First things first

Interoperability in health care IT will not be fully realized until hospitals have all critical information in a digital format to start with, according to one industry expert.

But that’s just the jump-off point for a multi-pronged process that must include reviewing outdated industry standards, the actual integration of disparate hardware and software with paper-based systems and sufficient government funding.

“There is a lot of time and effort and money being spent on digitizing health care processes,” said Michael Martineau, director of the Branham Group, an Ottawa-based IT consultancy. “Before we can even think about being interoperable we have to digitize and have electronic systems in the first place.”

The nice thing about paper is that it is highly interoperable, he said.

“I can send a chart from one (doctor) to another and they can read it and interpret it, but it is very difficult to share,” Martineau said. “How do we go about connecting all (hospital information) systems together?”

In health care there are a lot of stand-alone systems, he said, so whatever is digitized tends to be stand alone.

“The information is created in a system but there is no ability to share it with anybody else,” Martineau said. “Once I start integrating, then I need the data in a common format and I need to have messaging standards and the ability to interchange standards so data can be exchanged.”

Privacy and security concerns are driven together through the digitization and integration pieces of health care interoperability, because health care information has then been made widely available, according to Martineau.

“It’s just like the Internet when we started to connect PC’s,” he said. “We never worried about viruses or hackers before because we had all stand-alone systems.”

The same thing is happening in health care – digitization and integration are causing the trouble, Martineau said.

“It’s great to digitize health care information and put it in electronic forms,” he said. “It’s great that we are linking our hospitals together, but as soon as we do that we have now exposed it to the problems that come with being on a network.”

Martineau pointed to two things that need to happen to fix these kinds of problems. “We as a society need to decide what level of protection we want to have and are willing to pay for,” he said. ”The tradeoff in health care is privacy versus the benefits of my doctor having access to all my information.”

Martineau said that individuals’ health information is actually more secure in an electronic format than not.

“I can put a white coat on and wander into a hospital and pick up a chart and nobody is going to question me,” he said. “The flipside is that my ability to do that on a large scale is fairly limited in an electronic health care world because I can do it on a very large scale.”

A lot of the work also has to be done around standards on the identification of a patient, Martineau says.

“We need to know how we identify the provider and in what format do we do that because authentication is a big issue,” he said. “I want to make sure that the patient is identified and the provider is authorized to have that information.”

But getting to health care interoperability in the long run involves governments, dollars and funding, according to Martineau.

“Senior health care bureaucrats are starting to see the value in IT in health care,” Martineau said. “In fact most provinces are now stating fairly strongly that they see IT as an enabler of change.”

In one example in Ontario, Canada Health Infoway invested in a drug profile viewer to leverage the existing Ontario drug database and make that data readily and quickly available to the acute care sector in Ontario.

One hospital reported that it proved valuable the first day it was in production, according to Dennis Giokas, Canada Health Infoway CTO.

Brian Eaton ( is associate editor of and a regular contributor to CIO Government Review.