According to Ms. Kanta Masand, Jaslok Hospital’s managing trustee, the Patient Portal-integrated Napier EHR^m product will be leveraged for fostering physician-patient relationship improving overall care quality. Stating that Napier had been a strategic partner over the years in their growth, Kantha added that availability of the solution on mobile devices would enable the hospital to utilize it for all operational purposes.

Napier EHR^m consists of functionality and features that takes care of Admission, Discharge, and Transfer (ADT) cycle. It also encompasses core hospital information system, laboratory information system, and electronic medical records apart from serving over half-a-dozen specialties. The open-source solution also enables seamless flow of information across different technology platforms and is scalable. The mobile platform connects physicians, hospital workforce, and patients in real-time to enhance quality of care via greater transparency and cost-effectiveness.

Commenting further on the Napier EHR^m product, Jaslok Hospital’s Chief Information Officer, Ms. Viloo Williams, said that it would decrease the Total Cost of Ownership (TCO) due to parameterization, flexibility, and modularity in acclimatizing to the process changes easily.

Expressing happiness over the company’s growing relationship with Jaslok Hospital, Napier Healthcare Solutions, CEO Karthik Tirupathi, felt that the mobile solution upgrade endorses their product development strategy to utilize the latest web and mobile technologies.

Established in 1996, Napier Healthcare is an ISO 9001:2008, ISO 27001:2005 certified, HIPAA compliant company serving providers ranging from tertiary, secondary, and primary care to home, rural, and urban care. Located in Middle East, India, USA, and Africa, the company provides Hospital, Ambulatory, Mobility Healthcare, Public Sector, and Specialty Solutions, apart from Napier EHR^m. The company has also won many awards such as IBM Beacon Award 2011- Best Industry Solution for Healthcare, Frost & Sullivan- Hospital Information Company of the year 2010 and Frost & Sullivan- Healthcare IT Company of the year 2011.

This speech recognition solution consists of features like vSync technology (establishes a virtual channel to keep dictation client and EHR constantly synchronized), user login and password capabilities, and server-based management of Profile Optimization software. Providing dictation services on Citrix-based EHRs, it allows the providers to dictate directly or type into EHRS, while allowing them to play back, voice-edit or navigate dictation levering Full Text Control feature of the Dragon Medical 360 | Network Edition.

With this new speech recognition solution, clinicians will be able to generate or update medical notes using their own voice, and include it into the QuadraMed’s hospital information system. This is expected to enhance the documentation level, help in transitioning to a paperless environment, and lower administrative costs by reducing the need for clerical support services like transcription.

In order ensure quick adoption of the solution, it will be rolled out in a single, coordinated way using the ‘train the trainer’ method. Doctors in every unit are expected to leverage this new system while documentation will be stored and managed centrally. Expected to go on for eight weeks, the project will also allow close monitoring of the student’s academic progress.

The delivery of this first site license version installation of Nuance solution in Middle East provides King Fahd University Hospital with great security of service and support, according to Sassine Mazraani, CEO of Emerging Technologies, which will deploy as well as provide training, and ongoing support for this project, working closely with QuadraMed. Mazraani also says that the company wants to demonstrate the potential of speech recognition in accelerating the treatment process and lowering the length of hospital stay by reducing the waiting time for retrieving important medical data. Elaborating further, Mazraani adds that they are looking forward to improve the hospital’s treatment outcomes, diagnostic reliability, and decision making through Nuance’s platform.

Further, Lincoln Payne, Director of Nuance Healthcare’s Middle East Sales, stated that the current deployment agreement is a major milestone for the company, doctors, and patients.

Nuance Healthcare, a division of Burlington, MA-based Nuance Communications, Inc., provides clinical understanding solutions that capture patient medical information and transform it into meaningful, actionable data. It also provides test results management, transcription services, mobile solutions, radiology solutions, data analytic solutions, speech recognition, and HIM solutions.

