Interoperability in ‘bi-plane phase’

October 15, 2014 in Medical Technology

“I think all the heat in the room is emanating from this seat,” Erica Galvez cracked as she began her first presentation on the contentious matter of interoperability.

As ONC’s interoperability and exchange portfolio manager, Galvez’s comments came at a time when the office’s work to drive interoperability is under perhaps more intense scrutiny than ever.

Yet, a sense emerged on Wednesday morning during a meeting of the joint HIT Policy and Standards Committees that, while much work remains, the widely-accepted notion that there is no interoperability in America is wrong.

“This is not a world where ‘there is no interoperability’ is true,” said Arien Malec, vice president of data platform and acquisition tools at RelayHealth.

However, Malec was careful to acknowledge that the sort of “out-of-the-box cross-vendor interoperability” that would enable widespread health information exchange is not a reality today.

“We’re not quite in the jet engine phase,” said John Halamka, MD, CIO at Beth Israel Deaconess Medical Center and vice chair of the HIT Standards committee, “we’re in the bi-plane phase.”

[See also: Where’s the plan for interoperability?.]

RelayHealth’s Malec, for instance, added that RelayHealth recently passed the milestone of a billion annual transactions. 

“Information is moving,” Galvez said. “We’re not starting from zero.”

In addition to the “tremendous uptake in EHRs,” Galvez explained that one-third of doctors are exchanging different pieces of information such as allergies, lab results and medications, and that half of physicians receive discharge summaries. Among hospitals, 51 percent are able to query patient records electronically, and 41 percent can exchange secure messages containing patient data with external sources.

“Exchange is happening now,” Galvez explained, acknowledging that “it doesn’t necessarily meet our definition of interoperability.” 

But it is cause for optimism, according to Wes Rishel, a former Gartner distinguished analyst and a current member of the HIT Standards Committee.

“Health systems and groups of health systems working with patients are actually straining to move forward in interoperability now, as opposed to trying to find ways to accommodate arbitrary requirements,” Rishel said.

BIDMC CIO Halamka took it one step further by urging members of both committees to “celebrate our progress.”

[See also: Stage set for big interoperability push.]

Referring to Gartner’s Hype Cycle, Halamka continued that “we’ve gone from the peak of expectations to the trough of disillusionment and are on our way up the slope of enlightenment.”

No one is saying widespread interoperability and a Utopian ideal of nationwide health information exchange is here. Much work remains, many forks are in the road ahead — one piece of that inevitability will be satiating a public hungry for rapid-fire technological advancement in an industry amid industrialization.

“Solving any challenge inevitably leads to another challenge,” Rishel said. “The users don’t get satisfied, in some cases ever, because we’re always measured by ‘what have you done for me recently’ rather than anything else.”

[See also: Interoperability: supply and demand.]

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