CE-IT town hall: Interoperability holds key to better, less costly care

Interoperability between medical devices holds the promise of presenting more patient data and more accurate patient data, delivered in near real time. The end result could be better care at lower cost. These were among the points of discussion at the CE-IT Community’s first town hall meeting, held Nov. 1 and convened by the Association for the Advancement of Medical Instrumentation (AAMI), Healthcare Information and Management Systems Society (HIMSS) and American College of Clinical Engineering (ACCE).

“One of the big things to look for, especially as we move toward accountable care organizations, is outcomes data warehousing and quality-oriented information,” said co-presenter Steve Merritt, infrastructure engineer with Baystate Health in Springfield, Mass. “If we can get more discrete information into our data warehouses and our EMRs, we can get a lot better information out to be able to reduce the cost of healthcare across the spectrum.”

Merritt was joined by Elliot Sloane, PhD, a 36-year healthcare technology veteran who holds multiple posts spanning IT and clinical engineering, and Paul Maurer, director of applications for Main Line Health in Newton Square, Pa.

Sloane began by defining interoperability—or trying to.

“For a decade, we’ve been talking about what interoperability is, and we still don’t have a good definition,” he said. “Some interoperability might be termed as device-to-system, and that type of interoperability is often homogeneous." He exemplified a central station or a central smart pump system, where each device is an extension or a component of the whole system.

"We also have device-to-device interoperability, which is often heterogeneous," Sloane said, "where devices can send data to each other, and possibly control other devices or share information such as alarms and alerts. And we have device-to-EMR interoperability, which also is usually heterogeneous. In that case, you have devices sending data to or through one or more EMR systems, which may either log the information and/or transfer it to other parts of the system.”

Sloane described a number of “ecosystem terms” that can overlap or be used in combination.

“One is fully autonomous, where each device can be a whole system or subsystem independent from the others. This term applies to most legacy systems and legacy devices in the market, some middleware vendors whose products are registered as medical devices, and the ASTM-ICE [American Society for Testing and Materials-Integrating the Clinical Environment] standards," he said. "There’s also shared autonomy, in which devices can interact with other devices for the EMR—sharing of setting alarms or drug-dose alert errors—but the control remains with the patient device or device-clinician interface. And those are typical of the IHE [Integrating the Healthcare Enterprise] patient-care device structures.”

Sloane also talked about “integrated communication ecosystems,” where devices send data to a central aggregation device that stores and forwards information to an EMR or a clinical setting.

“There is overlap and combinations of these,” he said. “There is no clean, clear delineation separating them.”

An attendee asked the three how long they expected it to take for interoperability to be implemented on a broad scale.

“It comes down to how much we can accomplish financially at this point, when the economy is not doing too well,” said Merritt. “Where do we get the real, true return on investment? We need to really focus in on where we can obtain the clinical efficiencies with this type of stuff, and I think that’s really going to drive the marketplace. That’s really going to drive more interoperability.”

“We’re still some way off from true plug and play, but the pace of change … has really accelerated,” said Maurer. “When they’re replacing systems, organizations are taking the opportunity to replace them with systems that are more interoperable.”

“I have to admit that I find this an infuriatingly slow process,” said Sloane. “The standards work that’s been underway for three decades at the foundational level and probably a solid decade in convergence with EMRs, and policies and procedures that are emerging from the Office of the National Coordinator for Health IT, suggest that even the basic EMR interoperability will probably not be accomplished for five years. It’s probably going to be a decade before we see a more fully instrumented clinical environment that would look like the cockpit of a modern airplane, where virtually everything flows in and out of the system reliably.”

Sloane also spoke on the need for education in training for both CE and IT if interoperability is going to live up to its potential.

“We’ve been discussing this at AAMI meetings for the last five years at least with some intensity, and also at HIMSS meetings,” he said. “More and more of our BMET [biomedical engineering technologist] and clinical engineering community are seeking training and education in IT, whether it’s communications or security and privacy, networking, basic operating systems, basic software, systems design and development, so that we have a better understanding from the clinical technology side of how those technologies work and how to talk with the folks in the IT community. And we’re seeing more IT folks recognizing that their work has more and more clinical significance. They’re asking a lot more questions of clinical engineers, BMETs, nurses and physicians to understand the environment they’re working in.”