Utilizing MEHRS/eScript free of cost, providers can access an ePrescribing system (a solution that allows authorized providers to prescribe cost-effective and safe medicines from their personal systems), web-based EHR, and hospital discharge data, based on the Medicaid claims. Apart from this, radiology and lab test reports will also be made available in future. By providing access to patients’ health data at the point of care, MEHRS/eScript helps in avoiding medical mistakes, reducing duplicate procedures, and making informed clinical decision.

Explaining the current contract with the State of Mississippi Medicaid, Mike Gallagher, Chairman of MedeAnalytics, remarks that the state’s information landscape as complex, with numerous access points for patients. He also expressed excitement in aiding the state to alleviate rising costs and enhance quality.

MedeAnaytics’ Accountable Care Solution, complies with the final rules for the Medicare Shared Savings Program and leading commercial accountable care organizations (ACOs) specifications. Additionally, it also consists of change management expertise, analytic technology, and scalable administrative and clinical integration technology. The solution also allows coordination of care, cost reduction, and population health management.

Established in 1994, Emeryville, CA-based MedeAnalytics serves more than 850 healthcare facilities by providing solutions for physicians, payors, and hospitals. The company also provides revenue cycle and Performance Management consulting services.

Region Skane manages and communicates radiology images (PACS) and patient data (radiology information system) leveraging complete solutions from Sectra. A hospital department’s ability to manage and share both images as well as data with other units is vital for ensuring quality care as most patients will undergo a diagnostic imaging procedure at some point during their treatment period.

Currently, Region Skane has undertaken a new project to integrate all examination and patient information within the diagnostic imaging operations, similar to the way in which medical image management was coordinated three years ago.

Throwing more light on the current project, Peter Leander, Region Skane’s regional chief medical officer and senior physician, stated that they are in the process of migrating eight databases into a single one with support from Sectra’s IT experts, and simultaneously updating the server hardware in order to better coordinate and integrate examinations performed in the departments.

As per the current agreement, Sectra will also provide Region Skane with products that allow secure exchange of data and images with private caregivers and other county councils. Services such as radiation dose monitoring (Sectra DoseTrack), and dictation with speech recognition are also part of the contract.

Founded in 1978, Linkoping, Sweden-based, Sectra is located across 12 nations and offers its clients both medical and secure communication systems. The company provides IT solutions for rheumatology, radiology, osteoporosis, and orthopedics to over 1400 hospitals, imaging centers, and clinics across the globe by employing more than 500 employees. For the fiscal year 2011-12, the company’s net income was recorded to be SEK 833.676 million.

With accountable care developing rapidly, the report says that there exists an uncertainty regarding the industry’s capability in meeting its goals of enhancing patient experience, improving population health, and managing economical growth. Failure in the past to control costs and better quality through capitation and withholds programs can be attributed partly to insufficient retrospective data and a data format not useful for doctors. However, the ability to normalize, move, and analyze data much more robustly than it was 20 years ago, gives a lot of optimism and benefits for 2013 and beyond.

Commenting on the role of data in accountable care, Research Director of Accountable Care IT Strategies, IDC Health Insights, Cynthia Burghard finds access to comprehensive, timely, appropriate, accurate, and understandable information to be the lynchpin for success of accountable care. Cynthia also says that discussion with technology vendors and healthcare leaders, and survey results point analytics to be a top most investment priority for healthcare facilities involved in accountable care.

Although providers, when compared to payors, lag behind in technology investments, the report finds both to have similar priorities in analytics investments for population health management.

As per the new report, the top four capabilities for which analytics is used by healthcare setups are as follows:

• Identification of patients or people requiring care management. With 66% respondents of IDC Health Insights’ 2012 Accountable Care Survey stating this, it was the most frequently used method of planned analysis.
• Analyzing clinical outcomes as well as performance measurement and management were the second most common type of planned analysis with each mentioned by 64% of the survey respondents.
• Clinical decision-making at point of care was the third most frequently used type of planned analysis with 57% of the respondents citing so.

