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The interoperability hang-up

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   By John Kelly, February 2011

When it comes to information exchange, how should precede what.

Health information technology (HIT) has always held the promise of reducing costs and medical errors, improving efficiencies and enabling better patient care. However, in 2011 physicians and other healthcare professionals have even more reason to adopt HIT: The nearly $20 billion in federal incentives for demonstrating meaningful use. Providers responsible for selecting and implementing HIT to qualify for incentives should make educated decisions and be sure to select technology that meets their needs today and well into the future. For those of you having a need to exchange health information outside your own organization's four walls, it is important to not only be aware of interoperability, but to fully understand the concept and what it means for effective information exchange.

While interoperability has long been an industry buzz word, true interoperability, which allows for broad and seamless sharing of patient information between HIT systems, has yet to be achieved. This is because the industry has allowed itself to prematurely get embroiled in lengthy debates about what information should be exchanged (let's call this "content interoperability") before we have even resolved the issue of how that information gets exchanged (let's call this "transport interoperability"). This has delayed content innovation, and has left us with a better-than-nothing approach to content sharing. The industry needs to agree on transport interoperability in order to expedite the much more critical content interoperability discussion.

Resolve transport discussion, innovate on content

If the healthcare industry can agree on a standard way to move patient data from system to system, the conversation can then turn toward developing platforms that enable exchange of comprehensive health information between organizations, applications and systems, regardless of the content size, type and format.

Consider this analogy: Fed Ex delivery personnel just look at the outside of packages and get them to their destinations; personnel don't care what's inside the packages. Similarly, we in the healthcare industry should first be concerned with the logistics of shipping patient information before we delve too deeply into the content of the package and what to do with it. Today, we seem to be spending an inordinate amount of time discussing the data, when we don't yet have a suitable, effective way to get it back and forth to one another.

To look at another analogy: It seems as though we are trying to invent e-mail attachments before we even have e-mail communications. Early platforms for e-mail were created so two parties could send simple text back and forth. Now, people throughout the world can send attachments, MP3s, pictures and video via e-mail to anyone in a matter of seconds. The healthcare industry is building the attachments (i.e., EMRs, PHRs, clinical alerts, etc.) before we have set up a good mechanism, network or platform for transporting them.

Content-oriented debates have included: Who should own the content? Who should store the content? What kind of content should be shared? What kind of security should be wrapped around the content? We pay a high price for this often fruitless debate.

Today, there is no consensus as to the best transport method. One reason may be because many vendors are more concerned about figuring out ways to collect tolls on the transportation of patient information, which can tend to shut down innovation on the content side.

The end result is that content value is lacking, providers don't have easy access to all the patient information that exists and quality of care suffers.

Unified patient information management is 'the healthcare Internet'

Healthcare is an activity, a process, a matrix of supply-chain-type exercises. Thus the concept of a hub — a central entity that owns, stores and passes on data — can often act as a bottleneck to innovation because that setup almost forces the focus on superficial content issues and/or ownership of the transport capability.

Instead, we should be looking for a healthcare information-sharing model that enables patient information to exist in many places, and allows it to be pulled together at any time throughout the care continuum, from any location. It's time to think about applying the federated model to healthcare. In this model, data owners keep their data, but it is exchanged via a platform that securely gets the right data to the right party at the right time.

In healthcare, this relatively new concept is called unified patient-information management (UPIM). UPIM is a patient-centric approach to information management that is based on the notion that patients' administrative, financial and clinical information — though held in various places (HIT systems in various care settings) — can be accessed by a provider from a central location. UPIM is similar to kiosk banking: the data resides somewhere safe, but the user can use any ATM in the world to pull in necessary data when needed. Platforms for UPIM support application integration (integration between systems such as EMR, practice management, payer and patient communications) and workflow integration (seamless transfer of patient data between administrative, clinical and financial processes).

A platform for UPIM is similar to Just as an customer receives a box with products in it from various vendors, the platform for UPIM enables the user to get healthcare data from various sources. And similar to a multi-media content service provider, the platform enables the user to get all kinds of content from many sources and use it on many devices.

How? The platform for UPIM provides critical foundational elements, such as robust security architecture, common user interface and navigation, and application and workflow integration toolsets. In a sense, the platform screens and certifies applications, services and data, making sure they are secure and that they can work together. This means that HIT vendors and service providers can plug their applications into the platform, which manages the data and system interoperability and information exchange; the end user then only needs to log in once to navigate between all the applications and systems running on the platform and access the data that is passed between them.

UPIM enables information to pass seamlessly from one organization to the next. No single organization or hub owns or controls the data. Transport costs are low or nil. UPIM makes all the content debates up to now a moot point.

Workflow interoperability requires next-generation innovation and value

Platforms for UPIM enable content interoperability by supporting capabilities, solutions and tools that make it possible for providers and healthcare professionals to avail themselves of the patient content that exists. But the most valuable benefit that UPIM brings is workflow interoperability, which enables stakeholders to get and receive information about processes particular to their organizations, specialties, roles and needs. UPIM acts as a filter to allow the user to make sense of patient data. UPIM knows, in a sense, why the user is requesting a particular piece of information, and contextually provides all the related patient information that could be helpful to the user at that juncture.

For example, the UPIM system may present the user with a 360-degree view of a revenue cycle management process, showing not only the status of a claim but also where the claim submission went wrong (improper coding, for instance). Or, a provider performs an eligibility and benefit check for a patient and along with delivering back the E&B information from the health plan communication system, the system for UPIM may also deliver a piece of patient-specific clinical information from another application or data provider, which can inform the physician's encounter with that patient and improve quality of care.

As we begin 2011 with renewed energy and hope for a year of promising HIT development adoption, let's collectively encourage the industry to look at interoperability through a new lens of flexible, multi-channel, multi-platform and multi-vendor innovation.

John Kelly is chief information officer at NaviNet.
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Tags:  EMR / EHR