Written By

Jim VanderMey



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January 22, 2019

The State of Interoperability in Healthcare

Interoperability in Healthcare

The National Academy of Medicine (NAM) recently published a significant document that I am recommending to every CIO/CTO in healthcare as well as informing what I do as a newly appointed commissioner on the State of Michigan Health IT Commission.

The paper was written by a thoughtful group of scientists, physicians, and leaders from John Hopkins, Emory, DoD, VA, Mass General, ONC, Anthem, NIST and staff of the National Academy of Medicine.

As a CIO or CTO in healthcare, you know that one of the most challenging but necessary requirements in providing high-quality care is the interoperability between systems, technology, and data. It’s a problem that creates barriers in delivering patient outcomes and not a simple one to solve.

The thesis of the NAM’s document is that the interoperability problem can be addressed by a commitment to standards and data mobility that transcend individual technology purchases and is made a primary value when contracting or acquiring healthcare technology. By raising interoperability as a primary piece of criteria for decision-making and contracting, provider organizations can use the power of the market to begin moving the needle of what has become a systemic issue in the US healthcare system.

We begin by recognizing that interoperability works at a variety of layers.  The lower levels are easier to accomplish by technologists. The higher layers require significant process and people effort at the business level.

Levels of Health IT Interoperability

“True interoperability is the ability to seamlessly and automatically deliver data when and where it is needed under a trusted network without political, technical, or financial blocking.”

In the moment of clinical decision making, it is critical to have access to all the information needed to make the right decision at the right time for the right person.

The challenge for senior leaders and enterprise architects is to create and foster a vision of interoperability that is not based upon everyone using a single homogeneous system, but rather upon having data portability and sharing that enables patients to receive care over time, across a continuum.

I have worked in healthcare for almost 40 years in various environments: payer, long-term care, physician offices, home infusion therapy, delivery systems, innovative startups and large IDNs. Patients and members move through systems and providers because of changes in insurance, geography, job changes, physician retirement, or simple proximity and access. This is defined as Macro-level integration and is performed by lab providers, HIEs, or other system to system integrations. But as I’ve had conversations with healthcare systems across the country, many organizations are receiving and sending thousands to tens of thousands faxes every day to share patient information across disparate healthcare systems. Data integration, risk models and coordinating care is very difficult to perform without stronger macro-level integration.

Macro-tier Inter-facility Infographic

An interesting contribution of this document from NAM is the movement from Macro-tier community data sharing to Meso-tier within a system to Micro-tier at the point of care. OST is working on IoT initiatives with healthcare product companies that will impact the micro-tier integration, but what I constantly want to challenge our teams working in this space (and our customers) is how we will address integration at the higher-tiers and into the EHRs and provider workflows.

We are still far from the standards and ability to integrate up and down the stack, across the community, for the life of the patient.  But the NAM has given great guidance and should be required reading for anyone procuring or building Healthcare IT solutions.

Here’s a direct link to download the report:

Let me know what you think. I want to find a health system interested in doing this — for the sake of our patients.

It won’t happen unless we do it.

Disaster Recovery for Healthcare

A data center fire isn’t a good scenario for any business. But in healthcare, critical systems being down can have a truly negative impact on patients, the community and the business.



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About the Author

Jim VanderMey is the Chief Innovation Officer for OST. Jim has provided the technical leadership and product strategic planning for the organization since the very beginning. Jim is a technology visionary who sets the long and short-term direction for OST. He specializes in seeing the “big picture” of technology, the computer industry, and the business objectives supported by IT. As OST has gained an international reputation, Jim has taught and spoken at conferences in Europe, Japan, and throughout North America.

Jim attended the Grand Rapids School of Bible and Music as a pastoral ministries major, and went on to manage significant scale applications and infrastructures in the healthcare, manufacturing, and insurance industries. He has served as a consultant to many large organizations such as Herman Miller, Boeing, Priority Health, Magna-Donnelly Corporation, Hewlett Packard, Amway, Meijer, Komatsu, Mercedes, Navistar (International Truck), Flextronics, the US Navy and many hospital systems including Spectrum Health, Bronson Hospital, and HealthEast.

Jim has senior level data center skills in performance analysis and systems architecture, enterprise UNIX, reliability engineering, SAN design and implementation. He is a voracious learner and has held many technical certifications ranging from UNIX and Cisco administration through cloud architecture and design. As OST has grown and diversified, Jim has engaged with clients on product strategy, IT transformation, cloud enablement, CIO-level organizational change management, DevOps and IoT program leadership. Creating value by connecting the Data Center disciplines of the past to the Design-centric disciplines to help businesses leverage technology more effectively is a place of special focus for Jim in his recent engagements.

Jim has been heavily involved in OST’s healthcare initiatives where he has leveraged his decades of experience in healthcare, enterprise applications and systems architecture to design high performance infrastructures for the Epic EHR application and the client systems such as VDI for the access tier. He has also been directly engaged with the OST analytics team on assisting customers in the adoption of analytics to create substantial value and new revenue opportunities leveraging Big Data. In this space the combination of architecture, data visualization and design can be used to develop important new actionable insights.

Jim sits on the advisory board for the computer science/IS departments of Calvin College and Grand Valley State University Computer Science. He is an avid reader of all types of non-fiction and literature and most mornings can be found paddling a kayak, canoe or SUP before work. On the weekends, family and serving with his wife Ann at their church is a major focus.

Lastly, we must confess that some of OST’s peculiar culture is a direct derivation of Jim’s unorthodox style.