Some of the other key findings, apart from the above mentioned, include:

• New data sources and advanced analytics are being accepted by healthcare entities. IDC’s 2012 Global Technology and Industry Research Organization IT Survey participants have reported investments in advance analytics (social graph analysis, text mining, and streaming data monitoring and analysis) for the year 2013 as a priority.
• Data sources cited by the respondents indicate good opportunity for analytics. These include data types such as clinical structured data (73%), care management data (70%), claims (57%), etc, that are required for identifying and managing patients having chronic diseases or via wellness programs.
• Usage of new sources of information to support accountable care. Although the respondent’s percentage is low, the survey indicates a willingness to invest in novel sources of data like social media (32%), unstructured clinical information (29%), and mobile devices (42%). Also, health plans were found to be interested in new sources of data when compared to hospitals.
• The IDC Health Insights 2012 Accountable. The 2012 survey included 30 health plans and 40 hospitals and found that 75% of health plans willing to invest in between $1 million to $10 million, while hospitals intended to invest less than $1 million.

According to a 2013 Accenture and eHealth Initiative survey, accountable care organizations (ACOs) are adopting different methods for implementing IT and analytics in order to realize their goals. While only 40% of ACOs notice major advantages of analytics, like identifying high-risk procedures, improving patient safety, and increasing operational efficiency, most of the organizations find that the primary benefit of analytics has been in helping them to realize basic priorities such as decreasing gaps in care (84%), reducing hospital readmission rates (72%), and enhancing clinical outcomes (72%). However, shortage of trained staff and lack of clinical integration was found to be the primary barrier for utilizing analytics followed by inability of the existing infrastructure to support analytical tools. Certain providers also expressed concerns about the accuracy of algorithms and analytics, and the extent to which their institutions would protect their liability should there be a data breach.

With analytics paving the way for organizations to meet the accountable care program’s objectives, the 2012 Accenture report advises ACOs to prioritize their HIT requirements and identify ways in which analytics should be applied to care, population health, management, and administration. Implementation of solutions that are scalable and having robust architecture for providing different services is also suggested for ACOs.

Established in 1996, iMDsoft has offices in the US, Netherlands, Germany, Australia, and Israel and is part of the TPG Growth, an investment company concerned with growth equity and middle market transactions. The company’s flagship product, MetaVision, is a suite of solutions that gather, document, evaluate, report, and store hospital generated patient information, and provide workflow for entire care continuum.

Catering to the demands of IT professionals, clinicians, and executives, MetaVision provides solutions for infrastructure, decision support, real-time data access, protocol enforcement and care standardization, research & analysis, acute, perioperative, and critical care. It is also interoperable with medical devices and hospital information systems.

Released under MetaVision’s critical care solutions, MVpanorama provides important administrative, demographic, and clinical data. Thus, it bridges the gap between challenges of managing acute and critical care departments and patient-oriented health records.

Prioritizing events based on set specifications, MVpanorama, allows clinicians to identify patients needing immediate attention to initiate necessary action. By allowing care givers to isolate nursing jobs and medication administration that are due, it also facilitates timely completion of the tasks. Further, by providing an overview of the unit, it enables provider organizations to improvise its nursing resource allocation. With various layouts that are designed to assist individual workflow, the solution can be easily customized to meet specific demands of each unit. Additionally, it also enables easy recognition and completion of administrative tasks of ICU patients (discharge and demographic data).

According to iMDsoft’s CEO, David Sides, MVpanorama provides clinicians an overview of operational and clinical status of the unit and is vital for care management across patient communities.

With a strong network of safe portable water delivery spots spread across numerous villages and tier 4 towns of southern Punjab, and through the video-conferencing facility enabled at these points, the company enables families collecting water to consult a physician from Max Healthcare.

According to Amit Jain, CEO of HealthPoint Services, India, the whole idea of the project is providing quality, affordable healthcare services to rural locations at as low as Rs. 30 per consultation. He also said that the collaboration would initially focus on the 400 villages and towns in their catchment area. With Max Healthcare having a super specialty hospital in Bhatinda, regions around it will be in focus.

