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Lack of interoperability affects telehealth programs

The lack of interoperability has been a prevalent problem in healthcare for years and telehealth programs are by no means excluded or untouched.

Furthermore, the fact that telehealth programs and strategies require multiple technologies, platforms and locations means the impact is apparent, experts said.

"I'll give you an example. There was a program designed for home care and it required that we get information from [patients'] glucose monitors for the diabetics. That monitor didn't work with the software, it didn't send information in. So what do you do?" Iris Berman, vice president of telehealth services at Northwell Health in Great Neck, N.Y., said at the mHealth + Telehealth World Congress conference in Boston. "Do you make the consumer buy a new glucometer? What if it's not covered by insurance? Or do we ask the vendors, the developers of the interpretation software, to have an open API that accepts information from just about any device out there?"

It's up to us to say, 'We're not going to tolerate this anymore.' We really need to think about the big picture.
Iris Bermanvice president of telehealth services, Northwell Health

David Pauer, director of wellness at the Cleveland Clinic Employee Health Plan in Ohio, said his healthcare organization has had similar experiences regarding their telehealth programs.

"We've experienced that too because we've got a few different platforms that we use at the health plan," Pauer said at the conference.

Altogether, Cleveland Clinic's employee health plan uses about 20 different platforms, he said.

"We really try to limit that for the health plan members so maybe they only have two or three. We're hoping someday it would be just that one platform that they could use but at least trying to limit the number of different programs or platforms or even apps that they're using," Pauer said. "It's always a challenge."

APIs: The approach to interoperability in telehealth?

Berman believes APIs play an important role in creating interoperability. However, APIs alone won't work.

"It's not just the API itself, it's the design behind access. So if a provider has to click on one application to get to another application to finally get to the underlying," Berman said. "There's one for the camera and one for [another application], they're not going to do it or there's going to be mistakes made or you're going to have a very poor experience for the receiver of that care while they're waiting for all of this. So thinking through the architecture of all of that is very important."

Pauer, on the other hand, doesn't think APIs are the magical answer to interoperability many people believe them to be.

Even though applications and platforms could be opened up via APIs, he said, there could still be other complications such as the information not flowing in correctly, user error and more.

"So everything's connected properly but something gets cut off halfway between and then, too, for us the struggle is a lot of times we have people who don't use computers," Pauer said. "They might use a clinical work station, they're a nurse, they don't have a smartphone even, and we're trying to get them to use fairly sophisticated programs and platforms and apps."

Looking ahead

Despite these challenges, Berman remains hopeful. From her point of view, many in healthcare are realizing that interoperability needs to happen.

"It's up to us to say, 'We're not going to tolerate this anymore.' We really need to think about the big picture and it can't just be about, 'My product does this and nobody else can get to it,' but rather, 'How can I integrate my unique idea?'" Berman said. "We're not trying to say to businesses and vendors, 'Don't develop.' Of course we want that. There's always going to be something better, but how can I make that work with other things that are out there? You become more valuable that way. We can't be so segregated in our thoughts anymore."

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How has the lack of interoperability affected your telehealth program?
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API's are not the solution. To provide interoperability with all devices used for chronic disease management a system will have to manage hundreds of API's. Whats needed are robust, industry wide interoperability standards. The Personal Connected Health Alliance, an organization of HIMSS develops, maintains and publishes the Continua Design Guidelines for authentic interoperability. Looking at the big picture, several European countries have already or are adopting these guidelines in their health IT architecture.
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