Interoperability: One Key To Saving U.S. Healthcare

During this week's Health Information and Management Systems Society (HIMSS) conference in Las Vegas, I sat down with Dr. Rasu Shrestha, medical director of interoperability and imaging informatics at University of Pittsburgh Medical Center (UPMC), to discuss the role of interoperability in hospital and community practice. By the end of the conversation, I felt genuinely optimistic, for the first time in a long time, about the future of U.S. healthcare.

I've been a skeptic about IT's ability to fix healthcare since I first signed on as the editor of InformationWeek Healthcare. Over the years, I've known too many medical leaders who were infatuated with medical technology and willing to adopt the latest innovation even before there was sufficient proof that it actually cuts costs and saves lives. So I've wondered, is the new push for health IT just more of the same?

But the work that Shrestha and his UPMC colleagues are doing clearly isn't infatuation. SingleView, a project they recently completed, is one of the most impressive and useful technological developments I've seen.

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SingleView is a standards-based platform that pulls together the multiple picture archiving and communications systems, or PACS, used across the medical center's facilities. With 20 hospitals and 30 outpatient imaging centers, UPMC has numerous imaging systems and archives, each creating a silo of patient information.

SingleView lets the medical center's 20,000 radiologists, doctors, and other clinicians access reports and imaging studies in any of the PACS and other imaging systems across the enterprise. That way, they can easily find out which tests a patient has already had before scheduling new ones. The system also lets doctors compare a patient's previous images with current ones.

SingleView has considerably reduced the number of unnecessary and redundant tests ordered for patients and kept patients from being exposed to unnecessary radiation, Shrestha says. It's also cut the number of disputes with payers over unneeded and redundant testing.

Not content to limit the SingleView platform to imaging data within UPMC facilities, Shrestha's team recently created a cloud-based system called External Image Management Solution, or EIMS, which lets imaging centers that aren't part of the UPMC network connect to SingleView. If a patient sees a doctor at a UPMC hospital, that physician can access to all images taken of the patient both inside and outside the UPMC system.

Once Shrestha's team figured out how to share images, the next big interoperability challenge was connecting nine major healthcare systems in Western Pennsylvania to form a regional health information exchange (HIE) so that they could share all of a patient's data, not just imaging studies. They wanted the HIE to let various medical information systems to talk to one another, despite the fact that many speak different coding languages.

If they could "collate" all that data into one federated exchange, it would let clinicians offer a level of care that they couldn't achieve when they only had access to data from their individual hospital or practice.

To make that happen, Shrestha's group had to semantically harmonize drug information across the various EHR systems that doctors were using so they were all using the same terms and speaking the same language. That let physicians easily analyze data from all of the systems, looking for dangerous drug interactions. So now Mrs. Jones' doctor can quickly discover that the drug she was given in hospital A interacts with one her cardiologist prescribed in hospital B. In the past, those interactions were easily overlooked.

Interoperability is one of the keys to transforming healthcare. If the country's competing financial institutions can figure out an interoperable system that lets customers draw funds from any ATM machine, healthcare providers certainly can come up with a similar arrangement for medical data.

Healthcare providers must collect all sorts of performance data to meet emerging standards. The new Pay For Performance issue of InformationWeek Healthcare delves into the huge task ahead. Also in this issue: Why personal health records have flopped. (Free registration required.)