In 2005 the technology behind StarChart and StarPanel was licensed to Informatics Corporation of America (ICA) and rebranded as CareAlign, which has become a leading web-based software as a service. CareAlign provides community information networks -- such as health information exchanges (HIEs)-- and regional health information organizations (RHIOs) -- the integration and "matching" of structured and unstructured data unique to a patient to form a complete, longitudinal and universal health record.

Dr. Stead, also a senior adviser to ICA, urged the National Library of Medicine, the advisory body of the United States Department of Health and Human Services and the agent for managing current Health IT standards efforts, to implement a new definition of interoperability, which the agency did in May of this year.


"The definition we need to think about is 'information that can be assembled and interpreted in the light of current knowledge and reinterpreted as knowledge advances,'" states Dr. Stead. "That definition stands in pretty stark contrast to the more simplistic view that we would get a single correct answer and that the answer would be explicit and understandable by any system that you move it to. Very few of the things we use to describe biological systems fit that degree of explicit single definition."

Dr. Stead uses the example of testing a patient's potassium level. Lab procedures provide signals that are correlated to reach a clinical decision. As the medical profession advances, the way clinical decisions are made is going to change. EMR solutions that function only as transactional and reporting applications are not going to be useful in the future if the data comprising those records are static and cannot be dynamically reinterpreted in the future. This trend in EHR is termed "data liquidity."

"Making the data mean something outside the application is the one thing we can do to ensure that the data is useful over time," says Dr. Stead. "We know that technology is going to change dramatically if we change the care process to achieve the goals of health reform. Any technical approach that locks us in concrete is not going to survive these changes."

On the commercial front, Gary Zegiestowsky had a lot to say about the challenges that ICA and CareAlign have faced while integrating multiple proprietary EMR solutions within community networks. In less than six months CareAlign can be deployed to aggregate data from any source and in any form. As successful as ICA has become in this field, it is still a difficult feat to unite data from several vendors across a complex network of hospitals and clinics. Cooperation is key and proprietary competitiveness must be kept in check for it to work.

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