An HIT Moment with ... is a quick interview with someone we find interesting. Joe DeSantis is vice president of HealthShare Platforms of InterSystems of Cambridge, MA.
What interoperability benefits do healthcare organizations seek beyond just connecting systems, and what progress have they made?
First off, I think it’s important to say what we mean by interoperability. At the most tactical level, it means you can pass a clinical document from one system to another.
We think of it as something much more strategic to the organization. Sharing all health information, including financial and operational data, to achieve strategic objectives. If you have a platform that can view data as discrete elements and not simply as documents, you can support advanced analytics, decision support, rules, and other use cases. With robust connectivity, you can use your data in real time within the context of your existing workflows. And you have a foundation for creating new applications that work together and extend the capabilities of the entire system.
Our customers use our health informatics platform, called HealthShare, to achieve strategic interoperability and create an infrastructure of connected care solutions, not just to address their current challenges, but those that haven’t yet emerged. For example, North Shore-LIJ, one of the nation’s largest health systems and the largest in New York State, has harnessed strategic interoperability to improve care for its obstetrical population. This includes information sharing and care coordination among more than 100 providers, three outpatient EHRs, two inpatient EHRs, and two prenatal imaging centers. They share a coordinated record, dynamically identify members of the high-risk pool, and use alerts to notify providers of gaps in care. And, for a rapidly growing health system, North Shore-LIJ knows the platform can support its long-term needs.
On a regional or national level, strategic interoperability is essential to public health management. One statewide health information network, built on our platform, was able to reduce the time needed to report on a regional disease outbreak from several months to a few hours.
Describe the relationship between interoperability, population health management, and patient engagement.
Population health management and patient engagement are long-term goals for healthcare organizations. Both concepts are relatively new and important. They both offer the promise of helping to address the enormous issues related to chronic and lifestyle-related health problems. Neither is well defined yet.
Interoperability, or more importantly, strategic interoperability, is also a long-term goal. It differs from the others in that no one is really interested in interoperability for its own sake. They are interested in what they can do once they have it.
Population health management is about understanding the entire community served by your healthcare organization, not just the patients you have encountered. It is not a one-size-fits-all problem. There are no true off-the-shelf population health management applications. Instead, there are extensive services you can buy under the guise of a product.
The best approach to population health management, in my opinion, is to think of it as a collection of smaller, interlocking issues. The solution will be to deploy a number of focused applications, some from vendors, some custom built. These applications will need to work together and be integrated within the existing health information systems and workflows. This is why you need strategic interoperability to address this problem.
Patient engagement is about giving patients the tools to take charge of their own health. Again, strategic interoperability plays a big part. If you can provide a complete view of the patient’s information – not simply regurgitating test results from a single EHR – and if you can make services available to the patient within this context, like making appointments, education, communicating with providers, then you have something of value to offer your patient community. And coincidentally, you have a component of your population health management solution.
How is HealthShare different from other HIE, integration, and analytics solutions?
HIE, integration, and analytics products are, in general, single-issue solutions, each requiring separate management and often its own database. These solutions proliferate within organizations, ultimately contributing to information silos rather than addressing the fundamental challenges of healthcare.
HealthShare is above all a unified software platform designed for information sharing. The platform provides three important capabilities. It gives the ability to manage and store all kinds of data – relational, object, XML, unstructured – in a reliable, efficient, and interoperable manner. It provides connectivity – applications to applications, applications to users and devices, and users with communities. It provides insight, through analytics, as an embedded part of the entire platform. This gives our customers the ability to solve big problems.
One of the other key differentiators between individual solutions and a platform like ours is that once an organization adopts HealthShare, they have almost limitless growth options and multiple paths to success. They can implement a robust application module such as our Clinician Viewer. They can build out their own applications. And they can purchase HealthShare-based solutions from our many software partners.
What types of alerts are possible?
We refer to alerts as smart notifications, and again, the possibilities are nearly limitless. Because HealthShare aggregates, normalizes, and enhances all kinds of data in near real time, alerting capabilities are only bounded by your user base and your data investment.
Sometimes the simplest alerts offer the most rapid return on investment. For example, In Rhode Island, primary care doctors receive smart notifications when their patients are admitted or discharged from the hospital so they can properly manage care after discharge. They’ve measured a drop of more than 16 percent in 30-day readmissions for patients whose doctors subscribed to the alerts.
Many companies are selling analytics solutions. What factors will make specific vendors and their customers successful?
We have found that organizations that follow four important steps – capture, share, understand, and act – are more likely to achieve breakthroughs. Your organization first needs to capture health-related information. Then you have to share this information in a meaningful way among systems, applications, providers, organizations, and communities. The data, both structured and unstructured, must then be analyzed and understood.
Then you are ready to act. You can use the results to drive transformative action within your organization. For both vendors and customers, these four steps will be critical to success.
Mr. DeSantis: How does a platform, such as InterSystems’ HealthShare, normalize data that are coded using different clinical coding systems, such as a lab result, which is discrete, structured data, and which might be received by Reference Lab #1, denoting glycohemoglobin within the chemistry panel, Physician Office Lab #2, denoting glycohemoglobin as an independent test, HgbA1c, and Hospital Lab #3, using an embedded LOINC code, 4548-4? The platform must be able to recognize each of the three laboratory information system inputs representing the same value, glucose level. So far, I have not encountered such a platform or understand how such a platform can achieve this.
Terminology management is a difficult and important part of any health exchange solution. Many HIE products, which show data as independent documents from each data source, ignore the problem and rely on the physicians mind to resolve the issue.
In HealthShare we do the following. First, we treat all health information as discrete data elements. Second, we have a set of Terminology services, built into our platform, that can be used to perform an efficient run-time mapping from one code set into another. A different mapping can be used for each distinct data source, so in your example, we could map the laboratory codes from each of the 3 systems using a different mapping table. We preserve both the original unmapped as well as the mapped value for each data element. If custom mapping are in play, then there is work to do to set up the mapping tables.
Thank you very much for your answer to my question. Now I feel more confident that semantic interoperability can be realized.
This is a good exchange. I have found that most robust HIEs can perform the technical side of the mapping (ex: terminology cross walks, simple transformations). Some even come with the basic terminologies loaded once an organization signs a license agreement for the UMLS or with the third party vendor chosen (ex: Apelon, HealthLanguage). That is not the hard part. It is finding all the resources inside the organization to identify and decide the mappings for each healthcare organization and then across organizations. More importantly, it is finding practical medical informaticists to facilitate the internal and external dialogue. The standards are often acceptable for syntax but are incredibly lacking for semantics. This leaves each healthcare organization to define the standards for themselves, then negotiate with each other organization. The informaticists do not come cheap, there is a major shortage of them with practical experience and this is an on-going data governance and stewardship challenge for healthcare organizations. Sourcing these experts from consulting companies, the terminology middleware vendors or from the few HIE vendors that have resources is not financially sustainable. With these challenges the human interface engine (the physician) is the realistic option yet also unsustainable option.