HCI-DC 2014: Interoperability struggles on the ground

Nurses spend 35 percent of their time transcribing information from machines instead of focusing on patient care. Meanwhile, patients with chronic conditions rely on devices that do not talk to each other, while their providers often lack software to analyze their data. These challenges and more highlight the pressing need for greater interoperability, according to speakers at the Health Care Innovation Day on Feb. 6—a joint Office of the National Coordinator for Health IT and West Health Institute event.

Anna McCollister-Slipp, cofounder of Galileo Analytics, is a patient with Type 1 diabetes who uses four prescription medical devices, including an insulin pump and glucose monitor. While these devices foster dramatic improvement in diabetes care, lack of interoperability between them means that she cannot trend multiple data that would help her predict changes in insulin.

“They all use different data formats and standards and I can’t get that information all in one place,” she said. “It’s incredibly frustrating that we’ve invested so much in creating incredible technologies but we can’t connect them.”

Also she said her endocrinologist, whom she sees four times a year, has yet to download free software to access her glucose data. “Even though he requested it, the IT people haven’t gone around to downloading it. It’s a really easy thing for the institution to fix, but they haven’t yet,” she said, adding that she goes to a very reputable academic center known for biomedical informatics and innovation.

Neil Chawla, associate CMIO of Inova Health System in Falls Church, Va., said the health system has moved from 80 percent paper based to 99 percent electronic during the course of two years—leading to greater efficiencies, but also challenges.

For instance, pregnant patients often are referred to the hospital by private physicians not employed by the health system. These referring physicians use different EMRs that are unconnected to its system, and obtaining lab work is particularly challenging. As these physicians often contract lab work to third parties, Chawla said he is working to have these labs send data to the system directly.  

Benjamin Scot Miller, a father of an infant who spent time in the intensive care unit, said, “When you see devices surrounding your baby, you are scared to death. You hope doctors know what they’re doing and hope the devices work.”

He said lack of a centralized system meant that nurses often spent time on charts and handling devices as opposed to direct care. “Anything that can be done to make the nurses’ lives easier so they can spend time with your child will make you feel much better.”

Sarah McGregor, RN, a neonatal nurse at Nationwide Children Hospital in Columbus, Ohio, who worked with the Miller family, said direct care suffers because nurses are overwhelmed trying to complete their admission charts and pull data from the devices.

In another example, she said when babies are referred to the hospital, nurses must make phone calls to track down the transporting physician to learn the results of a baby’s initial blood gas test. This is especially critical if a baby has neonatal therapeutic hypothermia, which must be acted on within six hours.

“All I want to know is the initial blood gas,” she said. ‘It would be nice to have something that automatically tells me that information so I can give care more quickly and efficiently, and there is more time to directly take care of patients and facilitate bonding with parents and babies.”

From the nurses’ perspective, the ability to connect machines would be ideal. “There are still lots of devices that are disconnected and it does delay treatment for fragile babies,” she said.

Miller recalled nurses staying over their 12-hour shift to manually enter his son’s data into a computer. “It seems like a waste, and a lot of the extra efforts wears on them.”

Miller said a GI specialist equipped his son with a heart monitor after discharge, but to analyze the baby’s data, he had to drive the monitor to the hospital. “The solution would be to have access to that data from the hospital and some sort of threshold to track heart rate so I don’t have to drive in and give it to them,” he said.

In light of these real-world problems, Chawla said the challenge remains to take these newly adopted systems and start to make them better. “The tough part is we all want to boil the ocean, but everyone has limited resources,” adding that payment changes put a squeeze on providers who must determine how to prioritize resources.

McCollister-Slipp said the government has levers it can use to solve the interoperability conundrum, particularly by requiring medical devices to make data available in a standardized format. She urged for standards to serve as the basis of broader platforms to allow for connectivity.

“I don’t want to wait three years for this to happen. That's a long time for a patient. We, as patients, just can’t accept that. There is no excuse for the state we are in.”