Interoperability Begins with People

By Rhonda Smith, Health Informatics Specialist, DC Vital Records Division

When it comes to making data interoperable, we think about making better connections between systems. But in focusing on the technology, we sometimes undervalue the connections we need to make between people.

In my work at the vital records office for Washington, DC, I’ve learned that good systems begin with good relationships. If we don’t listen to and learn from the people we’re trying to connect with, we can create unnecessary problems for them, which can damage trust.

The potential of real-time connection

For the past year, we’ve been working with the National Center for Health Statistics on a project to make our death data more interoperable with the medical examiners who provide the data, with surveillance systems that monitor drug overdose deaths, with the national cancer registry, and with the National Vital Statistics System. This project, along with other interoperability projects taking place across the country, offers true lifesaving potential in terms of getting nearer to real-time data on opioids, suicide, cancer, and all causes of death.

In our office, we realized that changes to our electronic death registration system (EDRS) directly impact others’ workflow and day-to-day processes – and not all of these impacts are positive. We learned that you can build a new tool that will get your data faster from point A to point B, but if you haven’t also connected the people who are using that data, you won’t get very far.

It all starts with listening

This is why we went directly to the medical examiner’s office to see how they investigate, how they document information, and what laws and policies they’re working with. What we learned sparked a lot of changes in our system that, in turn, improved the quality and timeliness of our data.

We also spent time at every hospital in the area meeting with people who do death and birth registration. We talked with doctors and nurses to understand what challenges they face on the ground. How does it feel to ask families about their deceased relative? Can vital records help make it easier?

We reached out to the cancer registry, who told us they conduct a lot of follow-up activities with hospitals when someone dies. We learned that changing how we send them death information could not only affect them, but could also require more staff and resources from the hospitals they work with.

We also talked to CDC’s National Center for Injury Prevention and Control, where the State Unintentional Drug Overdose Reporting System (SUDORS) captures national surveillance data for drug overdose deaths, about how we could be more interoperable with them. We consulted the vendor who created our electronic death registration system to see what our capabilities were.

At every turn, we found people who were willing to share their needs and experiences so we could plan for this new and connected future together.

A community for connection

Nowhere was this spirit of collaboration more evident than when NCHS invited us to a meeting of their Implementers’ Community. The Implementers’ Community brings states involved in a project to modernize drug death data together with a broad array of people working with the data at every level, including registrars, medical examiners, data scientists, and IT developers.

We had been made aware of this project from our sister jurisdictions (Utah, California, and New York) who we share ideas and resources with regularly, and we were excited to join the discussion. From that meeting I understood that we don’t have to reinvent the wheel.

Many states are working on the same things we’re trying to do in DC. For instance, I heard about work to integrate with the cancer registry and then learned about a tool that’s being designed to do just that. We also brainstormed with the medical examiners’ community and with folks from CDC’s Injury Center to solve our common challenges.

Coordination informs technology

The meeting was held at the Georgia Tech Research Institute in conjunction with a “connectathon” where IT developers solve interoperability problems in real time. Our EDRS developer worked side-by-side for two days with the other developers. We came in not knowing how some of our files were going to get from point A to point B, and one of the developers from Georgia Tech created an API that solved the problem on the spot.

As the developers coded together, I sat with other representatives from jurisdictions and from NCHS. We spent valuable time talking through different scenarios around interoperability: How does this impact our process? What are our workflows? How are we going to operationalize this with stakeholders who will have to change what they do? We identified issues that needed to be fleshed out and were able to take next steps.

This is what interoperability is truly about. It’s about connecting people, information, and ideas. It’s about making sure everyone is heard and that people working on the same challenges can find each other. It’s about sharing solutions so that we’re efficient with our resources. It’s about recognizing that none of us operate in a bubble, and we need to move forward together.