Stating that the program will be reviewed once in three months, Max Healthcare CEO, Ajay Bakshi added that if found successful, it would be replicated in other healthcare organizations located in regions such as Uttarakhand and Noida.

He also believes that the venture will illustrate the ability of social entrepreneurship and successful utilization of technology in establishing a scalable model that offers primary healthcare services and clean water from a single point in a small town or village.

The 1900 bedded Max healthcare has 12 healthcare facilities in Punjab, Uttarakhand, and Delhi. Employing more than 5,400 support staff and 1,600 physicians, it provides a wide range of specialty care (pediatrics, cardiac sciences, neurosciences, IVF, urology, etc). Max Healthcare is also planning to expand its online services globally and is looking for a partner for the same.

Apart from Maxhealthcare, many hospitals such as Apollo and Fortis have also ventured into the online market. Fortis, in collaboration with GE, offers patients in small towns critical care via an electronic remote monitoring program, CritiNext.

Pricewaterhouse-Coopers’ executive director and leader, health care practice, says that online healthcare services are doing very well in the western world, and the current focus is on India. On the same note, Indian Economic Survey 2012-13 also emphasizes a greater focus on online healthcare delivery system and telemedicine segments.

According to the Senior Director of Health Care Asia, Microsoft, Gabe Rijpma, the organization enables medical practice to switch from a provider-centric piecework to patient-centric joint effort by providing productivity solutions that are cloud-based and integrated with numerous form factors. Expecting the company’s joint venture with Wipro to hasten healthcare transformation in India and across the globe, Gabe says the solution would assist providers in catering to the demands of an evolving healthcare scenario. Citing Wipro AssureHealth platform, Gabe said that it is a good illustration of the way company’s technology platforms (.NET, SQL, Windows Server, etc), integrated with a host of devices on Windows 8, are aiding in resolving social problems.

Elucidating further, Chief Technology Officer, Wipro Infotech, India and Middle East, T. K. Padmanabha states that the AssureHealth platform along with Microsoft platform stack may aid care providers in creating new revenue sources. Additionally, in the current healthcare scenario where medical services are working towards achieving patient satisfaction by effectively utilizing their resources, Padmanabha finds mobility-assisted medical technology to be crucial in saving time and improving productivity and convenience for patients and doctors, and thereby enhance care and reduce costs.

Wipro AssureHealth platform, leveraging Microsoft’s Mobility, Cloud and Analytics products, enables regular and accurate monitoring of patients through mobile applications and hosted services that integrate IT infrastructure, medical devices, and round the clock customer support, for providing highly scalable solutions.

The cardiac solution is designed to help cardiologists manage and monitor patients post cardiac procedures or the ones having myocardial infarction, cardiac failure, and angina in real-time via their hand held communication device (tablets or smartphones). It provides incessant ambulatory, wearable, and non-obtrusive ECG information to doctors. Thus, it eliminates frequent follow-up visits to out patient department, patient anxiety, and waiting time. It also helps in managing complications proactively by identifying them through intelligent analysis and by following an evidence-based approach to address them.

On the other hand the fetal monitoring services enable physicians to keep a watch on patients and offer better care by delivering uterine activity, as well as fetal and maternal heart rate recordings, captured from a fetal monitor, on to their mobile devices.

Commenting on the usefulness of the product, Medical Director of Manipal Hospital, Dr. H Sudarshan Ballal, says it is a wonderful union of technology and healthcare that allows a physician to remotely assess fetal condition, and initiate timely and necessary action. He was also optimistic about the product’s widespread utility in the future.

About Wipro Technologies
As a global IT business of Wipro Limited, Wipro Technologies provides wide range of services to its customers across 54 nations by employing more than 140,000 people. Wipro’s Centre of Excellence for eHealth initiatives develops novel solutions that address emerging market’s challenges. For developing solutions that address challenges of both accessibility and affordability, the eHealth Code of Ethics utilizes Wipro’s healthcare IT solutions and product engineering abilities.

