Interoperabilitas: Mengapa begitu sulit?

Hampir setiap orang sependapat bahwa interoperabilitas — menjadikan informasi kesehatan mengalir dengan lancar antara perangkat dan sistem IT yang terpisah — akan meningkatkan perawatan pasien dan menurunkan biaya. Kendatipun penggunaan teknologi dan gadget terkini, masih saja sulit terhubung untuk berbagi data kesehatan.

Salah satu tantangan interoperabilitas adalah bahwa peralatan medis yang berbeda dan pabrikan IT bidang kesehatan masing-masing memiliki teknologi antarmuka yang dipatenkan, sehingga tak ada cara untuk menghubungkan bagian-bagian yang terpisah. Tanpa antarmuka yang umum — sesuatu yang mirip kabel USB — rumah sakit terpaksa menghabiskan waktu dan uang untuk menata setiap teknologi dengan cara yang berbeda-beda.

Tambahan masalah bahwa tidak ada arsitektur menyeluruh untuk menciptakan interoperabilitas. “Di layanan kesehatan, kita tidak memiliki blueprint untuk menggabungkan bagian-bagian yang terpisah,” menurut McDermott.

Masalah lain adalah standardisasi yang kurang.  “Ada keengganan dalam komunitas IT untuk berbagi informasi guna pengembangan kapabilitas”. Kendala terbesar untuk interoperabilitas adalah menjadikan antara pembuat alat kesehatan dengan developer IT untuk saling bertukar pendapat dan informasi.

EHR vendors have also expressed frustration with the lack of interoperability, made more glaring with the shift to electronic health records. According to one study, 70% of physicians are spending less time with patients because of the demands of electronic record entry. The problem spurred athenahealth to launch a ‘Let Doctors Be Doctors’ campaign last October.

McDermott understands that frustration. “Hospitals and health systems don’t want to pay for things that don’t work together in a plug-and-play way, because it’s not good for patients,” she said. “There are absolute implications for patient safety, clinical care outcomes, clinician fatigue. We’re exhausting our workforce because they have to spend so much time troubleshooting the technology instead of having it function seamlessly in the background.”

The goal is to ensure that the architecture is vendor-neutral and supports real-time one-to-many communications, two-way data exchange, plug-and-play integration of devices and systems, the use of standards and the highest level of security, McDermott said.

“At the end of the day, we’re trying to make it easier and less expensive for devices to talk to each other, for devices to talk to EHRs and to other systems that support patient care and clinical decisionmaking, not to mention consumer access to information,” she said.

For Cerner, interoperability involves working with competitors and industry partners to achieve more “meaningful connectivity using available standards and creating new ones where there are gaps,” said Cerner VIce President of Interoperability Bob Robke. “Our ongoing innovation includes an open platform that strengthens scope and service along the continuum of care, making it easier and faster for developers to create apps that meet the needs of people and their healthcare providers,” he said.​

The federal government has also been involved in the press for greater health interoperability. Last October, the Office of the National Coordinator for Health Information Technology released its final roadmap on interoperability. Guiding it are three overarching themes: the need to move to a value-based healthcare system that enables consumers to access and share personal health data; the need to eliminate obstacles, whether intentional or inadvertent, to data sharing across organizational boundaries; and the need for federally recognized interoperability standards.

And on Jan. 26, the Food and Drug Administration released draft guidance on design considerations for manufacturers of  interoperable medical devices. Testing of devices should focus on the risks associated with interoperability, the potential for misuse and likely scenarios of events that could compromise patient safety.

In addition, the Senate’s Health, education, Labor & Pensions Committee last month unveiled legislation aimed at enhancing overall use and development of health IT. Among its proposals is the creation of a “trusted exchange network” for information sharing across health systems, EHR vendors and consumers. The bill would also create a set of “standardized data elements,” so that information could be easily entered and shared in patient registries.

Such initiatives notwithstanding, moving interoperability forward is a slow process and will take a concerted effort by the provider community, EHR vendors and devicemakers working together to tackle the obstacles. CMI hopes to provide that space. “You really need a place for all parties to say we should work with this architecture within the platform it creates, and everyone has access to the data in that platform and we can all compete on top of that,” McDermott said.