Interoperability: Moving Beyond Talk to Taking Action
Long a favorite topic of discussion among health IT insiders, interoperability has finally started to earn the attention of a wider industry audience.
To list just two of many possible recent examples: CMS illustrated its emphasis on the concept by relabeling the incentive program once known as “Meaningful Use” as the new and improved “Promoting Interoperability,” and six of the most prominent companies in technology – including Amazon, Microsoft and Google – publicly pledged to collaborate towards a future of true healthcare interoperability.
These are worthwhile endeavors, and I welcome anything that brings additional attention to this critical concept that at its essence is all about helping providers share data. However, agreeing on the importance of interoperability is the easy part. The big question is how we get there. In other words, how do we move from talk of interoperability’s tremendous value to action that accomplishes the ultimate goal of providing physicians with the right information at the right time to make the best decision for their patients? The answer lies in establishing clear data-exchange standards.
Fax machines: Easy to laugh at, not so easy to replace
CMS Administrator Seema Verma recently drew praise for announcing her intention to end providers’ use of fax machines to exchange patient information. It’s a worthy goal, but the problem is many providers are likely to ditch the fax machine only adopt the practice of emailing PDF files to share patient records. Unfortunately, exchanging pages and pages of unstructured clinical data does little to address the challenges of interoperability, as time-consuming, manual processes are still required for providers to unlock the information they need to deliver better care.
For two systems to be interoperable, they must be able to do two things: (1) exchange data and (2) subsequently present that data such that it can be understood by a user, according to HIMSS. Fax machines and email get us to number one but lack the structured format and defined data-exchange standards required to fulfill the second part of the equation.
In the absence of defined standards, providers are likely to continue experiencing difficulty in obtaining contextually relevant information at the point of care. No doubt, establishing and enforcing data-exchange standards will be a heavy lift, and the challenge goes beyond the not-insignificant technical considerations.
Established, incumbent players will resist complying in some cases. For example, many health systems won’t be thrilled about sharing patient information with their cross-town rivals, fearing that doing so could leave them vulnerable to patient-poaching by competitors. Some electronic health records vendors will resist data-sharing amidst worries of losing customers who can easily transfer data to competing vendors’ systems. And of course, there are always each player’s own financial considerations to factor into the decision.
Start small and scale
To achieve interoperability, the smoothest route is likely to paved with a well-designed incentive program that gains buy-in from payers, providers and health information technology companies. That’s where CMS comes in. The agency makes the most sense to serve as administrator of an incentive program, though any group that leads the initiative will be challenged to design a well-balanced carrot-and-stick system that rewards participation and adherence while punishing attempts at record-blocking.
This won’t be easy (sensing a theme here?), so the best approach is to start with just a few basic categories, such as medications, lab results, immunizations, allergies, and diagnoses. After we’ve proven the ability to reliably exchange these basic categories, we can move to more complex, unstructured data that is more complicated to convert to a standard format.
With all the hype and attention around interoperability, it can be easy to lose sight of why it’s so important: Information is power, and accurate, comprehensive data simply enables clinicians to make better decisions and patients to have better outcomes. That’s why it’s time that the healthcare industry does more than talk a good game when it comes to interoperability.