Interoperability holds the key to EHR, mobile health success

By: Neil Versel | Jan 24, 2013        

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Neil_Versel_LargeHave you seen all the pushback of late against the direction of the “meaningful use” EHR incentive program and EHRs in general?

The year started with the publication of a RAND Corp. study in Health Affairs cautioning that health IT had fallen far short of its potential so far. Notably, EHR design and implementation problems, a lack of interoperability and continued reluctance among providers to redesign care processes and spend time trying to “master difficult-to-use technology” has stood in the way of expected cost savings, efficiency gains and better care.

Meanwhile, interest groups all over the country have been publicizing their comments to the Department of Health and Human Services in response to the Health IT Policy Committee’s preliminary recommendations for Stage 3 of meaningful use, and quite a few have been critical of the whole direction of the program.

Not surprisingly, the American Medical Association (AMA) and the American Hospital Association (AHA) both said it was premature to develop rules for Stage 3 before Stage 2 starts in 2014 and while many providers have not yet achieved Stage 1. But even some EHR vendors have expressed reservations.

“The pace is too damn high,” John Glaser, Siemens Healthcare’s CEO of health services, told Forbes, suggesting that there hasn’t been enough time to focus on interoperability of health information. “We need the time to do it right,” Glaser said.

I don’t think anyone would argue at this point that there aren’t gaps in meaningful use and in health IT, particularly when it comes to interoperability. And that’s where mobile and personal health devices need to come in.

Last week, the Association for Advancement of Medical Instrumentation (AAMI) and the Food and Drug Administration (FDA) issued a report based on a summit they convened in October suggesting that policy-makers were ignoring all the data coming from connected medical devices by focusing so much on EHRs.

“Healthcare organizations are focused on getting electronic health records (EHRs) up and running. Very few are stepping into the even more complex space of device interoperability,” the report said. But they eventually will need to pay attention to the latter, which includes everything from home health monitors to fitness counters to inpatient telemetry equipment.

“Getting it right protects patients, contributes to clinical decisions and positive patient outcomes, and improves efficiency. Getting it wrong introduces significant risk and the likelihood of adverse patient events. Worse, getting it wrong doesn’t mean returning to the baseline risks of an unconnected world — it will lead to more serious situations than exist now. Safe interoperability is central, not peripheral, to the core mission of healthcare,” the AAMI and FDA said.

At least one person believes device interoperability is coming as soon as Stage 3, which is scheduled to start in 2016, or two years after a provider first achieves Stage 2, whichever is later. That person is Chuck Parker, executive director of the Continua Health Alliance.

Writing on the HIMSS blog this week, Parker said the current recommendations for Stage 3 promise to get everyone connected by encouraging patient engagement. “If [the HIT Policy Committee's] recommendations come to pass, Stage 3 will encourage medical practices and hospitals to enlist their patients to use health devices and apps, and to accept patient-generated data into EHRs,” Parker said.

“Studies of connected health show that when patients incorporate mHealth into their lives — at home, work, and on the go — they recognize the relationship between their health behaviors and experience of health and are consequently better able to self-manage. My prediction is that practices and hospitals embracing Stage 3 will discover a new capacity to bring about positive outcomes through timely, targeted interventions, both at the individual and population levels,” Parker continued, but then he added one caveat: devices and IT systems need to be connected.

“The fact is, unless personal health devices work together with minimal effort, patients are unlikely to stick with mHealth tools, and the momentous opportunity for connected health will be lost,” Parker said.

Yes, interoperability remains elusive and difficult. But we have to get it right. Billions of public and private dollars are on the line here, and more importantly, so are millions of lives.

  • Adrian Gropper

    The Stage 3 mandates are the last chance to get interoperability right before the $27 Billion incentives are spent. This will not happen for either EHRs or devices unless the software focus switches away from the institution and to the physician-patient relationship. Health IT needs to be modularized into substitutable components that can be prescribed by the physician or purchased by the patient the same as drugs, labs and referrals. The alternative to substitutable components under physician (rather than institutional or vendor) control is increasing regulation, cost, delay, and frustration.

  • http://kevinlmcmahon.com/ Kevin L McMahon

    Again, industry dismisses the role of patient self-directed feedback loops involving device connectivity (No EHR/EMR/PHR or standards based integration required). Provider directed use of data collected from the outpatient setting (fax, cellular, wifi, etc…) represents a tiny fraction of the actual data usage today and an even smaller portion in the future.

  • http://aneconomyofmeaning.wordpress.com/author/dwm1/ David Morf

    Need open standards for both device and EHR interoperability. Also,
    most legacy EHRs derive from billing systems, not substantive health and
    medical drivers. This comment cuts to the chase… “Until EHRs are used
    to keep patients well instead of billing for itemized treatments after
    they are already sick, costs will not come down.” See Jan 22, 2013
    context for those comments at
    http://blog.medsphere.com/the-rand-report-are-healthcare-and-health-it-in-a-dysfunctional-relationship/#more-177
    . The meat in that comment comes after the intro stuff. It’s worth
    reading.