regulatory mandate and get compliance dollars, even if health benefits are not readily apparent. Program participation is compulsory, and the CIO is responsible for project success no matter how complex it is. (For example, one state initiative was described as “Meaningful Use on steroids.”)
For others, it means wrestling with HIEs that are not ready for prime time. “We tried our state HIE and didn’t see the value,” said one CIO. “The only data coming back was our own data.” More than one CIO mentioned the challenge of “the last mile” — how to get data from the EMRs used by local physicians into a hospital system, especially if the state HIE isn’t ready to do the job.
For still others, the main thing is to keep their own physicians happy. Physicians are focused on their needs, and an initiative that feeds other systems but is disruptive or slows them will be a non-starter. “Anything that requires another login or click is not going to work,” one CIO said.
Another theme that emerged from the discussion was that people need to think through the various elements of an interoperability project, including:
- Putting a strategy in place
- Finding the resources to carry it out
- Building or acquiring the back-end components needed to enable the data to flow smoothly
- Making sure clinicians get the data that is important for them, rather than flooding them with all the data that becomes available
- Configuring the technology to deliver what the regulations require. As one CIO observed, “Technology is one thing, complying with regulations is another.”
The group also discussed the challenges of confirming patient identity when data flows between multiple systems. A common problem: the time and expense of remediating patient records after the patient visit, when data provided during registration conflicts with data from a back end system. “Every healthcare organization has a variation on this challenge,” observed one participant.
They also discussed possible solutions. One possibility was using credit bureaus to confirm patient identity. Another involved the anticipated national patient identifier. One CIO laid out the vision for multi-factor authentication, with three elements:
- National patient identifier
- Scanned image of the patient’s driver’s license
Practical details were not overlooked. One participant observed that whatever method is chosen, it has to be fast. Another mentioned something that is easy to ignore until it becomes a problem: all that identity data will have to be stored somewhere.
In talking with other hospitals at HIMSS16, I found that a lot of them don’t know where to look to even attempt to solve the problem of duplicate records before they happen. We have provided other hospitals a free assessment that gives them their duplicate rate, and the source of the problem. It provides hospitals a place to start for putting a plan in place to reduce their duplicate rate.
Medical Device Integration
The third main topic was the importance of medical device integration with the EHR, since it is very time-consuming for clinicians to have to reenter the data manually, and manual keying can lead to errors. An example of the importance of medical device integration cited by one of the CIOs was detecting sepsis, where the ability to integrate devices that monitor for signs of the condition can be a life saver.
They also agreed that many questions exist regarding specific standards for medical device connectivity. Some of the questions participants asked included, why can a particular EHR integrate with one pump but not another? Why can a vendor claim to be HL7 compliant but the specific information needed is not available?
Last September, the National Institute for Standards and Technology (NIST) and Iatric Systems co-hosted a webinar and reviewed Integrating the Healthcare Enterprise (IHE) standards for medical device integration. IHE’s patient care device (PCD) standards incorporate yet are more specific than simple HL7 standards. IHE PCD medical device connectivity standards include, but are not limited to:
- DEC: Device Enterprise Communication standards
- IPEC: Infusion Pump Event Communication standards
- PIV: Point-of-care Infusion Verification standards
- ACM: Alert Communication Management standards
That webinar was recorded and is available here to watch from the comfort of your own office.
Thanks to All!
Thanks to all participants for their insights and frankness. Every hospital environment is unique with a lot of moving parts, and many of these challenges seem to have no easy answers. Fortunately there are resources out there that understand interoperability, and know how to make it work.
For more information on the topic of Interoperability, you can view this educational webcast: Interoperability — Realizing Your Vision for some ideas that may help you move your interoperability goals forward.