Monday, February 13, 2012

IHE Connectathon Chicago: More participation than ever!

view off the test "floor"

The USA IHE Connectathon has become a big operation as 453 of engineers from all over the world settle down at the downtown Chicago Hyatt to test their software and device simulators (169 this year) against each other for compliance with any of the IHE defined profiles. This year’s compliance team was comprised of 55 people serving as “monitors” to check off 4572 test requirements for these profiles. Some of these tests are relatively simple to check, such as the validation of a clinical document to make sure it contains all of the required sections and data elements, but some of them require the participation of several actors as part of the test, which makes it somewhat hard to coordinate. While participating in this event represents a major investment for the participating companies in preparation, travel, personnel and allocated resources, the benefit is clear, there is no better place to do interoperability testing than in Chicago, on neutral territory with all engineering resources right there instead of in a clinical environment.

Participating as a monitor is a gratifying job, not only because one meets many new people in this domain, but also as there is no better way to learn about the implementation of standards than to see it actually work, or fail for that matter. The participants have plenty of opportunity to test prior to submitting a test for verification by one of the monitors, and most of them do so diligently, but in my experience one out of ten participants still fail to meet the test criteria and have to go back to the drawing board. There are also participants who drop out of particular scenarios because of the problems they are having.

The certification process itself is highly automated. Participating vendors can access the test requirements from an on-line source and schedule their tests with peers. Most peer-to-peer tests require a vendor to interface with three others and they are not allowed pick their peers from their own company. A monitor will access their worklist, which shows only the tests that they are assigned to, depending on the domain, and finds the location of the vendor who submitted the test to be verified. The test is demonstrated and after successfully completed, the vendor brings up the test again from a worklist, which has a QR code that allows the monitor to pull up this test at his or her tablet PC or smart phone and change its status to pass, fail or partially completed. An example of using the partially completed status occurs when a document consumer requests a certain form from a manager, fills it in, and forwards it to a repository. At this point the test status is marked partially completed. I would then have the vendor fill in certain fields and then go on to the receiver to check to see that the modified data elements were transmitted. If correct I would then set the status of the test to “pass”.

While verifying these tests, it is almost mind boggling to contemplate the many possibilities for improving healthcare delivery once all of these standards are implemented. The ability to exchange information from one’s personal health record into your physician’s electronic health record alone will eliminate all those lengthy questionnaires every time one visits another physician, and that only scratches the surface. The exchange of drug and allergy information, submission of clinical information in standard forms to agencies that are involved with population health will allow quality measures to be implemented, and so on; the sky is the limit.

Many standards that benefit efficient and more effective patient care have been developed in the past, and implementation has been patchy, for many reasons. One reason is that there is not always enough incentives for vendors to open up their architecture and allow others to seamlessly integrate and exchange information in a standard manner. Connectivity is in many cases on the bottom of the list of improvements. Hopefully this will change with the requirements to implement electronic health records in a meaningful manner in the USA, making many of the possibilities that could be glimpsed at Connectathon will be rolled out in commercial products soon.

Connectathon 2012 was another excellent event showing the great potential and opportunity for vendors to profit by implementing these new standards and to have a positive impact on patient care. Events like this can only increase the pressure on the vendors to roll out products and releases as soon as possible as more of them compete to reap the rewards that come with successfully implementing the IHE profiles.