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Making Genuine Healthcare Interoperability Possible

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"The biggest hurdle for #interoperability is the lack of a unified approach for requirements-based purchasing @JHUAPL"

Interoperability, or the ability of IT systems and devices to exchange data and interpret that shared data, has been a frustrating and costly challenge for the healthcare system. The lack of interoperability has created significant barriers to providing optimal care and achieving better patient outcomes. To better understand the obstacles preventing healthcare interoperability, Johns Hopkins Medicine and Johns Hopkins Applied Physics have joined forces – combining their engineering and medical resources to tackle one of the biggest issues in healthcare today. In this Q&A, we learn more about this forward-thinking collaboration and the challenges to making genuine health interoperability possible.

What challenges in the healthcare industry led Johns Hopkins Medicine (JHM) to partner with the Johns Hopkins Applied Physics Laboratory (APL)?

JHM and APL have collaborated on biomedical research initiatives beginning as early as 1965. These collaborations ranged from development of new clinical devices and clinical systems engineering, to face transplants and advanced prosthetic technology. But in 2011, the two institutions strategically joined forces to leverage the full spectrum of resources across JHM and APL.

The JHM/APL partnership focuses on improving the prediction, prevention, diagnosis, and treatment of illness, injury, and disease by leveraging systems-engineering principles and applying them to better understand individual health determinants. We are looking at the delivery of healthcare with the goal of re-engineering healthcare systems through improvements in the quality of care and reductions in error and costs.

Additionally, our National Health Mission Area (a part of APL) is focused on revolutionizing health through science and engineering. It was created to harness the power of the applied research, systems engineering, and technical expertise at APL with the clinical research capabilities of Johns Hopkins Medicine. The new Mission Area leverages APL’s established track record in areas such as biomechanics and injury mitigation systems, health surveillance, health systems optimization, and advanced neurally controlled prosthetics to support civilian and warfighter health.

What has surprised your team about tackling the interoperability challenge in healthcare and what have you identified as the biggest hurdle?

Systems engineering is a central tenet of much of the work done at APL. It has contributed to our past jaw-dropping achievements, such as sending a spacecraft on a nine-year voyage to Pluto and designing nuclear submarine systems. These projects would not have succeeded without clearly defined, measurable goals and a rigorous approach for achieving them. If there were any surprises in our healthcare work, it was the degree to which we could apply these same principals to tackle healthcare challenges. For instance, with Project Emerge – a systems-engineering project focused on eliminating preventable harm, we guided patients, family members, clinicians, and researchers from nearly 20 healthcare-related disciplines through an exhaustive process of defining our goals, understanding our priorities, listing the functions that the system must perform, and determining measures of success. These discussions led us to set the goal of reducing seven of the most common and serious preventable harms facing ICU patients. Our solution was a system that integrates data from several sources into one easy-to-read computer display – a display that served the needs of clinicians and patients. It combined data from existing technologies, such as the electronic patient record, with new ones, such as sensors that track patient activity or the angle of a bed. In the same way that pilots get all essential information in cockpit displays, Emerge lets clinicians quickly see if patients are getting all the care necessary to prevent the seven harms. This project was significant in demonstrating the value in creating a system that focuses on specific objectives or requirements including those of clinicians and patients.

We believe the biggest hurdle for the interoperability challenge in healthcare is the lack of a unified approach for requirements-based purchasing. A key difference between the way the Department of Defense (DoD) purchases equipment for warfighting applications and the way civilian healthcare providers purchase equipment is that DoD specifically states which attributes or characteristics the equipment they are considering must possess. They then select only from those providers whose product meets those requirements. In civilian healthcare, purchasers do not have the ability to drive industry in the same way since each hospital or clinic is a small fraction of the overall market base. To achieve similar results in civilian healthcare systems, the major health centers and institutions must come together to agree on a unified approach for requirements-based purchasing.

How do you see the potential outcome/s of the research integrating into everyday clinical practice? How might they impact industry stakeholders?

By harnessing our resources, opportunities exist for JHM and APL to impact healthcare, ranging from better understanding, identification, and treatment of illness, infection, injury, and disease, to the development of new technologies and identification of new processes to improve overall health and well-being. Our partnership is to not only focus on research and new discoveries, but also on the translation of those discoveries to clinical practice. Whether the translation is in the warfighting domain (where our soldiers, sailors, marines and airmen will leverage the best new solutions to improve their health and minimize their chances of injury or disease), or hospitals (where we will have integrated systems and solutions to ensure human-induced errors are eliminated and patients receive the treatment they need), we are singularly focused on ensuring our work has direct impact on better care for individuals and populations in our nation and across the world.

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