Connectivity between healthcare providers has been a sharp focus for IT initiatives since 2004, and the concept has assumed many forms

An idea can change a lot over eight years and while the intent of interoperability remains essentially the same, its application has split off in various directions since 2004, when the Bush administration called for establishment of electronic health records, universal connectivity between healthcare providers and named David Brailer, MD, as national health information technology coordinator.

EHRs remain a work in progress, though Brailer is long gone from his post and interoperability has meandered down divergent paths of connectivity. Over that time, new initiatives have sprung up as well, such as meaningful use, accountable care organizations and ICD-10 conversion. The lofty regional health information organization concept originally proposed has been largely scaled down to smaller health information exchanges.

All of these developments are part of a natural evolution for interoperability, which Robert Connely, senior vice president of innovation and strategy for Salt Lake City-based Medicity characterizes as "a stairway" of progress.

"Ten years before Bush started the EHR initiative there was the community health information network (CHIN) program," he said. "When CHINs started, connecting physicians together was seen as a good idea, but it had a cost barrier. Then the Internet took off and connectivity was a zero cost item. Then they appointed Brailer and the intent was to bring together technology and longitudinal data. Now it's the interoperability barrier and we will soon hit the semantic barrier. For every 10 years of progress we hit another riser in the steps."

Ultimately, interoperability is "a key capability, but not the goal," Connely said. "What we need to do is improve quality while managing costs. We need to prevent hospital readmissions and use touch points across the continuum to drive and mold behavior."

Patching archaic gaps

Despite the realization that antiquated systems cause information silos and disrupt connectivity, there are many smaller hospitals that aren't in a financial position to invest in new IT infrastructure, said Paul Burke, director of revenue cycle technology for Chadds Ford, Pa.-based IMA Consulting. Even so, he said there are low-cost options that can help improve their interoperability.

"There is still a lot of dated technology in the business office and organizations need to get additional functionality out of their old systems," Burke said. "The smaller community hospitals that are struggling haven't been able to put the resources into it. But there are boutique firms out there that can fill that need by bolting on additional applications for extra functionality."

New York City-based Infor specializes in helping hospitals expand their data interchange capabilities through a product called Cloverleaf. This middleware product is designed to blend with HIE products into a single platform.

"The systems have to merge together and we look at how to do it," said Ingrid Svensson, vice president of healthcare product management. "It involves a process of extending into the consolidation platform so it is not just sending bits and bytes, but integrating a singular patient record."

Infor has gained a broad footprint over the past 17 years and is entrenched in the interoperability market with some 900 customers in the United States and Europe, Svensson said.

"Our goal over time is to continually focus on how we can do things better, increase patient outcomes and reduce costs  -  and analytics is at the core of that," she said. "We have to make sure the data and information is there and develop those analytics. Going forward we will foster connectivity at the base, HIE at the top and information systems as part of clinical decision support. We will bake in meaningful use compliance as it comes in while continuing to work with customers to evolve and meet their needs."

Device connections

Medical devices are a key source of clinical data, but many hospital systems still lack a conduit for transference of that data into the electronic medical record, said Peter Witonsky, president of Panama City, Fla.-based iSirona. As an FDA-certified connector of medical devices, iSirona "grabs data from any machine and delivers it to any EMR," he said.

The company's software has the versatility to deliver data in the desired format, Witonsky said.

"We deliver from and to anywhere in any way possible," he said. "If you're a respiratory technician and need ventilator data in one format, we will deliver those elements to the respiratory therapist. If you're an ICU nurse, we will deliver the data elements you need."

Communications are also an interoperability issue, and Jacksonville, Fla.-based Intego has been working in the nurse call domain since the 1970s, said company founder Charles Bell Sr.

"During the early years we installed 1,800 systems in the Southeast  -  it was just a bell and a light," Bell said. "As time went on we wanted something that was software-driven and not hardware-limited. We saw all these disparate systems  -  the silos that needed to be combined and that is what we've done. We took all the disparate software pieces like nurse call, messaging, assignments, workflows, reporting and the HL7 engine and put it all into one piece."

The ProNet nurse call system's interoperability piece stems from its ability to talk to other servers in a facility, said ProNet Vice President James Higbe.

"Inside the facility the nurse call has been part of the infrastructure," he said. "We go in as a platform to bridge the gap in disparate systems. We use a common path for messages to traverse the multiple protocols and systems in a facility so that providers can respond quickly."

Patient calls are routed to an operator who triages the urgency of the call and dispatches the appropriate person, whether a nurse or an orderly. By sorting out true emergencies from patient complaints, it gives nurses a chance to focus on the most important aspects of their jobs, Higbe said.