Achieving True Interoperability: Data-Driven Approaches to Improving Health Philip R.O. Payne, PhD, FACMI Co-Founder, Signet Accel LLC ppayne@signetaccel.com Professor and Chair Professor and Chair, The Ohio State University, College of Medicine, Department of Biomedical Informatics Director The Ohio State University, Discovery Themes Initiative, Translational Data Analytics For the last decade, data-driven approaches to improving health have been top-of-mind for health care providers and professionals, most notably IT leaders, informaticists, clinicians, investigators and administrators. At the center of these efforts is the need to remedy our industry s interoperability problem. Since 2009, the federal government has spent $28 billion dollars supporting the adoption of meaningful use and health information technology, with a goal of ensuring interoperability between systems. Regrettably, just as much has been spent by healthcare systems and providers on products believed to be truly interoperable, only to discover they are not. Federal, local, and institutional regulations loom heavy alongside meaningful use deadlines. Return on investments seems implausible, frustrations rise, and truly connecting data to the benefit of the patient appears to many as a near-impossible goal. On October 6th, 2015, the Office of the National Coordinator for Health Information Technology (ONC) released its plan for achieving this goal of interoperability the final iteration of version 1.0 Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap. When viewed as a whole, this roadmap represents a bold and compelling vision for a future with a connected healthcare ecosystem in which data becomes a strategic, liquid, and highly impactful asset, accessible without great effort, and is used to inform and support interventions and approaches that improve the health of the nation. The message is clear; health IT products and services must be truly interoperable and work with their competitors offerings as well as they work with their own. This means disparate data should be shared and exchanged freely, translated and interpreted seamlessly, and delivered in a readable and usable format, regardless of its origin. Utilizing technology to increase access, safety, and security the triple aim can be achieved: advancing population health and improving patient satisfaction and experience of care, while reducing healthcare costs per capita. Implementing this vision requires innovative technologies that overcome both historical and technical barriers to health data sharing and interoperability. While the roadmap presents a 10-year plan to achieving this vision, we believe that future is accessible now, with true interoperability from Avec.
Meeting the Roadmap Head-On The United States, through the leadership of ONC and members of the Healthcare Information Technology (HIT) community, presented a comprehensive roadmap to achieve interoperability across, and between, the many different data resources and stakeholders that comprise the national healthcare enterprise ( Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap, ONC, 2015). The ONC Roadmap seeks to find a common set of data standards, technologies, and approaches that can collectively be used to link, exchange and harmonize the myriad of data generated by patients and providers, as well as data that serves to characterize the environments surrounding those persons. These efforts intend to enable and catalyze the use and reuse of comprehensive and well-understood datasets in order to inform approaches to achieving the triple aim. In doing so, the roadmap focuses on key areas of endeavor, including: Identifying the best possible standards that can be used to codify diverse and complex data, thus leading to shared understanding of that data; Promoting or enforcing the use of such standards through appropriate incentive structures for both technology developers and adopters; and Creating shared governance and oversight mechanisms that can ensure that the interests of participants in an interoperable health data ecosystem are both valued and respected. Another critical dimension of the ONC Roadmap is the recognition that numerous sources of significant healthcare data are generated outside of traditional healthcare delivery environments. Such data types can, and should be, incorporated into the emerging health data ecosystem in such a way that patients, providers, policymakers, and other involved parties can gain a more holistic view of the factors that influence the quality, safety, and cost of healthcare delivery, and perhaps more importantly, wellness promotion. In the quest to achieve the goals outlined in the roadmap, technology platforms must also meet and defeat a myriad of historical barriers to healthcare data sharing, including the ability to address the following critical technology and socio-cultural challenges: 1) Concerns over data ownership, stewardship, and valuation by those entities who generate data resources through their participation in the healthcare system; 2) The sustainability of financial incentive models for participation in data-sharing networks or equivalent constructs; 3) The satisfaction of core technical and functional requirements necessary to meet current future interoperability needs, as envisioned in the ONC Roadmap; and 4) The scalability and flexibility of technology platforms, so as to allow for the graceful and resource-efficient incorporation of constantly changing and diverse data sources and data encoding standards. Further, given the ONC Roadmap s aggressive timeline, it s essential that innovative and effective technology platforms be brought to market rapidly. To date, such solutions have not yet been delivered to the broad market.