Allscripts was selected by the center for its agility and integration its solutions, care coordination, and open architecture. According to Dr. Vinay Vaidya, Chief Medical Information Officer of the medical center, the hospital was not looking for a just another EHR, but a partner concentrating on quality, safety and regulatory outcomes that are specific to the center’s requirements and found Allscripts to satisfy the criteria.

As per agreement, the following solutions will be deployed at the medical center:

• Sunrise Financial Manager^TM: Driven by a visual workflow tool that supports current and future billing process needs (as required by different care delivery models), the solution offers functionality for billing revenue capture, and receivables management.
• Sunrise Ambulatory Care^TM: Contains customizable, easy-to-use documentation templates that enable complete and quick documentation of every patient encounter and automatically verifies physician orders with patient data present in an EHR. It also consists of Wellness & Immunization Manager, medical billing software, clinical decision support, and enables evaluation and management of coding and secure health messaging.
• Allscripts Community Record^TM: Developed in partnership company’s recent acquiree, dbMotion, Inc. (a provider of interoperability solution), it allows providers to access, view, and publish patient data to a single virtual patient record, allowing continuity of care and clinical partnerships even with disparate health information systems.

Remarking that a comprehensive view of each patient record would facilitate better care, Phoenix Children’s Hospital’s chief information officer, David Higginson states that they now have the flexibility to develop clinical projects vital to pediatric community leveraging Allscripts’ open platform.

Based in Chicago, IL and located across 46 locations, Allscripts caters to 1,500 hospitals, 180,000 physicians, 10,000 post acute care organizations, and employs more than 6,000 people. The company provides Ambulatory, Acute, Post Acute, Public Sector, and Community solutions, apart from Ambulatory and Acute add-ons. Strengthening its leadership position in consumer engagement, care coordination, and population health management, the company has also acquired Jardogs LLC, a provider of patient engagement solutions, apart from dbMotion, in March, 2013.

C.W. Corbijn van Willenswaard
Interoperability Architect
Philips Electronics India Limited

Before creating interoperable IT systems in healthcare, it is important to understand the meaning of interoperability. ‘Conceptual interoperability’ and ‘Data Information Knowledge Wisdom (DIKW) Pyramid’ are two terms used in a more generic context to indicate the exchange of data/information and its usage between different systems. DIKW Pyramid provides the basic difference between data and information.¹ Data is just a stream of bytes that is exchanged. It is turned into information by a system through addition of knowledge to the data.

Institute for Electrical and Electronics Engineering (IEEE) defines interoperability as “the ability of two or more systems or components to exchange information and to use the information that has been exchanged.”² According to the definition two systems just need to be able to use the data that is exchanged and turn it into information in their own functional context. This means interoperability depends on the functionality of the systems involved.

For example, Figure 1 shows the way IEEE interoperability definition looks in a standard web browser:

Figure 1: Information displayed in a standard web browser

When the same content is taken in the editor it appears like:

Figure 2: Information displayed in a text editor

Here, the text editor displays all the data including the text highlighting and the web browser turns it into information and displays it in a readable format. As many people cannot understand the full data with highlighting provided by the text editor, it shows the HTML structure only on request.

This everyday life example shows that information taken from internet requires systems to be interoperable. Given the dominance of a few big players in this area, it becomes relatively easy to validate web pages. However, considering the number of vendors involved and the larger variety of data in the healthcare environment, it almost seems impossible to handle interoperability in this sector.

Presence of different systems within a hospital and the fact that these very often are provided by different vendors makes it clear that the creation of interoperable systems is not a simple task. However, not all systems need to be interoperable and the expected functionality can also be different. The basic function of interoperability would be to display data in a correct, readable, and meaningful way on the target system.

For imaging systems, this would typically mean viewing the acquired images as on the acquisition station. A typical example of two systems not being interoperable for this is shown in Figure 3 and Figure 4. While the first image is the original one, the second is the one seen at the receiving system when all the data necessary for displaying it is not utilized. Depending on certain parameters, the result can vary from being almost completely black to completely white. Due to the changes in gray level, viewing and correct interpretation of the image may not be possible. This means, for basic viewing capabilities of medical images it is necessary to process a part of the dataset. Further processing of the dataset will require two systems to function at a higher level and indicate a next step in interoperability.

