Shutting down the 'sneakernet' with interoperability

By Joseph Smith and Michael Johns

When we were young physicians in training, computers had yet to take a leading role in clinical care. Data about patients, like vital signs, lab results and medication orders were not delivered electronically, but instead by a 'sneakernet,' of physicians, nurses, aids and technicians who would carry these notes, reports, files and even single numbers hastily scribbled on loose bits of paper, or even their own scrubs, from one location to another.

It might surprise you that we still rely on this sneakernet every day in 'modern' healthcare. How did the communications revolution that transformed industries such as banking, entertainment and telecom somehow leave healthcare behind?

It certainly was not due to a lack of vision or promises. Medical device manufacturers, electronic medical record vendors, CIOs, CMIOs and legions of healthcare futurists--yours truly included--have described a future of a seamless, connected array of smart and learning devices that form a rich, intelligent net around patients, helping to coordinate care and collect critical observations.

Today, in large measure as a result of federal programs to promote their use, EMR adoption has spread throughout almost all large hospital systems. Often costing hundreds of millions of dollars, they still end up consuming an enormous amount of precious clinician time, requiring manual data entry of patient reported information, often with skilled clinicians filling the role of scribe.

At the same time, the gifted gadgets surrounding the sickest patients make, analyze and display hundreds of measurements each hour, all in uncoordinated isolation. These devices rarely communicate with each other, so the integration, interpretation and documentation of this information becomes the job of the physician or clinician.

In intensive care units, this happens at a dizzying pace to the tune of electronic alarm bells and whistles, until at the end of a 12- or 18-hour shift, some incomplete summary set of this enormous amount of precious data is then entered by the caregiver into the patient's electronic health record.

Such an environment can lead to what otherwise would be intolerable mistakes, especially when compared to the streamlined efficiencies we see and expect everywhere else in modern industries.

Imagine if you had to transcribe the error codes from your car's dashboard to give to your mechanic?

The key problem is the lack of seamless communication between the many different pieces of medical technology used in patient care. If the smart devices around a patient could seamlessly share all of the information available, we could more efficiently and safely care for patients. It's time for healthcare to eliminate the sneakernet and reap the benefits of the Internet.

The advantages to improving this lack of communication are obvious. The Institute of Medicine points out that more than $130 billion is wasted each year through inefficiently delivered services, including mistakes, errors and preventable complications, which medical device interoperability could address. The West Health Institute's recent analysis of the opportunity suggests that more than $30 billion a year may be saved in the U.S. by saving clinician time, and by improving the timeliness and safety of clinical care through medical device interoperability. The leadership at the FDA has called for such interoperability to improve patient safety, and former President Clinton has also issued a call to action on this issue.

Interoperability is technically achievable. While easier for vendors to maintain a closed, proprietary communication and control structure for each stand-alone medical device and system, maintaining this status quo runs counter to the benefits to patients and our healthcare system.

How do we get there? It starts with doctors and hospitals requesting, and then requiring functional interoperability of the technology they purchase on behalf of their patients. Doing so will drive the rest of the ecosystem to deliver the regulatory, testing and certification requirements and ultimately create a market for the next wave of interoperable medical devices and systems.

Standards-based interoperability has already changed banking, retail, telecom, entertainment and virtually every other part of our lives and our economy--isn't it time we shut down the sneakernet and let interoperability improve healthcare?

Joseph Smith (@Unaffordable_Rx), a former practicing cardiologist, is chief medical and science officer of the West Health Institute (@WestHealth), an independent, non-profit medical research organization focused on lowering the cost of health care.

Michael M. E. Johns, former chancellor of Emory University, is the founding chairman of the board of the Center for Medical Interoperability (@MedInterop). Prior his role as Chancellor, Dr. Johns served as the Executive Vice President for Health Affairs and Chief Executive Officer of the Robert W. Woodruff Health Sciences Center of Emory University where he oversaw the University's widespread academic and clinical programs in health sciences and led strategic planning initiatives for both patient care and research.