The Department of Defense (DoD) Healthcare Management System Modernization (DHMSM) program has made sharing health information a top programmatic and system priority, emphasizing interoperability as a critical mission requirement. An interoperable solution will ensure that active duty military and their families, retirees and veterans receive consistent care, no matter where care is provided.
What is Interoperability?
Interoperability, put simply, is the ability for different health information technology systems to securely and electronically exchange computable patient information. Because patients receive care in different places, their health data can reside in many different systems. Interoperability helps clinicians improve the quality of patient care by ensuring health information is available wherever and whenever it’s needed, no matter where or by whom care was provided in the past.
True interoperability is far more complex than just simple data-sharing. Because each different system can record data in a unique way, the data from one system may not be useful when it moves to a new system. In fact, if the data is recorded differently between two communicating systems, it’s the equivalent of being written in a foreign language to each system. To effectively share data and offer clinicians and patients usable health information, health systems must achieve “semantic interoperability,” which means they adhere to consistent standards for formatting, terminology, grouping and transferring information. This way, it is not just data that is shared between systems, but also the meaning of that data.
Semantic interoperability enables clinicians to easily access and analyze health data, gives care providers the context in which medical information is created, and ensures that the right data is shared with the right systems in a timely, standardized, accurate and meaningful way. Standards-based approaches like those supported by Integrating the Healthcare Enterprise (IHE) and HL7’s emerging Fast Healthcare Interoperability Resources (FHIR) standard help achieve semantic interoperability by giving healthcare providers an avenue to exchange useful information that benefits the patient.
Why Do We Need Interoperability?
The DHMSM program can further enable the Military Health System (MHS) to provide better care for its beneficiaries by effectively and efficiently sharing health information with other health systems. Continuing to advance interoperability is important because the more than 9.6 million beneficiaries in the MHS receive care at more than 1,230 locations across 16 countries, including 55 hospitals and medical centers, 352 ambulatory care clinics, 282 dental clinics and more than 300 expeditionary units. Additionally, approximately 60 percent of care is provided by external sources, including private hospitals, community clinics and VA hospitals.
We have an important challenge to remove the burden of coordinating the patient records from the patients’ shoulders. People shouldn’t have to carry paper copies of their medical records from deployment to deployment, from one doctor’s office to the next. Their records should digitally follow them wherever they go, and to any care provider they choose.
Furthermore, achieving full semantic interoperability opens up significant opportunities to improve quality of care, including:
- Improving coordination of care between providers, making it easier to manage chronic or complex conditions through access to all of a patient’s health information.
- Offering automated, real-time clinical decision support to care providers.
- Capturing consistent data, which can be better analyzed to make care decisions and identify trends or potential efficiencies and improvements.
- Supporting automated bio-surveillance and disease surveillance by local, state and federal public health agencies.
- Providing patient and medical information electronically for secondary uses, such as populating immunization registries, supporting disability claims determination and compliance with mandatory state and federal reporting.
Interoperability from the Leidos Partnership for Defense Health
The Leidos Partnership for Defense Health was created to bring together the global expertise and presence of Leidos, Accenture, Cerner and Henry Schein to further support and continue to serve the defense community. Our interoperable, easy-to-use solution will connect the continuum of care from the battlefield to acute care and outpatient environments, both domestically and abroad. Our experience in executing interoperable EHR solutions at the scale required for the DHMSM program is extensive and proven.
Leidos has in-depth knowledge and experience with similar programs, including work on the Armed Forces Health Longitudinal Technology Application/Composite Health Care System, the Veterans Health Information Systems and Technology Architecture (VistA), and the development of a health information exchange solution for the Social Security Administration that enabled doctors and hospitals to gather the medical information necessary to process the 15 million disability applications received each year. Leidos is also working with the Centers for Disease Control and Prevention (CDC) to support the National Healthcare Safety Network, a nationwide, interoperable system designed to improve patient safety and reduce or eliminate healthcare associated infections (HAIs). NHSN is the official HAI reporting system of record for 22 states and the Centers for Medicare and Medicaid Services’ Hospital Inpatient Quality Reporting (HIQR) program. Leidos’ healthcare interoperability experts assigned to NHSN provide solutions and technical support to EHR and infection control system vendors on developing and implementing secure, standards-based interoperability with NHSN on behalf of healthcare providers.
Cerner’s leadership role in advancing interoperability in the health IT industry goes back almost a decade. In 2005, Cerner reached out to competing health IT companies to co-fund RAND research on the need for a national patient identification system, something that would solve a major barrier to safe nationwide interoperability. Since that time, Cerner has contributed substantial intellectual capital and intellectual property to advance the cause of interoperability. One example of Cerner’s commitment was the contribution of more than 150,000 lines of code to Direct, an open-source secure email protocol that providers can use to talk to other providers outside of their institution. The solution has been effective, and is part of Meaningful Use requirements. Additionally, Cerner is one of the co-founders of CommonWell Health Alliance, a vendor-led collaborative committed to achieving ubiquitous, nationwide interoperability, by solving the problem of the missing national patient identifier. Cerner continues to demonstrate its commitment to interoperability by contributing intellectual property to new standards, like HL7’s FHIR that allow for easy access to health information regardless of the underlying technology platform. Cerner has consistently advocated for initiatives like these through its participation in federal and industry advisory committees like HIMSS Electronic Health Record Association (EHRA). In addition to industry leadership, the company is a trusted provider of EHR solutions, supporting HIEs in the United States, United Kingdom and Middle East, and, in the US, is connected to more than 40 state immunization registries. To facilitate the exchange of information, Cerner currently connects to more than 120 other EHR vendors. Black Book rated Cerner as the No. 1 inpatient Electronic Health Records/Health Information Exchange (EHR/HIE) provider1, and Chilmark named Cerner as the only major EHR vendor with an HIE solution that truly embraces multi-vendor interoperability2.
Accenture is the largest EHR integrator in the world with experience implementing nationwide EHR systems for Singapore, Australia and Norway. In Singapore, Accenture built a national electronic health record (NEHR) system, enabling a common access point for over 36,000 healthcare providers and its population of more than 5 million. Accenture is currently working with Australia’s Department of Health and Ageing to deploy the country’s Personally Controlled Electronic Health Record (PCEHR) system—an initiative that spans all Australia-based health systems and will provide over 21 million patients with a single record to manage care. Accenture is also deploying a national EHR system in Norway that will securely maintain personal medical history information for more than a million patients under the national health program.
Henry Schein Practice Solutions offers the leading dental software solutions in the United States and Canada. Its public health software, Dentrix Enterprise, interoperates with more than 40 medical solutions through the HL7 standard. These interfaces have been replicated hundreds of times in community health centers, federally qualified health centers, correctional facilities and hospitals throughout the country. Henry Schein participated in the HIMSS 2014 Interoperability Showcase to promote integrations, to increase staff efficiency and improve patient information exchange. With a presence in more than 25 countries worldwide, Henry Schein truly understands global deployment of programs and systems.
1 “State of the Enterprise Health Information Exchange Industry.” BLACK BOOK MARKET RESEARCH 2014 USER SURVEY. (2014): 62. Print2 “2013 HIE Market Trends Report.” Chilmark Research. (2013): 112. Print