Why Can’t We All Just Get Along?

by Lisa Jaffe Hubbell

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Wait a while, and we’ll have to. Interoperability is coming to HIT.

Disconnected. Challenging. Inefficient. Risky. Those words pop up in almost any article that looks at interoperability in healthcare information technology (HIT). Playing well together may be a lesson we should have learned in kindergarten, but many HIT vendors have had no incentive to do so. Until now.

"For a long time, best-of-breed vendors and those selling enterprise systems were at odds," says Eric Mueller, president of the services division of WPC, a HIT company based in Nashville and Seattle. "They haven't wanted to and haven't had to play well together."

Now, those companies are required to become certified, adopting basic standards of interoperability.

"Our job is to work well with others," says Robert Hitchcock, MD, FACEP, chief medical information officer of T-System, a best-of-breed emergency department (ED) system based in Dallas.

"A decision once driven by clinicians is now being made by healthcare organization executives. The focus is now on being cost effective, reducing maintenance needs, and increasing efficiency."

Those selling mammoth systems such as Epic used to argue that best-of-breed systems couldn't interface with theirs, and they could provide it all anyway. Now, meaningful use rules, mandated basic standards for sharing information, requirements for better transitions of care, and certification of HIT systems all "force" vendors to work better together.

"Now, a facility can have solutions that will all speak the same language and will have to share data," Dr. Hitchcock says.

Already, Dr. Hitchcock sees changes in attitudes, with even the biggest enterprise vendors talking to best-of-breed companies about how to package solutions together-like how an ED module from T-System might work with EPIC in a fluid and useful manner.

"It is part of our survival as best of breed that we be able to share information in a robust manner," he says.

Some vendors are making a point of learning to share both information and the client arena. Through the EHR Association, 46 vendors-with clients representing approximately 90 percent of the operational electronic health record (EHR) systems in hospitals, clinics, and physician practices-work to ensure that while they compete arduously against each other, they also provide products that can interact to the benefit of clients and patients and comply with the same standards.

"Those who have adopted the 'play nice' mantra recognize the critical importance to their business, as well as to health care, of interoperability and integration," says Justin Barnes, vice president of marketing, corporate development, and governmental affairs at Greenway Medical Technologies of Carrollton, Georgia, and former chairman of the EHR Association.

"Play Nice" and More

"It takes more than just being able to plug this system into that older network and upload that new software over there," Barnes stresses. "You have to find a solution that doesn't just work with others, but that will enhance your workflow, increase patient safety, and achieve your goals regarding return on investment. Interoperability is critically important, but workflow and usability are also paramount."

Indeed, one of the main problems the current vice chair of the association, Charlie Jarvis, FACHE, sees as a vice president of healthcare services and government relations at NextGen Healthcare, based in Horsham, Pennsylvania, is that people don't often look for the best solution to their problem, in part because there are an increasing number of choices and because they are educating themselves as they go through the purchasing process.

"Vendors have a real responsibility to educate purchasers," says Jarvis. "You have to be comfortable saying a product isn't right for everyone. With hundreds of solutions available, no single one is going to be right for the whole marketplace."

Indeed, Dr. Hitchcock is quick to note that even large enterprise systems are different in one location compared with the "same" product in another.

Choice is vital for the health of the healthcare industry, where regional differences can make the needs of otherwise similar facilities differ, as well as to the health of the HIT industry. Working well together will be part and parcel of developing win-win scenarios.

"It's much harder to compete against a vendor that doesn't play by the same standards you do," Jarvis says. "It's easier when you are going up against someone playing the same game you are."

The Keys to Success

What should you do to make sure you get exactly what you need? Mueller says the technology has to go back to the problem you want to solve 100 percent of the time. Know what you want to make the system do and why.

Next, listen to the people who have to use the systems, as well as those who have to implement it. Make sure that innovators-be they internal or external- are sitting at the table with those who use the system, those who implement it, and the executives who purchase it.

"As a purchaser, you have to ask probing questions and demand solid answers-and not just about one hot topic," says Jarvis. "Ask how the product is certified now and what will be done to ensure it stays certified. Ask about the product's track record. Ask for a list of clients. Ask why people leave for another vendor. Ask about success stories."

Barnes adds that you need to make sure that whatever numbers you get about product use applies to discreet users. Super-users who make the most use of HIT can skew data.

"You want to see who uses it and how," he says.

Dr. Hitchcock, like Mueller, wants to see more people at the table discussing HIT solutions.

"Clinicians must deliver the highest quality patient care. They need tools to ensure they are efficient and can provide all the information required at the point of care as they make decisions that affect real people."

If you are a clinician and you are not asked to be a part of the discussion, force yourself into it. "You will be affected by these decisions every single day, so get a seat at the table," says Dr. Hitchcock.

Decision-makers under pressure to adopt new HIT solutions today must also pay attention to what they will need two, three, five, or even 10 years down the road, adds Dr. Hitchcock: "What you see as a quick fix may not be what you need in the long term."