Figure 1 provides a synopsis of the rapid timeline. It also highlights key issues that such technologies can, and should, address to attend to barriers of health data sharing and interoperability, namely: 1) Support for modern, scalable, and cost-effective distributed data sharing paradigms; 2) Scalable and flexible data harmonization, provenance, and interoperable API delivery, in support of the creation of a true data interoperability ecosystem; 3) The ability to enable process- and outcome-oriented measures of technology use to inform data sharing and interoperability programs, and document demonstrable value therein; and 4) The delivery of tools that support the creation of interoperable data analytics pipelines that are technology-agnostic, thereby enabling sense-making in the emerging biomedical big data era. 2015 2017-18 2020 Coordinated Governance, Exchange, and Trust Communities Rules of the road Goverance Expanded access Support for the Creation of Distributed Data Sharing Paradigms Standards for Interoperability Data codification APIs Data provenance Product certification Scalable and Flexible Data Harmonization, Provenance Controls, and Standard-based APIs Drivers and Regulatory MU2 MU3+ Other Policy Levers Process and Outcome-based Measures of Platform Utilization Care Providers and Consumer Use of Technology Support for continuum of care Integration of consumer generated data Consumer-facing tools and portals Data-Source Agnostic Integration Pipelines Figure 1: Synopsis of the ONC timeline for implementing healthcare data interoperability, as envisioned in the roadmap. Note the major functional needs relative to technology platforms targeting this domain, shown in alignment with the ONC Roadmap s phases. Each of these issues, whether technical or socio-cultural, serve to challenge the deployment of data sharing and true interoperability solutions in the healthcare domain, and thus must be considered carefully when designing new and efficacious solutions to achieve the goals of the ONC Roadmap. While there have been many past attempts to design such a solution, and undoubtedly many current efforts to do the same, there is one solution already proven to meet and exceed all of these challenges and that solution is ready for deployment today.
Meet Avec, the true interoperability solution In response to this critical need, Signet Accel designed and delivered the Avec platform, a proven, ready-to-deploy and highly-effective solution that delivers true interoperability and meets the goals and needs enumerated in the ONC s Connecting Health and Care for the Nation report and roadmap. Avec was purpose-built from the ground up to bring true interoperability to the healthcare ecosystem and address the fundamental issues surrounding data sharing, in arguably the most complex healthcare and research environment in history. Initiated at The Ohio State University in collaboration with investigators and technologists on an international scale, Avec eschews traditional data sharing and harmonization approaches to create an entirely new paradigm for distributed, scalable, and high-performance interoperability between both disparate and heterogeneous data resources and stakeholders. We refer to its primary distinguishing attribute as true interoperability, as it delivers all that interoperability was originally intended to do it truly connects and protects your data, as it is and where it is. True interoperability with Avec doesn t require duplication of data or additional hardware. It doesn t disrupt the process of collecting data, the manner in which it s stored, where it s stored, how it s structured or what language the data speaks. True interoperability capitalizes on existing investments, provides more complete answers, and reduces the time it takes to see real results. At its core, Avec is purpose-built to: Allow data generators to control where, when, and how data is shared with others and harmonized across standards and models, enabling such data owners to remain assured that concerns surrounding ownership, stewardship, and valuation can be addressed at a policy level that is fully supported by underlying technologies; Distribute the costs and infrastructure for data sharing and interoperability, such that each participant capitalizes on current investments and only supports those expenses directly aligned with their participation in such sharing regimes, and the costs and values therein; and Scale and evolve gracefully to support constantly changing biomedical big data standards, types, and models in a manner that is fully independent of any and all data generating technologies. In addition, Avec incorporates an extremely lightweight technology deployment approach, alongside a library of data adapters that can interoperate with current HIT data generation platforms in a turnkey manner (such as common EHRs), thus lowering costs and increasing the benefits of true data interoperability and sharing. In response to ONC s report and roadmap, Avec provides unique and compelling advantages. The table below addresses critical technology needs and functional requirements incumbent to achieving the goals enumerated in the document. Of note, such technical issues are broadly aligned with a set of requirements described in the report. For each such area, we compare and contrast the functional profiles of existing data sharing and interoperability solutions (data warehouses, cloud-based repositories, and transactional systems) with Avec and its competitive advantage.
