Feature: Interoperability still hits technological snags, leaders needed

The pace of progress in developing interoperability between medical devices and data destinations is influenced as much by well-articulated demand as by technical capability—and it’s up to CMIOs and other beneficiaries of such interoperability to push the issue, said Julian M. Goldman, MD, medical director of the biomedical engineering program at Partners HealthCare System in Boston.

Device makers intent on manufacturing the best products possible may not have standardization of output as a priority, nor see the payoff for the cost if the signals from customers are not clear and adamant. “It’s a tricky chicken-and-egg problem,” said Goldman. Providers have “done a poor job” in the past of explaining what has to change in medical-device interface functionality, he said.

Emerging payment model designs, with their quality measurement and efficiency objectives, are finally bringing the benefits into sharp relief. “The market forces are starting to coalesce; hospitals are starting to become clearer on the potential benefits of the reduced costs of equipment maintenance, improvements in patient safety and the ability to deliver more innovative care,” said Goldman, a practicing anesthesiologist at Boston’s Massachusetts General Hospital.

Those forces led NorthShore University HealthSystem in Illinois to engineer custom interfaces in a few key areas to make the services available to clinicians despite declaring generally it doesn’t want to go that route. Direct interfaces, one per device vendor, are enabling data from blood pressure cuffs and fetal monitoring systems to flow into the four-hospital EMR. “Why should nurses have to take a blood pressure, write it down on a piece of paper, then go to a computer somewhere and enter it?” said CMIO Arnold Wagner Jr., MD. “You can ‘fat-finger it,’ you can miss a piece of paper; you also lose the timeliness of the information.”

Springfield, Mass.-based Baystate Health System also was driven to make exceptions. “We do have some middleware; we try to avoid it when we can,” said Steve Merritt, infrastructure engineer at the health system. One site that didn’t wait for standards was the cardiac cath lab, where technologists interfaced bedside monitors putting out information clinicians in that setting need to see while performing their work, he said.

Partners, Johns Hopkins Hospital, Kaiser Permanente and several other health systems have sought to incorporate a set of interoperability standards into procurement contracts as one way to both inform and encourage vendors about where they need to head in this area. 

A major revision of the procurement template first introduced in 2008, called MD FIRE (Medical Device Free Interoperability Requirements for the Enterprise) is scheduled to be available by late February for any provider who wants to use it, said Goldman. “It’s open, standardized interfaces that provide the kind of functionality that are needed to send accurate and complete data to the [electronic record].”

The program he heads at the Center for Integration of Medicine and Innovative Technology also is collecting clinical requirements and scenarios and sharing them with manufacturers, researchers and standards development organizations, a push that he said should involve CMIOs. “It’s incumbent on the CMIOs to do what they can to direct the marketplace to deliver products that meet requirements. What that means is they have to contribute to articulating the requirements.”