I optimistically chose 5-10 years, but 10+ may be more realistic. I have been on a project to try to standardize clinical data and make it consistent between two hospitals in the same healthcare network, for a clinical documentation project. Until you get into the details of turning a clinical note into something transmittable between two systems, you cannot understand the complexity. I remember spending an hour in a meeting discussing what values should be in the "stool appearance" drop-down... Unless every provider uses the same list, or every interface engine has a translation table...how can one system send to the other? Things like that need to be done..and with 1000s of different ideas/opinions/research on what exactly a Stool Appearance drop down to look like, it's going to be very difficult. Of course you can always transmit entire documents and notes, but if you want to make data interoperable, it needs years and clinical revamping.
Randy Bak - 6 years ago
Everyone everywhere? From legacy systems run by stressed organizations operating at the margin of survival?
Patient-generated data, from outside of hospital/ clinic? Genomic data? 3rd party analysis of same?
Clinically relevant is the touchstone. *Truly* clinically relevant may be much smaller subset, but, still, you have to get to it.
Patient-sovereign software, leveraging API-architecture through consent/ authorization/ access services and the patient's right to their data, may be a route, which works because it flips the paradigm.
Aging boomers will change the hospital industry on the way out, just like they did on the way in. Aging in place, chronic disease management, stronger and more significant patient relationships will reset the technologies used to care for patients.
Julie McGovern - 6 years ago
I still vividly remember attending an Interoperability conference in 2003, at that time experts were sure that in 5-10 years, all systems would be talking to each other. What year is it now?
Tonya Wills - 6 years ago
Part 2 - Judy knows that creating interoperability for all EHRs slows the sales of her Epic Everywhere solution - from a business standpoint, why would she do it. It does not make business sense for her. It would be like a central shipping application that allowed you to see USPS, UPS and FedEx from the same window and told you which was the cheapest for the route you are looking to send - just does not make business sense.
Tonya Wills - 6 years ago
I work in this industry every day and the reality of what the vendors hype as coming and what is really available is a large chasm. The EHRs that tell Payers to wait for the development of their FHIR calls fail to mention that 90% of their install base will not be able to use that functionality unless they upgrade - which they won't.
So you have an industry where users wait because the EHRs tell them - it is coming in 6 months and EHRs who see no true economic value in giving these interoperability functions to their users.
DevWatson - 6 years ago
Data exchange will only move forward once EMR vendors and Health Systems understand they do not own the data - it belongs to the patient. And to get to that point may take payment penalties for those that do not share.
ItsAllGood - 6 years ago
Ask 5 physicians what "all clinically relevant data" is and you'll get 7 different answers.
The reality is that all all of the data you mention in your example can be shared today. Why isn't it? A) because doctors aren't demanding it. And B) because there remain competitive business reasons to not share data with providers (aka as competitors) outside an IDN. Interoperability remains mostly a business challenge, not a technology challenge.
Ken Rosenfeld - 6 years ago
I was torn between 5-10 and 10+, but decided to lean to the optimistic side. Most definitely not before this time frame, as disappointing as this is. There are aspects that will take longer (e.g., pathology), as today it is not widely digitized. More needs to be done to emphasize the need for the FULL relevant record - too much emphasis still today for making only PAMI (procedures, allergies, medications, and immunizations) data interoperable, as the "least common denominator". Finally starting to see more recognition of interoperability needed for clinical reports, which is addressed in the next version of FHIR -but will still take a long time. It is possible that patient-driven requests will drive more of the "full record" capability in the nearer term. All parties must keep up the drumbeat for this though...
RD - 6 years ago
“All” clinically relevant information is casting a wide net, including all scanned documents, waveforms, diagnostic resolution MRIs and mammos and cine loops, and it also assumes that every internal niche clinical system in a large organization can participate in HIE or at least communicate with the primary system responsible for HIE. If that’s what you mean, it won’t happen in 10 years in this country with our broken fragmented healthcare ayatem, and maybe never.
