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CMIO: Steps to solve the healthcare interoperability problem

Stanford Health Care CMIO offers tips on what can be done to improve interoperability in healthcare.

The healthcare interoperability problem is a puzzle many in health IT are trying to solve. Some health IT experts say the key lies in standards, some blame EHR vendors and their unwillingness to work together to share data, and others say the lack of interoperability doesn't lie with any one organization or vendor, but, instead, is an industrywide problem.

Christopher Sharp, chief medical information officer and a practicing general internal medicine physician at Stanford Health Care in Stanford, Calif., said he believes three things need to happen in order to solve this healthcare interoperability problem.

Record locator technologies

Christopher Sharp, CMIO at Stanford Health CareChristopher Sharp

First things first: "If you're going to exchange records, you need to know where those records are so you can go ask for them," Sharp said.

That's why Stanford Health Care has started using Surescripts' extensive national record locator service. Sharp added that he expects to see a broader base of all the places a patient may have records. Using record locator technologies will provide better visibility into where gaps occur in connections that allow hospitals to acquire the patient data they need.

"So, whether records are at another organization that is fully electronic, but not yet connected to an open exchange, at an organization that doesn't have the capabilities of exchange or at an organization that doesn't have the data in a way that it can be exchanged ... we'll know through this record locator service," Sharp said. "Record location is a really important way to reach beyond our regional exchange partners and across the country so that we can request them to try to complete the record for the patient."

Trust agreements

"Karen DeSalvo [the assistant secretary for health at the U.S. Department of Health and Human Services] gave a great quote at HIMSS. She said, 'Data moves at the speed of trust,'" Sharp recalled. "I thought that was really brilliant, because how do we get more exchange and more sharing to happen? We have to have trust agreements that create broader networks."

One example of this, Sharp said, is the eHealth Exchange, of which Stanford Health Care is a part. The eHealth Exchange "brings many providers on many different EHRs into a trust framework and gives us the opportunity to query across that entire network," Sharp said.

Healthcare CIOs have offered up other solutions, as well. One CIO created an in-house interoperability software, while another suggested something similar to Sharp's idea: Using HIEs as the plumbing to exchange information.

"We've tried to maintain a strategy to join public and open exchanges," Sharp said.

He added that concerns about exchanging between EHR vendors "become less important than exchanging on these larger networks."

Effectively utilize data

Another important piece of the puzzle to solving the healthcare interoperability problem is effectively utilizing the data.

"Here, it's no longer about large networks. It goes back to the level of the EHR vendors and how they help users to digest that data," Sharp said.

This data has to be reconciled and harmonized to really be useful for doctors, because, otherwise, it just becomes voluminous, inaccessible text -- a tremendous challenge to manage.
Christopher SharpCMIO at Stanford Health Care

In order for this to happen, standards are required, he said. "Those data have to be discrete and exchanged based on a standard."

Sharp used the Continuity of Care Document as an example. Using this, medications can be reconciled into the patient's medical record, he explained.

"A provider can say, 'I see. I have you on these three medications. But it looks like you're on two more from another healthcare organization that you saw last week. Let me add those medications, so I have a full view of your care,'" he said.

"This data has to be reconciled and harmonized to really be useful for doctors, because, otherwise, it just becomes voluminous, inaccessible text," Sharp said, adding that this is "a tremendous challenge to manage."

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