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Lack of interoperability is still an issue in healthcare, due mainly to the lack of incentives for vendors to make their systems and applications easily interoperable.
Despite the lack of vendor incentives, it's not that interoperability can't be done or that it's not happening, said Indranil Ganguly, VP and CIO at JFK Health System in Edison, N.J. Achieving true interoperability, he said, just requires that healthcare organizations sink more money into additional technologies to make it happen today.
What Ganguly means by true interoperability is sharing information directly from one EHR to another without the high cost and without the need for third-party technologies to make it happen. "So we do [share data], but we do it at a fairly high cost. Sometimes that cost becomes unsustainable."
Ganguly added that he thinks the incentive to achieve true interoperability "has to come from the customer side."
While healthcare organizations and the government are pushing in that direction -- the government is requiring vendors provide APIs -- there is still a lot of work to be done, experts said. And until true interoperability becomes a reality, healthcare organizations are turning to other approaches to create it, including third-party applications, health information exchanges (HIEs) and APIs.
Third-party approaches find favor
It's not uncommon for healthcare organizations to solve their lack of interoperability woes by working with a third party. Often, healthcare organizations will use more than one EHR within their environment. Those EHRs don't talk to each other, and that's where third-party software comes in.
This was true for the University of Pittsburgh Medical Center (UPMC) in Pennsylvania, which uses several different EHRs: one for oncology, one for ambulatory and one for in-patient, said Ed McCallister, senior vice president and CIO at UPMC. UPMC uses Epic's EHR for ambulatory and Cerner's EHR for in-patient. Ultimately, UPMC developed in-house interoperability software with dbMotion, originally an Israeli software company now based in Pittsburgh, P.A., that lets healthcare companies take data from two or more EHRs and normalize it so the two systems can talk to each other.
Hardin Memorial Health, an integrated healthcare delivery network in Elizabethtown, K.Y., had to solve a similar problem. It also had multiple EHRs within its organizations and needed to use third-party technology to get a full view of the patient.
Nicole Heim, vice president of IT and CIO at Milford Regional Medical Center in Milford, Mass., said that they also used a third-party strategy to overcome the lack of interoperability within the healthcare organization.
"I think you need something in the middle," she said. "You can certainly send information from one system to another, point-to-point, but having something in the middle … you can be agile, you can change based on the needs of different systems. Where you have point-to-point from one system to another, one vendor has to make changes rather than you having control of that."
She believes that third-party technology is absolutely necessary.
"You need an interface. You need something in the middle there to make that happen," she said.
Going beyond third-party apps
But McCallister differs, saying that third-party interoperability technologies are not the answer. He said that although EHRs took healthcare in the right direction by digitizing information that was once in a folder in a drawer, they are still lacking and not the right model for documenting patient information or for sharing it.
"More so than a vendor product that would tie [EHRs] together… [we need a technology that would] pull the information at the point of care into a layer that is more tied to patient care than what an EHR is today," he said.
Nicole Heimvice president of IT and CIO at Milford Regional Medical Center
Ganguly also doesn't believe that third-party interoperability applications are the answer simply because of the unsustainable cost; especially for smaller healthcare organizations.
"It requires, first of all, purchasing those third-party applications either from your EHR vendor or independently," he said. "Then, you've got to have a staff of people who can program those connections and that's expensive for smaller organizations to do."
McCallister said UPMC is exploring artificial intelligence and machine learning to create interoperability within their organization.
"[A] neural network type of an arrangement more so than with the interoperability solutions," he said, because this type of technology, "it knows that I'm in both [EHR] systems and it ties me together so that there's only one me."
HIEs still crucial to interoperability
"You need the core technology from an HIE vendor and that helps you bring the data together," he said.
Anantraman explained that Northwell Health built its own internal HIE and then built care coordination applications on top.
"What we're doing is leveraging from the APIs that our vendors … have provided us," he said, referring to the EHR vendors they're using like Allscripts. "[We are] starting to build more interesting applications using the data that is in our HIE as well as in the EHRs but enabling better workflows particularly at the intersection of traditional visits."
Anantraman explained that when a patient is discharged from the hospital, for example, he wants to be able to provide care management services to the appropriate patients. However, those workflows don't fit well across the various EHRs Northwell Health uses, and Anantraman said the goal is to build a care plan for the patient that spans across in-patient, out-patient and even phone visits.
"We started building … an application for care coordination, a care management application, which has a number of pieces including using data from an HIE and also starting to send messages back into the doctor's office using APIs," Anantraman said. "For instance, we use the API to inform doctors [if] one of their patients got readmitted. These APIs allow us to deliver a message directly into the inbox of the healthcare provider."
APIs are required by the government to aid interoperability
Epic and Cerner are working together to create interoperability
MACRA interoperability measures are set by ONC