When I was younger all of my health data was in a folder in my family doctor’s office. If I had to go to the hospital all of my care would have been given there and the records were stored in a folder at the hospital. It seemed to work pretty well back then. I could get paper copies of the records from either place and it wasn’t very complicated. And, the term health IT interoperability didn’t exist.
Times are different now.
People travel a lot more, not just on summer vacation. People see multiple specialists, often in different health systems. There are significant hurdles involved in sharing data, and data security is a major problem. The old ways don’t always work very well. Now the problem healthcare needs to solve is front and center, and it’s referred to as health IT interoperability.
As time goes on, there are increased and more complex demands on the healthcare system. Readmissions and surgical site infections can be hard to track. There are threats to the public health that need real-time solutions. Our population is aging and requires more healthcare services. Patients are opting for telemedicine visits and remote care solutions. Because relevant patient data can be hard to locate among the various providers tending to the patient, there is too much duplicate testing being done. Doctors are required to use electronic health records (EHR) but few are happy with them, especially when they have to use different systems at different sites and offices.
Finally there are new technologies on the horizon that are posed to change how medicine is practiced. Clinical decision support (CDS) is an engine that runs on a fuel of data. Dirty or flawed data means that CDS will underperform. No data and the engine dies. Population data can help predict overall health trends, but that too relies on a wealth of readily accessible, accurate data.
The bottom line is that we need to exchange data effortlessly and efficiently NOW.
What is HSPC?
Health IT interoperability allows for data exchange between EHRs. Our current legacy systems use separate copies of different vendor software, each with tables created by different organizations. This makes seamless exchange difficult. If everyone was on the same software with the same version and same data tables then data transfer would be easy. But this is not going to happen for quite a while…if ever.
If we are going to get the interoperability we need, then we have to develop a means for computers at one healthcare facility to talk to computers at other healthcare facilities. The Healthcare Services Platform Consortium (HSPC) was formed to address this problem by setting the standards upon which different healthcare systems can share data.
To communicate with others, you have to speak the same language. Terminologies are the languages of health informatics. The core of the HSPC approach is SOLOR, which uses 3 separate terminologies:
(1) SNOMED (Systematized Nomenclature of Medicine)
(2) LOINC (Logical Observations Identifiers, Names, Codes)
(3) RxNorm (from the National Library of Medicine)
Each member of an exchange needs to encode their information into one or more of these terminologies and is then sent from one system to another using the standards framework known as Fast Healthcare Interoperability Resources (FIHR) It not always easy, but at least it’s a first step along the thousand mile trek.
Why Should We Care?
There is probably no better example of why we should care about interoperability than the care of our veterans. A veteran may initially be treated in a military hospital, but afterwards may be seen at either VA, university or community healthcare facilities. All of the providers need access to all of the data to make the best decisions. Our healthcare system should be set up to provide veterans with the best possible care we can give them. In light of the sacrifices they were willing to make for the safety and security of us all, assuring our healthcare system offers each and every one of them the chance to achieve the best outcomes should be an absolute given.
A veteran may face one or more mental health challenges, including depression, post-traumatic stress disorder (PTSD) and consequences of traumatic brain injury (TBI). Some try to self medicate with opiates or alcohol and become addicted and disconnected from life. For some veterans, addiction and depression lead to suicide–a serious problem that devastates families. Approximately 20 veterans a day are committing suicide. This distressing statistic points to a mental health crisis that must be addressed by our healthcare system. Achieving interoperability will help healthcare teams and family members better coordinate care for veterans and assure they are getting proper treatment, that there are no lapses in their treatment, that all obstacles to their treatment have been addressed and/or removed, and allow all stakeholders to closely monitor progress. Medical calculators can be used by clinicians to help identify and manage risk of suicide and depression. With interoperable healthcare systems, a clinician can run these calculators and then share the results with everyone else involved in the veteran’s care, no matter their location, using FIHR resources. The bottom line is: seamless sharing of information among clinicians, and often the patient and family members as well, translates into better care for the veteran. Here are a few sample calculators that can be used when treating veterans:
- Indications to Screen a Patient for Depression
- Criteria for At-Risk Alcohol Drinking
- Recommendations for Preventing a Suicide Attempt in the Emergency Department
- Head Injury Prognosis Calculator for Patient with Severe Head Injury
- Model for Predicting Depression After Mild Traumatic Brain Injury
- Predictors for Persistent Postconcussion Syndrome (PCS) Following Mild Traumatic Brain Injury in Adults
- Indications for Suspecting Post-Traumatic Stress Disorder (PTSD)
- Combat Addiction in a Combat Veteran with Post-Traumatic Stress Disorder
We need interoperability and we need it now. There’s no time to wait while veterans’ and many other lives are at risk. If you’d like to be part of the solution, join HSPC and help make it happen.