Organizing systems to demand IT interoperability

Medical devices now measure and track many types of clinical information about patients. But few of these devices can communicate with others. Instead, healthcare workers must manually transfer data from the devices to patients' electronic health records.

“If you're ill, you'll be surrounded by as many as a dozen devices,” said Dr. Joseph Smith, chief medical and science officer at the West Health Institute. “Each of them focuses as if it's alone.”

For example, the medical device that delivers a hypertension drug also should be able to access a patient's blood-pressure reading and adjust the drug accordingly, Smith said. “This is something that technology does extremely well, if you let it,” he said.

EHR systems offered by different vendors often don't share information either. This lack of interoperability results in a greater risk of error, lack of coordination among care settings, and wasted time and money.

“The biggest cost is, we're wearing out our healthcare workers,” said Ed Cantwell, executive director of the Center for Medical Interoperability. His group hopes to leverage the clout of healthcare providers to force technology vendors to build low-cost, two-way “plug and play” interoperability for seamless data exchange into all health information technology systems.

The West Health Institute estimates that medical interoperability could save the U.S. healthcare system as much as $30 billion a year by reducing redundant testing, adverse events, manual data entry and information delays that cause longer lengths of stay. One study found that 16.5% of missed emergency department diagnoses that harmed patients were linked to problems transmitting test results to the provider.

Until now, device and EHR vendors haven't had incentives to develop software and other technologies that communicate with competitors' products, Cantwell said. In the U.S., no single health system makes up enough of any vendor's business to force change. Healthcare technology purchasers have to change that dynamic, he argued.

“If you believe in the free market, the buyer has some clout over the vendor,” said Smith, who serves on CMI's board.

Cantwell, a former Air Force fighter pilot, envisions a healthcare interoperability platform that functions like an air traffic control system. His group's first task was to recruit health system CEOs who share this vision. The 14-member board includes 11 CEOs from major systems including HCA, Community Health Systems, Scripps Health and Cedars-Sinai Health System.

Smith said he was invited to speak at the next meeting of the Advanced Medical Technology Association, the trade group for devicemakers. “They have their own concerns, but they appreciate that there is a certain commonality on how data are organized,” he said.

CMI also engages in advocacy with policymakers. Its board members have met with the federal health IT coordinator's office and the Food and Drug Administration. They have sent a letter to Dr. Karen DeSalvo, the national coordinator for health information technology, asking her agency to define a national interoperability roadmap, and to ensure that federal health IT contracts push toward device interoperability.

The not-for-profit center was spun off two years ago by the West Health Institute, an organization that focuses on pioneering technologies to expand healthcare access and reduce costs. CMI's funding comes from the Gary and Mary West Foundation as well as dues-paying members.

Cantwell, who spent much of his earlier career in the telecommunications industry, noted that the cable TV industry established a standard for transferring electronic data. He would like to see similar standards for healthcare technology. “Our thesis is that healthcare is the most important utility,” he said.

Besides having devices that can feed data directly into a patient's electronic record, a more immediate CMI goal is to have different vendors' EHR systems communicate with each other, said CMI board member Dr. Jon Pryor, CEO of Hennepin Healthcare System. “People bounce around between systems,” Pryor said. “There's a greater potential of losing information if it's not all in one spot.”

By the end of the year, CMI plans to open a laboratory at a yet-to-be determined location to devise, test and certify interoperability solutions. The lab will recreate the space, equipment and IT systems found in healthcare settings. CMI already has more than 20 engineers working in an interim lab, and Cantwell thinks it needs about 150.

“This is perhaps one of the biggest undertakings in healthcare,” Cantwell said. “It's going to come down to a group of really strong leaders.”