There’s a healthcare revolution going on out there. The digital age came upon us, new technologies arose, and the American healthcare system underwent a seismic transformation. With the HITECH Act, accompanying the 2009 economic stimulus, and the Affordable Care Act in 2010, there’s been a national push for the adoption and advancement of health information technology, most importantly of the interoperability of health information technology. But what exactly does interoperability mean, and why is it so important?
“In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.” That was President George W. Bush speaking during a panel discussion on the benefits of healthcare information technology at the Intercontinental Cleveland Clinic Suite Hotel in 2005. It was under his administration that The Office of the National Coordinator for Health IT (ONC) was created. That organization begins its definition of interoperability as: “The ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.”
When the government, and by extension the healthcare industry, talks about health information technology (HIT), they’re almost always talking about Electronic Health Records (EHR). When they talk about interoperability, on a basic level they’re talking about the transfer of EHR data between different systems. To some it’s fundamental to the future success of healthcare, a "roadmap" for health information technology; for many it remains an unfulfilled promise.
Beyond Electronic Health Records
What about everything that’s not EHR? There’s more to information technology across healthcare than EHR, but it’s not patient data, it's hospital data. So what about the hospitals themselves as networks of information being interoperable? While the healthcare system wrestles with the bureaucracy, economics and logistics of the interoperability of EHR, hospitals themselves must create environments of interoperability for everything else — that is to say, interoperability for data and technology that’s not EHR.
In 2015 the ONC published its report: “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap”, which details the vision of a “Nationwide learning health system — an environment that links the care delivery system with communities and societal supports in ‘closed loops’ of electronic health information flow, at many different levels, to enable continuous learning and improved health. This kind of system allows individuals to select platforms and apps to share and use their own electronic health information to meet their needs without undue constraints.” The document calls for a “seamless data system” where information is “available to the right people, at the right place, at the right time.” It’s a tall order and a bold vision, with a call for full implementation to be achieved by 2024.
What if we think of hospitals themselves (staff, finances, equipment, materials, the physical environment, etc.) as environments that support closed loops of information technology flow at many different levels? The system here would be the hospital, and it would allow staff to select platforms and apps to share and use data to meet their needs without undue constraints, with data flowing seamlessly through the hospital and health system, across service request management software, to computerized maintenance management system (CMMS) software, to enterprise resource planning (ERP) software, etc.
The future described by some of interoperability in healthcare is a world in which the data follows you the patient, and your entire health record is available as easily as your bank account is at an ATM. Allow us to then to indulge in another vision for the future of healthcare — one where the status and whereabouts of hospital equipment are accessed by a clinical engineer as easily as our ATM analogy. A future hospital where a facilities manager accepting a work order can easily access an inventory database, gain purchase approval, order parts, and that data is automatically shared with accounting. A future where a nurse requesting support for two separate pieces of equipment from two separate departments using two separate systems, simply uses one app from a tablet or smartphone for their service requests. All of this is beginning to happen right now. It’s far from ubiquitous, but it’s fundamental to the success of healthcare moving forward, and it's a part of this revolution that deserves more coverage.
The government has laid out a roadmap for the future of patient data in the next decade. “Health information technology (health IT) that facilitates the secure, efficient and effective sharing and use of electronic health information when and where it is needed is an important contributor to improving health outcomes, improving health care quality and lowering health care costs — the three overarching aims that the U.S. is striving to achieve.” The interoperability of all other hospital systems contributes to the same goals. For now, interoperability in healthcare might still be just a vision, but it's a vision worth sharing.