HIT National Editor

CHICAGO – Real estate has its well-known drumbeat of "location, location, location."

And the annual conference of the Health Information Management Systems Society (HIMSS; Chicago) appears this year to have a similar single-concept drumbeat – getting fueled by the expectation of new government funding: interoperability – interoperability, interoperability, interoperability.

Even without the iambic fluidity of the real estate mantra, interoperability is much easier said than done, an HIT concept around for a long time but one that actually may be nearing realization.

It's a huge juggling act, according to one presentation by a large and diverse healthcare system; but becoming more achievable in the medical device arena, as seen in the conference's Interoperability Showcase; and developing with ease among informed patients, via the Internet, as described by another presenter.

The development of a comprehensive electronic health record (EHR) has often been compared to ATM banking – "If banks can do it, why can't healthcare?" But a presentation titled "Achieving the EHR's Promise: Columbia University's Academic Physician Partnership," detailed why recording health information isn't quite like spitting out an account balance, especially in grown-like-Topsy U.S. healthcare.

It's been especially no easy feat for Columbia Doctors (New York), said Richard Levine, MD, the president/chairman of this pieces/parts accumulation of clinical and educational practices.

Levine said that any healthcare group may describe itself as an "extraordinarily complex organization – but we're even more complex": Columbia Doctors is comprised of about 1,200 physicians, 150 practice groups, 40 different cites, 500,000 annual patient office visits, a teaching hospital serving two campuses – Columbia and Cornell – and an overall structure he called "very specialized, very siloed."

He termed the IT legacy situation of this conglomerate "a mélange of disparate parts," which the organization in late 2007 decided to tie together with a single EHR.

Describing the progress made over the past two years was Peter Stetson, MD, Columbia's chief medical information officer, who cited various initial barriers, including the costs of implementing tablet-style computers, entrenched loyalty to existing IT systems and the general difficulty of changing physician behaviors.

He described the competition to choose a vendor, starting with about a dozen firms, paring it down to two, holding a competition – resulting in the winning selection of Allscripts (Chicago) – and the ongoing process of installing, refining, identifying departmental "champions," and meeting regularly, overall a process that one of his Powerpoints described succinctly as "HARD."

Stetson said that the EHR still being implemented – branded as CROWN, for Clinical Records Online Web Network, powered by Allscripts – is breaking down the organization's non-interoperable silos and eventually used in the organization's research efforts.

And he told Healthcare InfoTech Business Report that broad interoperability would be the key to linking privately developed EHRs to any national EHR, if that should eventually transpire – though tending to doubt such a development.

Among the ongoing features of HIMSS 2009 is a series of "Interoperability Showcases," offering, if not a hands-on demonstration of the concept, at least a good look-see.

The HIT reporter happened to join (wisely and appropriately, he thought) the "Medical Device Interoperability" demonstration, which involved three kiosk set-ups – an OR, an ICU and a recovery area – each festooned with a bank of monitors gathering data from a very sick "virtual" patient, this information then flowing into an EHR monitor to provide a collaborative tracking, and record, of how this patient was doing.

The demonstration was provided by Interoperability Healthcare Exchange, a non-profit group focused on promoting seamless interchange among devices to create a seamless e-approach for greatly improved speed and improved patient care.

IHE presenter Manny Fuzul said that the showcase is designed not to show the quality of the individual devices being used, but rather the quality of the conversation amongst them.

However, the phalanx of monitors at each station mostly reminded the HIT reporter of a NASA command HQ – and wondering how much all of this would cost, and how many hospitals actually will be able to make all of this technology available to patients?

Against the obvious barriers for creating EHRs and interoperable medical devices, Clay Shirky, author and adjunct professor at New York University's telecommunications program, described the ease with which individual patients are transforming the basic healthcare model via the Internet and spontaneous "social" communities.

Though he didn't characterize this as interoperability, that is what he described: individuals linking up with one another and building a critical mass of medical expertise impossible before with the telephone or other traditional modes of communication.

Following are just three examples he gave of the ways in which individuals have been able to link up with many others to impact healthcare:

A doctor issuing a letter concerning problems with the Durom Hip Implant made by Zimmer (Warsaw, Indiana), the letter picked up and disseminated on Facebook and forcing, with this broad distribution, quick action by the company and a recall.

Individuals with the same disease becoming fairly expert at the therapeutic options available, providing specific advice to one another, as well as support, concerning the pros and cons of the various treatment choices.

And Wikipedia offering a growing amount of specialized information concerning healthcare, and doing so with an efficiency and rapidity – quickly corrected if in error not seen on professional online medical sites.

Overall, Shirky said the Internet has worked to put large pressure on the traditional model of communications, a model, he said, that tries to emphasize "building trust." But he argued that this cannot be done artificially.

Rather, he said that information flows "where trust has already been built" and thus explains the communication that is developing over the Internet, among individuals who come to develop trustworthy relationships and are reshaping the basic models for disseminating healthcare knowledge.

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