In this context, the image is part of a set acquired to determine the brain functionality. To create a corresponding functional map of the brain, the application needs more information from the dataset. The application must be able to recognize that this is a time series created to measure brain activity. Also, the data describing the time sequence and the way the brain was activated is needed. This means interpretation of the data, is again more complex. The result is however, an image that reveals more information to the user (Figure 5).

Figure 3: Original gray-scale image

Figure 4: Transferred gray-scale image

Figure 5: Processed image

Courtesy: Philips Electronics India Limited

When it comes to products, it is very important to decide on the means and extent to which interoperability can be supported because for many products interoperability is just one of the supporting features. Interoperability for data creating systems means focus on the external environment, in addition to the core activity of creating images. For receiving systems (archives and processing workstations), this is more a part of the core functionality as these images are part of the inputs that needs to be processed and interpreted by a clinician for diagnosis. As the integration of hospital systems is increasing, extension of system borders is gaining importance. Normally, development of a feature is dependent only on the developing organization; however, this is not the case for the interoperability feature.

Interoperability problem is neither new nor specific to healthcare. It is normally handled by standardizing interfaces. Standard interfaces used for the exchange of data will reduce the effort of implementation and validation by limiting the number of choices a vendor can make. With the use of standardized interfaces validation can focus on the implementation of the standard and will be independent of the systems using the data. There will however, still be the issue of different vendors having different interpretations of the standard that makes validation not straightforward. This is applicable for all standardized interfaces, but the wide range of products in healthcare results in a large variety of data using the interfaces. Hence, testing interoperability with a set of real products will be necessary.

Achieving Interoperability
There are two major mechanisms used to achieve interoperable IT systems in healthcare:
standardization of interfaces and content, and validation of the systems as early and broadly as possible.

Standardization
Standardization is an important requirement to achieve interoperability at a reasonable expense and effort. Interoperability can be achieved using globally defined standards. The three major standards used in the healthcare environment are:

• Health Level Seven International (HL7): Having members in over 55 countries, HL7 focuses on creating standards for the exchange, management and integration of electronic healthcare information.³
• Digital Imaging and Communication in Medicine (DICOM): It is an international standard for the storage and exchange of medical images and related information. It specifies the format for exchanging images and quality for its clinical utilization.⁴ With many global companies, users and general organizations associated with DICOM, it is possible to create a standard that is defined by producers and users.
• Integrating the Healthcare Enterprise (IHE): It is a consortium of healthcare industry and professionals to improve the way systems share information. While HL7 and DICOM supply the means (connectivity), IHE describes the workflows (interoperability) in a hospital.⁵ By describing the workflows it bridges the gap between the generic descriptions in the HL7 and DICOM standard and the real-time usage. IHE is focusing on the cooperation of different products by defining the functions and data used by the products in a specific workflow. These hospital workflows are described in profiles. Each profile is describing a specific workflow in the hospital and limits the options available in the HL7 and DICOM standard. Thus, IHE specifies a method to establish interoperability between different IT systems in a hospital based on available standards.

Below figure represents different standards used in a hospital for achieving interoperability among various systems.

Figure 6: Different standards used in a hospital

Participating in these three standardization organizations is very important for a vendor to achieve interoperability of their products. By participating in different workgroups of these organizations vendors can:

• Contribute to the definition of standards
• Keep standards in-line with their products. New developments in standards will mostly be evolutionary and the resultant changes can most likely be implemented in an easy way. It can, however, take a lot of effort as some updates are extensions to the standards.
• Get early information that can influence their roadmaps and products
• Discussions in the work groups reveal different ways of interpreting a standard, which can be accepted or could need a description to make clear which one to use. By taking care of multiple interpretations before releasing the product, the vendor can avoid customer annoyance and the need to fix problems in the field.

