Interoperability is a term that has been a buzzword in digital healthcare circles for years. But it is only recently, with the COVID crisis, perhaps, that the critical benefit of systems being able to talk to each other across national and regional boundaries has been acknowledged on a global basis.

The pandemic not only accelerated the digital transformation of healthcare delivery and the adoption of telehealth services, it also increased the need for innovative processes and redesigned workflows across healthcare – with interoperability a clear facilitator of this.

A perfect storm for healthcare

“We are at a point now where we can really see some of the benefits that have arisen out of the crisis for digital health,” says Dr Petra Wilson, European Program Director of the UK’s Personal Connected Health Alliance, in a HIMSS webinar this month. “Because of COVID-19, many countries across Europe have really embraced digital health in a new way. They have needed, like every country in Europe and indeed the world, to share data around infection status. So we have, if you like, a perfect storm at the moment, which is a greater use of digital health tools.”

And Austria’s national electronic health record, ELGA, had been one such platform showing a dramatic increase in uptake during the pandemic. And it was, of course, not alone in this among European countries, with many experiencing an upsurge in demand and involvement in their EHR platforms with the onset of the crisis.

Austria at the forefront

And the achievements of the ELGA platform have been significant, in getting the right information to the clinician at the right time, at the point of care.

Dr Gerhard Pölzl, Senior Physician at the Department of Cardiology, University Medical Center Innsbruck in Austria, speaks of ELGA’s use in practice at Austria’s HerzMobil Tirol, a disease management program for people with cardiac issues. “This telemedicine program has made automatic event detection of serious deterioration of the patient easier, making it easier to identify those that might need early intervention,” he says, in the webinar.

“We have recently published a retrospective comparison of outcomes of patients on the program compared with patients managed in a usual care way,” says Dr Pölzl.“We were able to show that, the management in HerzMobil Tirol was highly significant with regards to the reduction of the combined endpoint including all comorbidity heart failure readmissions and there was a 49% reduction in this combined endpoint after six months.”

Yet, until COVID reared its head, the system had not experienced a high level of take-up, says Christian Stark, Project Manager, Clinical Information Systems & eHealth, EHR/ ELGA at Tirol Kliniken GmbH /University Medical Center Innsbruck, Austria.

“But the pandemic, as bad as it was, was a push for the system across Austria. In Austria we have about eight million people with social insurance coverage and 320,000 of them had opted out of the ELGA system before COVID. Many of these people have opted in again through the pandemic, however, because they have now experienced the value of the system,” he says.

Surprisingly perhaps, HerzMobil Tirol’s mainly elderly patients have taken to the system like the proverbial ducks to water. “What we have learnt is that between 70 and 80% of patients have come along with the system pretty well and particularly if they have some support from their family – grandsons or granddaughters, for example.”

Information overload

Thomas Schabetsberger is Head of eHealth & Patient Engagement, Strategy & Business Development Lead eHealth at Siemens Healthineers, who were responsible for building ELGA and numerous other national, regional, and enterprise-level healthcare networks, with an aim to integrate with rather than replace existing systems. For more than 10 years, the company have been working to integrate their products with those of hundreds of other vendors across the world.

He says that bringing data together for healthcare use is not always plain sailing.“Setting up a network is not in itself a major technical hurdle. The technical aspects are all solvable. Where health information exchange often fails or is heavily delayed is as a result of other aspects – such as financial, organisational and legal difficulties. “And even if those risks have been mitigated and shared electronic health record platforms have been established, health data exchange is not the panacea for meeting the information needs of organisations and caregivers. There is a risk that, if all information is there and is shared, users will suffer from information overload and drown in information!”

“Such technologies must prove their own value and have to ensure that the relevant and aggregated information is provided to the user. Besides the technical challenges there are a lot of other challenges that need to be resolved.”

There are also still many issues that make clinicians hesitant to use new tools, says Dr Pölzl: “There has been a lot of resistance among clinicians, it is still widely believed that telemedicine is a new discipline and that simply obtaining a lot of data automatically translates into a better outcome for patients. The opinion most clinicians have of telehealth remain still quite low.”

“For telemedicine to fulfil its potential, it must be embedded in a network of healthcare stakeholders. Clinicians and nurses, for example, must both have meaningful positions in the management of the network.”

Dr Pölzl also mentioned the importance of a tailored, personalised approach to each patient; simple, streamlined access to data for caregivers and for any telemedicine program to facilitate quick, easy communication in order for a telehealth system to be truly effective. He also mentioned that remuneration needed to be guaranteed, as within Austria, HerzMobil was the only telehealth program to have been remunerated for several years.

A change in mindset

There needs to be a change in mindset, comments Christian Stark, else telemedicine will not get the support it needs to fulfil itself. “The clinical payment models in most countries are set up so that a healthcare institution only earns money when a patient shows up at that healthcare facility and is treated there. In telehealth, where the patient remains at home if possible but is closely monitored by the hospital and physician - because they are not in the hospital, no-one is prepared to pay for it.

“So there must be a change in mindset among insurance companies and government funding, such that the hospital will also get money while the patient is being treated in a telehealth setting. This is one of the obstacles at a governmental and organisational level that is preventing these models from working to their full potential.”

Thomas Schabetsberger spoke about the importance of participating in testing events to ensure that systems would be able to work together: “We have participated for more than 10 years in, for example, IHE Connectathons and Projectathons, where we test our software against other vendors’ software to see if they can communicate with each other.

“After such events, we’re not only confident that our solutions can speak with others’, but also we know that we can solve an interoperability issue with other vendors with confidence. Real interoperability is not a ‘plug and play’ thing where you simply connect the cables, and it works. You can only really be sure that you are able to solve interoperability issues if you have participated in testing events like these.”

A question of semantics

There also needs to be a mindset shift around semantics in order for telehealth services to reach their potential, says Christian Stark: “Everything has to be well defined and standardised into so-called value sets for a telehealth system is to work. In Austria, for example, the Government and the ELGA community have set up a terminology server, so that everyone participates in, gets information about how to provide information in a way that it can be automatically interpreted and parsed by other systems, which works well.

“And there needs to be organisational readiness to use these technologies so that clinicians know that they can access information from totally different healthcare organisation within the country. This is an important mental shift that needs to be made.”

Find out more in the Interoperability: Bridging the Gap Between Clinical and Technical Aspects of Telehealth Services webinar