Interoperability: A critical mess

I recently moderated a panel discussion on one of the most intractable problems in healthcare today: the ability--or lack thereof--to seamlessly share data across organizations, systems, platforms, devices and more. The live and online event on interoperability was hosted by West Health, a research organization that focuses on technologies to reduce healthcare costs.

Interoperability is an issue that the health IT community has been talking about for so many years--and yet solutions are tantalizingly out of reach. This despite the fact that there are enormous incentives to get it done.  

The discussion kicked off with an arresting image--a photo of a patient in an intensive care unit room chock full of medical devices and a menagerie of carts and monitors. A jumble of wires completed the vision. You could barely see the patient and the clinician in the middle of it all. Different medical devices and systems look different, of course, but what struck me was that each monitor display also had a different look and feel.

The picture is a good analogy for interoperability itself--it's an intensive, mission-critical mess that the industry must address.  

"When you look at that photo, it's hard to imagine that is the standard of care for patients in the intensive care unit in this country. There's something like 10 or 12 devices trying to maintain the care and wellbeing of her father in this most dire time," said Nick Valeriani, chief executive of the San Diego-based West Health. "And none of those devices talk to one another. None of those devices share information to enhance both his safety, the quality of his care and the cost of that care."

Because panelist Jeff Balser, M.D., vice chancellor of Vanderbilt University Medical Center in Nashville, has spent a lot of time in ICU rooms during his medical career, and he gave the audience some specifics about what is wrong with that ICU picture.

"One of these devices ... opens and shuts a balloon to assist the heart in beating. So you can just imagine the timing of that pulsation would need to be synchronized with the EKG," he said.

"Way back here is the electro-cardiogram being recorded off the chest. And those two devices have to talk to each other or nothing works. I used to spend about an hour ... fighting with those two machines to make them talk to each other," he said. "Instead of taking care of the patient, I was making those devices talk to each other. It still doesn't work."

The thing about interoperability is that success in this area will not only lead to better patient care but is also good business.

There's a human element here, the panelists said.

"The data that I carry as a patient belongs to me. It's not a vendor's data. It's not my hospital's data. It's not my doctor's data. I want my data to flow where it needs to be when I'm receiving any kind of healthcare," said Michael Johns, M.D., chairman of West Health's newly-formed Center for Medical Interoperability and former chancellor of Emory University in Atlanta and CEO of its Health Sciences Center. "The way information and data flows is a real detriment to the quality of patient care."

At Vanderbilt, Balser conducted a survey asking patients what is important to them. There were 40 things on the list, from free parking to knowing that all of their providers have access to the same information.

"One of the things on the list was knowing all of my providers have access to the same information. "I thought people would pick that--it came in No. 1 ... It even beat parking," he said. "People know immediately when we don't have our act together. They get it. And we don't have our act together."

As for the business side of things, integration is especially critical in an era of accountable care, which has changed the provider landscape. "Hospitals come together and form health systems and networks that get bigger and bigger ... physicians come from groups of twos and threes to groups in the fifties and hundreds and join up with the health systems," Johns said. "The business model is that if we could [achieve interoperability], we would create tremendous efficiencies ... we can do more throughput, we can have physicians and nurses taking care of people, talking to people, listening to people rather than sitting at the machine trying to find the data from the last visits and logging in from one web page to the other web page to try to get the lab data and imaging data and patient history."

Balser agreed. "We're spending an enormous amount of money hiring really highly-trained people to waste their time doing useless work," he said. "It's costing us a fortune."

West Health's mission is research to reduce the cost of healthcare, noted Valeriani. And interoperability is a ripe environment for cost reduction. Analysis by West Health found the healthcare industry could save roughly $30 billion if it fixes the interoperability problem, including $12 billion in savings when highly trained people are providing care instead of transcribing data from one device or system to another.

There was a lot more to discuss--more than I can fit in a single column. You can find a video of the full event and the photo of the ICU room that I described here. And you can follow the Twitter conversation during the event here.

By the way, FierceHealthIT has just published our latest free eBook, Interoperability: The Path To Management and Standardizing Health Data. Be sure to check it out and let me know what you think about how we can move interoperability out of the intensive care unit--or into it, as the case may be. - Gienna (@Gienna and @FierceHealthIT)

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