Validation
Products will be validated against the applicable interoperability claims, which can be:

• HL7 Claim
• DICOM Conformance Statement
• IHE Integration Statement

While IHE Integration Statement provides an overview of the IHE profiles supported by the system, HL7 claim and the DICOM conformance statement are documents describing the capabilities of the system. The interfaces used by the system are described in a standard way by HL7 and DICOM. Since most interfaces have different functional options, the choices made for these optional elements are also described.

Additionally, there is a description of the data model and data elements. Currently, most of the systems support either HL7 and/or DICOM (only systems that are working at both the hospital and the imaging level have to support both).

All three claims are made and validated by the vendor. For the IHE statement, vendors can validate their product against those of other vendors in accordance with specific IHE profiles at ‘IHE Connectathon Test Sessions’, an event hosted by IHE at several places in the world, throughout the year. Major events are those of the USA, Europe, and Asia. The set of vendors participating in these events vary per region as most of the events witness participation of local vendors and as such rotating the participation of the different events is very beneficial for many global vendors. Thousands of validation tests will be performed at the event and many errors will be identified, which are very often solved during the event itself to pass the IHE profile.⁶
The main advantage of this event is that it provides an opportunity to validate the products’ interoperability against systems it will face in the field before releasing them into the market. From a business point of view this will have following benefits:

• High customer satisfaction as fewer defects reach the customer. If the defects reach the hospital, then the effect is directly visible through lost hours or extra hours for workarounds.
• Save a lot of time and money spent on fixing the issues at customer site. Solving defects at the event is easier as involved systems and engineering knowledge are readily available. This could be very difficult or almost impossible to arrange when the products are released and the problem shows up at the customer’s place.

Figure 7⁷ provides an overview on the cost of defect fixing and thus, demonstrates the advantages of early validation

Figure 7: Cost of fixing defects at various stages

With the cost of fixing a defect expected to increase by more than 150 times at the operations phase, as shown in the above graph, it is beneficial to identify the defects prior to the product release by participating in the ‘IHE Connectathon’ series.

Last year a Testathon was organized in Bangalore India as a trial as there is no Connectathon yet in India. Although smaller than the formal Connectathon, it showed that it is a very useful mechanism as most of the vendors found issues in their interoperability interfaces. With many large companies having development processes in India, Testathon might further bring down cost as traveling is minimized. Commenting on the role of Testathon in improving the overall productivity of the healthcare industry, Mr. A Vijayarajan, CEO Clintics & President HIMSS India said that “Interoperability not only streamlines workflow and enhances quality of care but improves the overall productivity in the hospital. This is an important first step needed by all in the Healthcare Ecosystem.” ⁸

As interoperability is still an evolving feature for most of the systems, standards may change with new insights. The main reason for the evolving interoperability features is that most of the products are still in the transition phase from standalone systems to being part of a fully integrated environment and requires a change in mentality for product developers. In a hospital, product is no longer the main system; it is just a part of the larger system called hospital workflow. So the hospital workflow system could be described as the combination of different products working seamlessly together.

Most of the products are capable of sending all the data they contain, but the hospital workflow might not be optimal if it cannot use all the available data as information. Hence, there is a need to look at the overall hospital workflow and figure out which information is missing. Standardization will need to make sure that this can be done with minimum impact for the different products.

Questions which pop up during this process are:

• Can a generic pattern be identified for the workflows that need to be standardized?
• Is the workflow pattern the same for all hospitals/countries and if yes, can it be used to mitigate the differences by making changes in the configuration of systems?
• What does it take to fit products into the hospital’s workflows?
• What does it take for the products in a workflow to use and supply the extra information needed for smooth interoperability?
• What happens when the data is sent to a picture archiving and communication system (PACS) and then forwarded to a viewing/processing station?

The future course of interoperability is an interesting and challenging subject to discuss. With so many companies involved, there will be different views and it will take several years to develop a standard. The time to implement the standards in hospitals will be even longer as cost and safety do not allow changes to occur overnight. It is a very big challenge to create interoperable systems in healthcare, taking into account factors like cost cuts, quality improvement, and increased number of patients.

References