Jay Rath
The problem of healthcare interoperability begins at the patient’s bedside.
Imagine a patient in intensive care. Close at hand may be an infusion pump, a ventilator, a pulse oximeter and other devices.
“They’re surrounded by some of the most sophisticated equipment you can possibly find, concentrated in a small location,” says Aaron Goldmuntz. “They often don’t share data amongst each other, which could really be beneficial in treating that patient. They rarely share the same clock time.”
Fixing all this is the work of the Center for Medical Interoperability, which in April opened its doors in Nashville.
The non-profit was created in 2011. Its new headquarters features a variety of lab and other spaces specifically designed to engender creativity, and even recreate the patient experience.
“You can interject all the noise of what it’s like to be in an operating or intensive care environment, with some of the beeps and whirrs,” says Goldmuntz, the center’s vice president for business development and finance.
The center is a research and development lab. It hosts visiting engineers and technical experts. With staff, they work together to develop IT architectures, interfaces and specifications that can be consistently deployed by health systems, medical device manufacturers, electronic health record vendors and others.
The center currently has around a dozen employees, but it has expansion space to accommodate 100 in all; most of those will engineers.
Only Snippets of Information
The problem of bedside interoperability cascades into other systems. For example, “there’s a tremendous amount of data that’s captured within the electronic medical record, and more and more data from medical devices,” says Goldmuntz. “EMRs work to capture some of that information, but they typically capture only snippets.”
This is happening during an era, by contrast, in which you can get real-time data to help you effectively navigate through a large city.
“Then think about the amount of patient data that’s being collected that’s not being shared or transmitted, that could really help you navigate the healthcare system,” he says. “That’s what we’re trying to do.”
The ultimate goal is a “plug-and-play” environment for healthcare, in which there is assured interoperability and connectivity inside and outside the hospital.
The center doesn’t lobby, and while it has a learning space, it plays a limited educational role. “It’s very much a technical organization,” explains Goldmuntz. “We’re not developing any products. What we’re working on is defining what the appropriate specifications [for medical devices] would be.”
Similar to Underwriters Laboratories Inc., “we’ll then serve as a testing certification body to show adherence to those specifications.”
Vendors are welcome to visit the center. In fact, one of the facility’s missions is to work with vendors to help define specifications. However, only hospitals and health systems or organizations in the continuum of care are allowed to become members.
“The power lies within the hospitals and health systems that are buying equipment,” says Goldmuntz. “Gathering them to speak with one voice will help define specifications.”
The center does not take contributions from vendors so that it may remain vendor agnostic. However, “we’d welcome any vendor, such as Epic and Moxe, for example, to participate in technical engagements. We have a number of work groups where we directly engage in the vendor community to contribute and participate.”
The center imposes an “appropriate” structure of intellectual property rights.
Security Great Concern of Interoperability
The much ballyhooed “internet of things” has arrived, and provider systems are early adopters.
“That happens more and more in the hospital,” says Goldmuntz. “And more and more vendors are coming to the hospital with connected devices — which is great, but they have to tie-in in and appropriate way.”
Cybersecurity is a big concern. “I don’t want to raise the alarm that everything’s not secure,” he says. “But can they be improved upon? Absolutely.”
Different methods of transmission have different vulnerabilities. These days a lot of networking is wireless. “Oftentimes those aren’t managed appropriately,” he says, “both the technologies that are connecting as well as the overall architecture of the system that manages it.”
Vulnerabilities arise at data touch-points. “Oftentimes you have different network nodes from different equipment that’s entering the network,” he says. “Those have the potential to create vulnerability points.”
That’s an issue that the center is taking very seriously. Some of its foundational work focuses on identity and authentication of connected devices.
“What follows then is how that data is transmitted in a secure way,” says Goldmuntz. “Wireless is a fundamental part of that. Having proprietary medical information that can flow effectively –versus other enterprise or commercial data — all that can be managed very effectively with the right architecture.”
So far, he says, the center has enjoyed strong and broad engagement from the vendor community.
“We really intend to be an open organization, a transparent organization,” says Goldmuntz. “If others are interested in participating with us, we welcome the opportunity to do so, whether it’s a health system that wants to become a member, or a vendor that wants to participate in some of our work.”
In the end, he says, “When you think about what we’re doing, it’s really about plumbing: making sure that the data flows effectively and securely to the right place.
“But that’s not the real innovation. The real innovation is what you do with that data, to transform care, and make that useful. We are patient-focused organization. We never want to lose sight of that.”
The center is a joint initiative of some of the largest for-profit, not-for-profit and academic health systems in the United States, including – such as Ascension Health, Community Health Systems, Hospital Corporation of America, LifePoint Health and Vanderbilt University Medical Center.