ONC Principles of Interoperability Building Upon Existing Health IT Infrastructure Conventional Interoperability Solutions (Central Data Repository, Cloud-based Data Sharing, Transactional Data Exchange) Additional IT infrastructure needed to achieve interoperability Signet Accel Avec Platform Uses existing IT infrastructure to achieve interoperability Maintain Modularity Centralized, single-platform system Distributed, multi-platform system One Size Does Not Fit All Variable abilities to scale Elastic, scalable solution Consider the Current Environment and Support Multiple Levels of Advancement Proprietary technologies controlled by vendors or contributors Platform-independent, uses open-source and standards-based technologies Empower Individuals Centralized control of data Distributed controls of data Simplify Complex deployment and management process Simple, user-centered deployment and management process Protect Privacy and Security in All Aspects of Interoperability Data stewards do not directly control access to data resources Data stewards maintain control of data resources Leverage the Market Variable use of market-driven technologies Designed to use state-of-the-art and market-driven technologies Focus on Value High initial deployment and ongoing management costs Incremental deployment and management costs, driven by utilization Scalability and Universal Access Scaling and access constrained by physical infrastructure Scaling and access grows organically based upon utilization and participation Table 1: Overview of the ONC s roadmap technical requirements for healthcare data sharing and interoperability, and a comparison of the profiles of extant technologies to the Avec solution. Beyond the ONC Roadmap, Avec provides even greater value by maximizing existing investments in acquiring and maintaining data and ensuring that investments in sophisticated analytics and data visualization tools have full access to all the data possible presenting the most complete answer, accelerating research and improving care and setting the stage for sustainability and impact. Among those investing in technology to fuel research and treatment, achieving the triple aim is necessary to sustain this great work and open greater opportunities for care and cure. Avec delivers such results, supporting self- sustaining programs with uninterrupted focus on improving outcomes. In an increasingly competitive and resource-constrained environment, Avec allows investigators to ask more questions and receive more complete answers in less time. Imagine what investigators could achieve if given the ability to ask 10,000 questions versus 10. Avec represents the future of healthcare as envisioned by the ONC Roadmap, and it s available now, not a decade from now.
A New Era in Healthcare As we stand at the precipice of a new era in healthcare one in which the widespread and intelligent use of data resources enable the delivery of timely, tailored, safe, and cost-effective care and wellness promotion time is of the essence. ONC s Connecting Health and Care for the Nation report and roadmap provides a blueprint and bold vision for the cultural, policy, and technical endeavors required to attain such a state, but achieving this vision is predicated on achieving true interoperability between all participants in the healthcare ecosystem Policy-Driven Control of Data Ownership, Stewardship, and Value Generation TRUE INTEROPERABILITY IN HEALTHCARE Graceful Evolution and Scalability of Core Technologies Distributed Cost for Participation in Data Interoperability and Sharing Figure 3: Signet Accel s vision for true interoperability in the healthcare data ecosystem, realized through Avec. When the barriers to true interoperability are thoughtfully considered, it is readily apparent that approaches to achieving it have been every bit as siloed as the data we seek to connect. Interoperability is not purely a technical problem, a policy problem, or a user experience problem. It s a problem that requires an integrated and holistic approach, not a reductionist methodology. True interoperability is attained by taking a systems-level approach that yields systems-level benefits, in turn overcoming the silos that presently prevent us from achieving the triple aim. To truly solve the problem of interoperability, Avec was purposely built with careful consideration given to the problems presented by each community, and solving them simultaneously. It meets and exceeds each of their needs and requirements, along with the vision of the ONC report and roadmap, with a unique, compelling, and ready-to-deploy solution that is unprecedented in the healthcare data sharing and interoperability domain.
