By Sarianne Gruber
I am a Healthcare guy. I have worked in healthcare all my life. My first job out of UC Berkeley was a scrub tech. Later I jumped over to Health IT because I saw the opportunity to really transform healthcare. I have been doing Health Information Exchange and Interoperability for the last 15 to 20 years. My role here at Infor is a Strategy Director with my main focus on interoperability, which is pretty much Cloverleaf related, and to understand what our customers need. – Jerry Rankin, Strategy Director, Healthcare Interoperability Infor, Inc.
A veteran in the field of Interoperability and the Health Information Exchange, Jerry Rankin leads healthcare organizations on a quest for solutions such as the cloud-based Cloverleaf Integration Suite 6.2, which was demoed at the Inforum Conference. I reached out to Mr. Rankin to learn more about the interoperability challenge especially as it takes on HIEs, medical devices, and wearables. Our conversation also covered the dramatic increase in patient-generated data and FHIR’s latest version to hit the market. Below is a gently edited version of our interview.
Where is Interoperability today?
Rankin: The conversation published in the press today focuses on interoperability from EHR to EHR. We have spent a lot of money promoting EHRs for physicians’ practices and hospitals with success rates of adoption. The situation on interoperability is not that we can’t get EHRs to talk together: the ability to exchange clinical summaries has successfully been done in production for a decade or longer. However, this document exchange paradigm is handicapped by two things – the workflow for sending and receiving the clinical summary is typically clunky, and document delivered isn’t very satisfying; You get more information than you need and not enough of what you actually want, plus extraneous or “bloat” EHR documentation. We are seeing a move towards API based data exchange, and it is the right move. Now in trial use, is the FHIR standard coming out of HL7. These APIs are able to access more discrete sets of data permitting more data fluidity, which is a significant improvement from the clunky document exchange workflow. I see it as the right direction. And to a significant degree, the challenge has been less about interoperability but more about the functionality of the EHR itself. The key is how it handles the necessary work flow to address providers’ needs.
We talk a lot about interoperability in the industry and exchanging these bloated documents in EHRs. But recognize that Infor has customers that exchange data across their own institutions at the rate of over 240 million messages a day! In that sense, interoperability is alive and well. Healthcare is a team sport, and there is too much focus on the physician and the acute episode. If we look at healthcare as an ecosystem – patients, physicians, other types of providers collaborating across the medical community, it needs to be connected in a fluid or natural way. That is where interoperability comes in. The industry is evolving new capabilities like the FHIR standard and rest APIs. In this way, we can get the data we need, when we need it, and use it in a more discreet purposeful fashion. Interoperability is alive and well.
Where is Healthcare with Data?
Rankin: In a sense, the healthcare industry is awash in too much data, and what is needed is actionable insight from that data in context and in real time. I attended the Inform conference, and there Duncan Angove (President, Infor) spoke about networked intelligence. A good example of this in healthcare might be Patient Generated Data – and to give an illustrative example: Yes, we have the ability to take step count or a heart rate from my Fitbit and make it available to a doctor. First of all, an EHR has no place for this type of data, and secondly, a doctor would rarely want to see it. A significant pattern change in your step count or weight change would be useful for a care coordinator. If blood pressure goes up, a step count drops or your weight balloons, the recognition of this type pattern could be summed up. From all this data, the pattern change really needs to be communicated in a just a few words and sent to the right person in the context of their work flow. We have potentially millions of bits of data floating around that aren’t particularly any use for someone, but the conclusions that are drawn from the patterns are significant.
Where is Healthcare with the new improved version of FHIR?
Rankin: The older version of healthcare messaging prior to FHIR (Fast Healthcare Interoperability Resources, pronounced ‘fire’) is typically called HL7 version 2 messaging. Unfortunately, these v2 messages are not easily human readable and are event-based push messaging. For example, a lab system generates a result that my calcium is high or when my blood pressure is taken, the system simply generates an HL7 result and pushes it out. You can receive information at the time someone is admitted to the hospital, including demographic location or when a bed change occurs. Messages are published and broadcasted, and this is the traditional way that physicians and systems exchange health information. With FHIR, it is more like the web, and it’s based on a JSON message structure, which is easier to read from a human perspective. It’s got REST-based interaction protocols. Young web developers can easily understand how to exchange the data. The FHIR standard itself also constructs and describes information packets that are called FHIR resources, which are more like standard chunks of information. Basically, you request or subscribe to an information feed. You can request information like what is the patient’s demographic information or what were the patient’s lab results are in this particular date range. Historically, systems were not well architected to answer questions like this. Instead, they simply published and made available these results. In FHIR’s latest version, you can request the information you want when you want it in the context of the work flow. The protocol is also a little easier for implementers to implement. The focus is on easier implementation.
What should we be concerned and excited about in Healthcare?
A real concern is getting people to use all the tools available to them. It’s about sitting down with us human beings and figuring out how to prioritize and leverage all the available technology. What is exciting is that we are at a turning point of healthcare. Presently, we are undergoing a digitalization revolution in healthcare, and the pace is just going to pick up, just like the sort of trends we see in other industries elsewhere in our life such as the capabilities that come from Google and Amazon. The power of network intelligence and data fluidity will truly transform healthcare in a huge way. As healthcare moves off of the acute care episodic model and moves to an ecosystem care management model will see improvements in cost quality and acceptability and engagement of everybody across the board. It’s really exciting to be a contributor to this revolution.
Infor hosted its annual summer conference Inforum at the Jacob Javits Center in New York City. Next year’s event will take place in Washington D.C. in fall 2018. Learn more about Infor and their services.