Jim Filkins - 6 years ago
I think 5-10 years is about right, but the trends with payers and the younger consumers eschewing the PCP relationship in favor of the retail medical experience will drive a de-centralization and specialization of technology that will not benefit the big three- Cerner, Epic, and Meditech. Crystal balls are fun!
I optimistically chose 5-10 years, but 10+ may be more realistic. I have been on a project to try to standardize clinical data and make it consistent between two hospitals in the same healthcare network, for a clinical documentation project. Until you get into the details of turning a clinical note into something transmittable between two systems, you cannot understand the complexity. I remember spending an hour in a meeting discussing what values should be in the "stool appearance" drop-down... Unless every provider uses the same list, or every interface engine has a translation table...how can one system send to the other? Things like that need to be done..and with 1000s of different ideas/opinions/research on what exactly a Stool Appearance drop down to look like, it's going to be very difficult. Of course you can always transmit entire documents and notes, but if you want to make data interoperable, it needs years and clinical revamping.
Everyone everywhere? From legacy systems run by stressed organizations operating at the margin of survival?
Patient-generated data, from outside of hospital/ clinic? Genomic data? 3rd party analysis of same?
Clinically relevant is the touchstone. *Truly* clinically relevant may be much smaller subset, but, still, you have to get to it.
Patient-sovereign software, leveraging API-architecture through consent/ authorization/ access services and the patient's right to their data, may be a route, which works because it flips the paradigm.
Aging boomers will change the hospital industry on the way out, just like they did on the way in. Aging in place, chronic disease management, stronger and more significant patient relationships will reset the technologies used to care for patients.
I still vividly remember attending an Interoperability conference in 2003, at that time experts were sure that in 5-10 years, all systems would be talking to each other. What year is it now?
Part 2 - Judy knows that creating interoperability for all EHRs slows the sales of her Epic Everywhere solution - from a business standpoint, why would she do it. It does not make business sense for her. It would be like a central shipping application that allowed you to see USPS, UPS and FedEx from the same window and told you which was the cheapest for the route you are looking to send - just does not make business sense.
I work in this industry every day and the reality of what the vendors hype as coming and what is really available is a large chasm. The EHRs that tell Payers to wait for the development of their FHIR calls fail to mention that 90% of their install base will not be able to use that functionality unless they upgrade - which they won't.
So you have an industry where users wait because the EHRs tell them - it is coming in 6 months and EHRs who see no true economic value in giving these interoperability functions to their users.
Data exchange will only move forward once EMR vendors and Health Systems understand they do not own the data - it belongs to the patient. And to get to that point may take payment penalties for those that do not share.
Ask 5 physicians what "all clinically relevant data" is and you'll get 7 different answers.
The reality is that all all of the data you mention in your example can be shared today. Why isn't it? A) because doctors aren't demanding it. And B) because there remain competitive business reasons to not share data with providers (aka as competitors) outside an IDN. Interoperability remains mostly a business challenge, not a technology challenge.
I was torn between 5-10 and 10+, but decided to lean to the optimistic side. Most definitely not before this time frame, as disappointing as this is. There are aspects that will take longer (e.g., pathology), as today it is not widely digitized. More needs to be done to emphasize the need for the FULL relevant record - too much emphasis still today for making only PAMI (procedures, allergies, medications, and immunizations) data interoperable, as the "least common denominator". Finally starting to see more recognition of interoperability needed for clinical reports, which is addressed in the next version of FHIR -but will still take a long time. It is possible that patient-driven requests will drive more of the "full record" capability in the nearer term. All parties must keep up the drumbeat for this though...
“All” clinically relevant information is casting a wide net, including all scanned documents, waveforms, diagnostic resolution MRIs and mammos and cine loops, and it also assumes that every internal niche clinical system in a large organization can participate in HIE or at least communicate with the primary system responsible for HIE. If that’s what you mean, it won’t happen in 10 years in this country with our broken fragmented healthcare ayatem, and maybe never.
I think 5-10 years is about right, but the trends with payers and the younger consumers eschewing the PCP relationship in favor of the retail medical experience will drive a de-centralization and specialization of technology that will not benefit the big three- Cerner, Epic, and Meditech. Crystal balls are fun!