Interoperability Showcase 2012 Thoughts

The Interoperability Showcase at HIMSS 12 was a popular exhibit floor destination again this year. It was a little hard to locate being situated at the back of the ground floor in the two level exhibit arrangement. There were more independent events making the Showcase more like the three ring circus of the convention itself. Taking a stroll around the site was well-worth the effort.

This was the fourth year that I worked as a volunteer docent. Interoperability demonstrations are based on clinically relevant use cases. This year's menu had fewer but more complex use cases that integrated the services of a larger group of vendors and more deeply highlighted the mechanics of health information exchange. This worked so well in most cases that it was easy to overlook the tremendous effort that vendors and others invest to make interoperability a reality. Health information exchange is enabled by standards produced by standards development organizations and harmonized by others such as Integrating the Healthcare Enterprise (IHE) and the Standards and Interoperability Framework (S&I Framework.) Vendors must qualify for the Interoperability Showcase by successfully completing live interoperability testing at the annual IHE Connectathon that is held for North America in January in Chicago.


Wisely, I think, the organizers shrunk down the number of use cases to just eleven or twelve. Also, teams of vendors that were part of each use case were clustered sequentially in individual pods. This eliminated the docent task of leading tours around numerous pods to complete the use case demonstrations. It also nearly eliminated even the need for docents. Tours worked much more smoothly for sure but my pleasure serving as a volunteer docent was adversely affected. Each group of tours is introduced by a "barker talk" designed to attract attendees to the site. This year the barker speakers saw much of their work taken over by an introductory video that covered much of their previous content territory.


A large section of real estate was reserved for Health Information Exchange this year. There was a pod for early pilots of the Direct Project and another for adopters of NwHIN Exchange, mostly federal partners is various Beacon Grant activities. I had expected more representation HISPs (health information service providers) and more information about digital certificate management.


I often take a critical view of the world I discuss. At this point I would like to take a positive (mostly) turn and look at what I thought was exciting at the Showcase. First, there was a new pod called the Digital Visualizer that featured a series of large flat displays that showed real-time the flow of electronic transactions in a number of the use cases being demonstrated. This was a well-thought out demonstration of the wiring diagram of the information flows from EHRs and patient care devices to HIEs and even across communities of HIEs. The standards being used to support the transactions were also shown. The only problem is that the visualizer stood alone away from the pods where the use cases were carried out so there was a serious disconnect there. Also, since the displays were set up to show real-time data flow, things happened too fast to be meaningful to most observers. My advice would be to enhance the value of this important teaching work by bringing the display information to each Use Case Pod. Also, by creating a slow motion recording or movie of the information flow, the attendees would really get a chance to understand the miracle of standards-based health information exchange that is possible although rarely implemented today.


Finally, there were two demonstrations that completely knocked my socks off and were the most impressive examples of interoperability at this year's exhibit. The first was an example of an automated operating room suite. The anesthesia machine, patient monitors, and infusion pumps (from disparate vendors) all sent information to a central processor that then fed the data, real-time to the EHR. There the data is permanently recorded but could also be monitored remotely, say by ICU staff waiting to receive the patient post-op. The system relieves the anesthesiologist from the mundane tasks of periodically recording vital sign information, IV fluid flows, and drug administration and frees up time to devote to monitoring a patient's status in the OR. The second impressive use case, one for cardiology, showed exchange of information between several different EHRs. During the presentation information was retrieved via HIE using a hybrid structure. The federated approach was used to retrieve x-ray images from the native PACS archive (because of the large file size for radiographs, CT scans, and especially MRI.) The EKG was retrieved from the registry/repository for viewing by both the primary care physician and the cardiologist. Thus documents, images, and other types of graphical information were exchanged seamlessly using sophisticated HIE architecture, even across different information exchanges. I think this example represents the moving puck those involved in health information exchange are trying to track.