Standing in the Interoperability Showcase at HIMSS10 is frankly amazing.  We are participating in the Emergency Department interoperability scenarios, passing clinical documentation to and from other systems, using IHE standards for information exchange.  I was standing with a friend and CMIO who is a practicing physician, and when he saw how easy it was to get information regardless of source, his comment was, “This is how it is supposed to work, how it was always supposed to work.”  I agree.  And more vendors than ever are participating.

Talking with the HIMSS folks that orchestrated the impressive setup, I come to find that the numbers of folks “interoperating” in this display have more than doubled in the past two years, now demoing nearly 60 use cases and 28 clinical scenarios. Similar to the IHE show in January, the interest in interoperability and move to embrace standards at HIMSS is palpable. And it’s not just on the show floor – I have been talking to vendors all over that are now delivering or planning to deliver shortly to their customers this type of technology.

I guess that’s no surprise – since everyone from Microsoft to Rubbermaid wants to get at a piece of the stimulus money, and in addition to ARRA there’s a large pot of interoperability grant money available.  CMS has clearly decided that transitions of care are important, and that interoperability has to happen regardless.  Easier, robust interoperability clearly levels the playing field in a hospital, and allows for departments to decide what kind of system they would prefer to use.  The advantages of a single system are much less in that scenario, and the advantages of companies that can focus on a particular department become more apparent when the systems work together seamlessly.  Things are clearly changing, so I decided to take some time today (the 2nd day of HIMSS) to find out where the chips are really starting to fall in the never ending debate around Best of Breed vs. One HCIT System Fits All. Just how divided are these camps, and is one side winning out?

My sleuthing resulted in these pieces of evidence that point to a real reluctance to abandon quality, efficiency and for the sake of one record:

·         The CHIME CIO Focus Group revealed that while it’s 50/50, those who move to house wide HIS systems understand that they will only have “good enough” in many departments, and that some house-wide systems pose a challenge in themselves to interoperate with their own modules;

·         Two seminars highlighted CIOs that are clinging tightly to their specialized systems in various parts of the hospitals, saying that they can’t “afford NOT to specialize” given the clinical and financial results they are unwilling to yield;

·         In one large integrated network, 75 percent are sticking to processes that involve selecting the best tools in each department. With the rise of standards, they see the challenge as a non issue.

What I’m hearing is that the problem of making sure that data flows seamlessly from the outpatient to the inpatient and everywhere else is something that hospitals feel they will have to solve for current and future versions of “meaningful use” and that CMS is clearly focusing here.  Once you go about trying to solve this problem, you find out that there’s more help available from vendors than there ever has been, and some of the traditional resistance to interoperating very important information like medications and allergies just seems to melt away.

One CIO at the CHIME Forum said interoperating best of breed systems was like buying a car with 500 different parts from 500 of the best car manufacturers in the world – an engine from Ferrari, a transmission from BMW and a suspension from Mercedes – and his role is to put them together and make them work. And suddenly he feels like he has the tools to do so.  His organization bought an HIE product and they have gone from several hundred to tens of thousands of documents exchanged in about six months.  They are delivering real value to their physicians by embracing this strategy, and by doing so have provided a platform for all future systems to pass highly clinical information to each other.

Interoperability remains a challenge, but from what I’m hearing at HIMSS, it’s one that hospitals feel they have to embrace.  The interoperability showcase showed that car with 500 parts, and it looked pretty good, ran pretty well, and from a doctor’s point of view, it had some serious horsepower.  All the value of integration, with all the focus of people who really know their area: just what we need when the road ahead looks anything but straight and flat!

- Dr. Mark Crockett