Just as the healthcare ecosystem stands ready to embrace data-driven approaches to achieving the triple aim, Avec is ready to provide the solution. Truly connecting data to the benefit of the patient is no longer a near-impossible goal. Trusted by the world s leading healthcare academic institutions, hospitals, and research networks, Avec enables true interoperability of mission-critical data spanning healthcare research, delivery, and population health domains with all of the ensuing benefits to individuals, their families, their communities and the health of the nation. The preceding text was written by Dr. Philip Payne in his role as both co-founder of, and advisor to, Avec and Signet Accel, LLC. References: 1. Sprott D, Wilkes L. Understanding service-oriented architecture. The Architecture Journal. 2004;1(1):10-7. 2. Payne P, Ervin D, Dhaval R, Borlawsky T, Lai A. TRIAD: The Translational Research Informatics and Data Management Grid. Applied clinical informatics. 2011;2(3):331. 3. Foster I, Kesselman C. The globus toolkit. The grid: blueprint for a new computing infrastructure. 1999:259-78. 4. Oster S, Langella S, Hastings S, Ervin D, Madduri R, Phillips J, et al. cagrid 1.0: an enterprise Grid infrastructure for biomedical research. Journal of the American Medical Informatics Association. 2008;15(2):138-49. Your query ends here. At Signet Accel, it s our mission to bring true interoperability to healthcare that emboldens discovery at the bench and beyond profoundly affecting the ability of investigators and clinicians to understand, treat, and cure. Our approach is unique. We use a federated data model that allows for the integration of seemingly incompatible data from an ever-growing number of disparate locations without the need for duplication, common standards, or centralization. As a result, we get collaboration at the bench to the bedside faster. Our approach encourages sharing among institutions and individuals while respecting ownership and honoring appropriate permissions. All the while, we maintain patient privacy and ensure data security, enabling complete and transparent control of who accesses the data and for what reasons. And, it works. We know that this isn t easy. It takes a diversity of skills not unlike the diversity of data we work with and that is why we have assembled a team of expert technologists, researchers, and engineers with a shared focus and depth of experience in healthcare. We stand ready to show you what is truly possible when it all comes together. Experience true interoperability with Avec. Contact: 614.300.1101 info@signetaccel.com SignetAccel.com About Signet Accel Signet Accel s Avec platform is true interoperability realized in healthcare. As the sole alternative to traditional, centralized data management solutions, Avec delivers the industry s only purpose-built federated data integration platform, developed and refined over 12 years at The Ohio State University. Signet Accel s software products and services power the work of consortia, institutions, and health professionals around the world with unmatched security, sharing capability and speed of discovery advancing academic research, achieving meaningful use objectives, and enabling the continuum of care. Learn how to make your data meaningful and achieve true interoperability with SignetAccel.com.
Philip R.O. Payne, PhD, FACMI Co-Founder, Signet Accel LLC Dr. Payne co-led the formation of Signet Accel and the creation of what is now the Avec platform. Currently Professor and Chair of the Department of Biomedical Informatics at The Ohio State University, College of Medicine, Dr. Payne is an internationally recognized leader in the field of clinical research informatics and translational bioinformatics. He is the author of over 175 publications focusing on the intersection of biomedical informatics and the clinical and translational science domains, including several seminal reports that have served to define a new sub-domain of biomedical informatics theory and practice specifically focusing upon clinical research applications. Read Dr. Payne s complete biography.