It’s appropriate that this year’s Connectathon, the annual geekfest sponsored by Integrating the Healthcare Enterprise, should feature the release of the free e-book Interoperability for Dummies (IHE Edition), since the entire purpose of both the event and the organization is to make interoperability so easy that it’s invisible. (See sidebar to get your copy.)

“Because [interoperability] is so technical, vendors don't even talk about it with their customers, so they don’t understand that IHE is important in making interoperability happen,” said Joyce Sensmeier, vice president of informatics at HIMSS and president of IHE USA. “All health information exchanges are using IHE in one way or another. Awareness of it is finally growing.” One of IHE’s objectives is to have its specifications incorporated into certification requirements for meaningful use, and to have providers require IHE-style interoperability in the software and medical devices they purchase.

The Interoperability Showcase that occupies such a prominent place on the HIMSS exhibit floor would not be possible without the Connectathon, which serves as a dress rehearsal. (For a more detailed explanation of how the Connectathon operates, see “Scenes from the Lollapalooza of HIT”.

IHE is an international consortium of professional organizations, government agencies, vendors, providers, and research institutions dedicated to developing consensus on exactly how to use the many health care data exchange standards in consistent ways. A number of Connectathons are held each year across the globe, and each one pushes the industry farther along the road to “plug and play” amongst all of its information systems and medical devices.

This year’s U.S. event, the 16th of its kind, was held late January in Chicago, and attracted 113 companies testing interoperability among 146 different products. As in previous years, the cavernous basement of the Hyatt Regency Chicago contained row after row of folding tables covered with computing and medical equipment, manned (and womanned) by the finest technical minds in HIT.

For More Information:

  • Download Interoperability for Dummies e-book
  • List of IHE certified vendors and products
  • IHE/ICSA Labs white paper on interoperability certification
  • IHE Product Registry: Vendors file “IHE Integration Statements” here, to identify the specific IHE capabilities of a given product. Not independently certified, but indicates the status of the vendor’s internal interoperability testing efforts.
  • All about the Standards and Interoperability Framework

ONC jumps in

Among the participants this year was the ONC, testing part of its Standards and Interoperability Framework that allows health information exchanges to share their provider directories. ONC interoperability chief Doug Fridsma, M.D., also the keynote speaker at the educational conference on Wednesday, spent part of the week in the basement among the techs. “I’m in a suit, so nobody respects me,” he joked. The “federated provider directory” would allow any provider to easily track down any other, so that an ER doc in, say, Oregon could electronically contact a sick tourist’s regular physician in New York and import his health information through Direct secure messaging.

Multiple speakers looked at the challenges of inter-institution communication at this year’s educational session. Fridsma’s keynote, “Strategy and Principles to Accelerate HIE and Interoperability,” went over much familiar ground regarding ONC’s role in standardizing meaning, structure, transport, security, and services. “Standardization is critical to unlocking the potential of data to improve outcomes,” he said. “If you’ve got data sitting in an EHR not doing anything, it’s lazy data.”

In answer to an audience question, Fridsma conceded the limits of structure. He recalled a schizophrenic patient he had cared for as an internal medicine resident, who, when stable on her medications, would dress in impeccably matched outfits. “I could tell I needed to adjust her meds if her outfit didn’t match,” he said. “But there’s no ICD code for ‘shoes do not match purse.’”

Anita Samarth, co-founder and president of consulting firm Clinovations, Washington, DC, and author of Interoperability for Dummies, talked about “Interoperability Made Easy,” clearly an ironic title in light of the complexities she described in her hometown health care market. “No organization has an inpatient-outpatient integrated solution, and every organization has had to do [information exchange between disparate systems] within its own organization,” she said. With a large number of commuters coming from Maryland and Virginia, cross-border care coordination is an everyday need. Ipads, smartphones and other advanced gadgetry have raised expectations among both physicians and patients that EHR information should be available everywhere, and healthcare providers ignore that expectation at their peril, she added.

Representatives of several health information exchanges discussed the state of their operations, including Jason Buckner, vice president of operations at Cincinnati HealthBridge and John Kansky, Executive Director of the Indiana Health Information Exchange. They collaborate with several other HIEs in surrounding states to offer Direct secure messaging among providers and an “untethered” personal health record that aggregates relevant information from all the providers in all of the exchanges.

Eric Heflin, Chief Technology Officer at Healtheway, a cross-industry collaborative to advance health information exchange, gave a progress report on his organization’s efforts in “The Value of Universal Interoperability.” The national eHealth Exchange (the successor organization to the Nationwide Health Information Network initiative) is concentrating on simple, highly structured communications. “We’re constraining the specs to factor out flexibility and options,” he said. “Every time there’s an option, the options don’t communicate.” More than 40 organizations are sharing data, including four federal agencies, six states, eight ONC-funded Beacon Communities and more than a dozen health information organizations. Together, they cover 50 million patients and pushed 26 million transactions last year.

Health information exchange between providers has been something of a stepchild to the meaningful use program, lessening its effectiveness, said Chuck Tryon, co-chair of the ONC Beacon-EHR Vendor Affinity Group, in his session, “Illustrations of Community HIEs and Interoperability: The Search for Real.” The affinity group has been active in pushing adoption of consistent standards among Beacon communities and EHR vendors. Tryon said some vendors have ignored or poorly applied several standards that are crucial for effective information exchange, and that the ONC’s EHR certification program isn’t stringent enough, either in its standards or in the penalties for failure to comply.

“If we believe in the value of HIE and interoperability, it needs to become a front-row topic and a focus of meaningful use requirements, and not an afterthought,” he said.

'Seal of approval'

For the first time this year, Connectathon participants could seek formal IHE certification at the event through a program offered jointly by IHE USA and ICSA Labs, a software-testing division of Verizon. When a vendor can demonstrate that one of its products can interoperate with others following IHE guidelines, ICSA certifies that transaction as IHE compliant. Sensmeier says system purchasers can look for that certification to confirm that the system comes with certain interoperability that doesn’t have to be further tweaked.

The certification program was announced last year, and products from several vendors were certified over the summer, including Baxter Healthcare, B. Braun Medical, CareFusion. Corepoint Health, Greenway Medical Technologies Inc., Hospira, InterSystems Corp. and Masimo Corp. 

Next year, the Connectathon will have a new home in downtown Cleveland at the HIMSS Innovation Center, which opened in October on the fourth floor of the Global Center for Health Innovation, adjacent to the Cleveland Convention Center. Sensmeier said the Innovation Center will also be used to help vendors get IHE certification for their products throughout the year.


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