The state of EMR interoperability in healthcare: five observations

May 22, 2013

It’s no secret that information technology is quickly becoming one of the most important components of the healthcare system. Those who work in the industry have been inundated with myriad flowcharts and diagrams illustrating how digital healthcare will create a better world. Indeed, the continuum of care has seen significant benefits from this digitization revolution—increased operational efficiencies, a reduction in transcription errors, and better access to patient data for caregivers and other medical professionals, to name a few.

At the center of this digital storm is the Electronic Medical Record, or EMR. Used to track a patient’s medical history while traveling through the continuum of care, the EMR is the hub of a communications network that spans everything the patient encounters along the way. Obviously, laboratory results are no small part of the data required to successfully diagnose and treat patients, which is why getting that data into the EMR and making it accessible to caregivers is increasingly important.

In order to achieve this, several disparate systems and devices need to be able to speak to each other and share information. They need to “operate inter-dependently,” which is why interoperability has become such a buzzword. Here are five observations about EMR integration and interoperability that should help shed some light on the importance and complexity of this issue.

1) The stakes are high. Everyone involved in healthcare—providers, insurance companies, manufacturers, state and federal government—is betting big on digitizing healthcare. Everything from e-prescriptions to e-payments, and lab results to X-ray images, are being converted from paper to bits and bytes. While each stakeholder has different reasons for driving these changes, everyone agrees that improving the quality of care is good for patients, and that’s a good thing. But investing millions of dollars in new technology has its risks, and not everyone is going to realize the same amount of benefit.

2) It’s not as easy as it seems. The devil is in the details. Other industries, such as banking, have been working on interoperability for a long time, and have successfully made bank account access look almost seamless. But healthcare IT is a nascent, fragmented place where tiny startups go head-to-head with multimillion dollar corporations every day. Within the typical hospital there are dozens of different information technologies that must reliably and accurately share information with the EMR and with each other millions of times per second, without anything getting lost or scrambled. And the stakes are much higher in healthcare than almost any other industry. In the business world, a missing packet of data means someone can’t open their quarterly earnings spreadsheet. In healthcare, a missing packet of data means someone could be misdiagnosed—or worse.

3) No standards = big problem. To make things even more challenging, there are no standards to tell the IT programmers and medical equipment engineers how to design their systems to talk to one another. Demanding interoperability of every one of thousands of different systems where few standards exist is futile. But all of the grand plans and visions of digital healthcare depend on interoperability. Without it, everything comes crashing down. It’s important to recognize that some pieces of the puzzle are there. For example, Health Level 7 (HL7) standards establish a common syntax for sharing medical information, but too much wiggle room within the standard prohibits true interoperability. For example, if a particular EMR tags hemoglobin count as “HB,” and the incoming HL7 message tags it as “HGB,” the message will be successfully received, but the EMR won’t know what to do with the data.

4) There is still hope. There are brave souls out there who seek to create order amid the chaos and shine the light of interoperability into every dark, dank crevice of proprietary, territorial old-think. Several intra-industry groups have sprung up to help make interoperability happen. One of those entities is Integrating the Healthcare Enterprise (IHE), a nonprofit industry group whose goal is to establish standardized “profiles” using open-source standards such as HL7 and ISO/IEEE 11073 Medical/health device communication standards, for all different kinds of clinical workflows and scenarios. IHE’s approach is especially exciting to industry folks because they invite all parties to sit down and test their systems with each other in a controlled environment using the IHE profiles, which ensures that the systems work and meet the profile requirements.

5) Collaboration is key. Every year, IHE sponsors several “Connectathons” around the world. To thousands of healthcare IT and medical equipment professionals, these meetings play a critical role in the future of healthcare interoperability. Imagine 500+ software and equipment engineers from more than 100 different companies huddled together at their laptops in a single room for five days with servers humming and keyboards tapping, all working toward the common goal of interoperability. It’s not competition but cooperation that has made the Connectathons such a success. Participants believe that interoperability is really possible, because it is given the right framework.

Of course, IHE isn’t the only vehicle for collaboration in healthcare. Another industry group, the Continua Alliance, also offers opportunities for companies to work together toward interoperability through its quarterly “Plugfest” gatherings. There’s also nothing stopping companies from working together on their own, and that is already happening. But such one-on-one collaboration rarely occurs without a common economic stimulus.

So where do we go from here? Time will tell, but there is no doubt that everyone involved in EMR connectivity needs to learn as much as they can about the issue in order to make informed decisions. As with other technological trends, certain solutions will come to the fore while others drop away, and overall implementation costs will eventually come down. For now, we’re all in this together, so it’s in our best interest to help make EMR interoperability as safe, efficient, and cost-effective as possible.

Kent Lupino, BS, MA, a 13-year veteran of the medical device industry, is currently a Senior Product Manager for North Carolina-based SunTech Medical, Inc.

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