Member Article

Last week, Waller co-hosted a roundtable discussion on interoperability with Brentwood Capital Advisors and were joined by healthcare IT companies, investors, providers and payors.

Will Morrow, VP of HCA’s Health Insight Capital, and Hal Andrews, President of Healthcare for Digital Reasoning, kicked off the discussion with a case study on HCA’s work to achieve data interoperability and how HCA’s strategy led to its recent investment in Digital Reasoning.

Following the case study, roundtable participants discussed the barriers, opportunities and goals around interoperability. Here are some key highlights from the discussion:

1) The goal. Interoperability isn’t the end game. Instead, it is a step toward the goal of using multi-system data to inform decision-making. For HCA, the long-term goal is global data interoperability, but there are immediate and manageable use cases today where specific systems and data interoperability can improve quality, efficiency and outcomes for patients. Many use cases are based on analysis of historical data, but some of the most exciting are prescriptive or predictive uses of real time data for clinical decision support at the bedside.

2) Best approach. The level of interoperability needed to support healthcare is not limited to purely technical interoperability, or simply compiling data from multiple systems. One of the key challenges is syntactic and semantic interoperability, where data from multiple sources can be effectively processed and analyzed with symbols carrying consistent meaning across systems. Once it started “connecting the pipes”, HCA also invested heavily in synthesizing data and quality control to make its data more usable.

There were several questions from the floor about how to build quality data sets and encourage synthesized data entry on the front end. The panelists discussed various ways to attack consistent syntax, including: 1) train users on syntax, 2) use data technologists and/or dictionaries to clean up the data after entry or 3) use adaptive systems, such as Digital Reasoning’s products that can adapt to syntax differences effectively. Andrews pointed to the use of real-time voice-to-text transcription as one solution that should improve the quality of information entered into the system.

3) The role of clinicians. A question was posed from the audience regarding what happens when data conflicts with the choices made by physicians. Morrow acknowledged that data driven decision support products have the potential to create conflicts in complex clinical decision-making environments. The clinician’s informed decision is the final word, so the solution must be tailored as a support system rather than an override of professional judgment. Data about historical patterns have been less of a challenge for HCA, because physicians are scientists who tend to love data and enjoy data-driven discovery. An effective way to deliver most messages to physicians is to give them the data and let it speak. For HCA, data has launched more productive conversations than conflicts.

4) Requirements needed to implement the change. Andrews noted that Digital Reasoning’s experience with HCA indicates that, given its size, scale, capital, and data stores, HCA is in an excellent position to implement noticeable change as it relates to interoperability. Audience members asked how hospitals, health systems or physician groups of smaller size can obtain the benefits of interoperable data. The panelists discussed the purpose of the HCA/Digital Reasoning investment, which is to develop, refine and bring to market data products and services that, while incubated at HCA, have applicability and value to providers generally. This is something that neither company could accomplish independently, but they can do effectively together.

5) The role of the government. With respect to the role of the government in driving interoperability, the group discussed the government’s role in Meaningful Use as a good case study. While the group had different views on the effectiveness and results of the implementation of Meaningful Use, there was general agreement that Meaningful Use was a well-intentioned idea made difficult by rapid demand and differing agendas. The group agreed that the time is not right for another Meaningful Use type of government program to address interoperability, and that the private sector needs time to adapt to the post-Meaningful Use environment. There are private sector collaborations underway that will fill the gap, and perhaps have an even greater chance of success.

6) Providers and payors working together. Payors are driving toward interoperability through efforts such as Patient-Centered Medical Homes and Episodes of Care. In these initiatives, payors and providers are sharing information and from these experiences can suggest to the government what to do as it relates to interoperability. Payors and providers share many common goals and are primarily on the same page with respect to how to improve the system, but there are still many steps to take before they are rowing in the exact same direction.

Our event was not the first in recent weeks to cover the topic of interoperability. The Nashville Health Care Council featured a panel on interoperability on April 8 and Jumpstart Foundry hosted their quarterlyHealth:Further event on interoperability on May 10. We were pleased to work with Brentwood Capital to advance the discussion and look forward to continuing to bring people to the table to achieve these ambitious goals and realize the potential of interoperability.