The interoperability discussion is perpetual and all-inclusive. Providers want it, the federal government mandates it and vendors get caught in debate about it.
Definitions of interoperability vary, and the term is often used interchangeably — and incorrectly — with data exchange. What interoperability is not — and what data exchange is — is the sending and receiving of information from other systems or platforms. Email does that. Interoperability is the ability of disparate IT systems to send and receive data seamlessly, interpret that data and display the information in a readable, usable format, and add to the longitudinal patient record.
Collectively, the healthcare industry laments the state of interoperability, saying the capabilities for this type of interaction aren’t where they needs to be, or blaming certain parties for inhibiting advancement in this arena. (Here are 15 healthcare leaders’ thoughts on the subject.) Borrowing from two of these leaders thoughts is the idea that the industry owes it to their patients to progress, and quickly.
“As healthcare professionals, and as an industry, we can no longer accept the status quo. It is possible to have real-time, two-way, low-cost, standards-based connectivity that enables improved decision-making and assures safety at lower cost,” wrote Michael M. E. Johns, MD, founding chairman of the Center for Medical Interoperability, and William Stead, MD, chairman of the technical advisory committee of the Center for Medical Interoperability, in a contributed piece to Becker’s Hospital Review.
That said, what is the current state of interoperability? Here are six thoughts.
1. In many regards, interoperability seems stagnant, and not for lack of technology. It’s trite, but healthcare is the slowest industry in the uptake of meaningful and useful data exchange. The financial industry is lauded as a prime example of interoperability, as no matter which bank one uses, that individual can go to any ATM to withdraw money, thanks to ATM networks like NYCE, Cirrus and Star. Doug Dietzman, executive director of Great Lakes Health Connect in Michigan, a health information exchange, outlined this example in a previous interview with Becker’s Hospital Review.
2. However, that doesn’t mean vendors aren’t exchanging information or utilizing networks to share information. Epic’s self-reported data indicates the vendor exchanged 15.3 million patient records on the company’s Care Everywhere network in June 2015 between Epic EHRs, with non-Epic EHRs, HIEs and government agencies. Other vendors including Cerner, Allscripts, McKesson and athenahealth are developing coalitions and collaborations to develop solutions fostering interoperability, notably the CommonWell Health Alliance. Throughout the industry data is being exchanged and presumably used. But there remain opportunities for advancement and more efficient, effective ways of interoperating.
3. There’s a kind of chicken-and-egg question in the interoperability universe regarding where that advancement will come from. Which needs to and which will come first: The regulations and policies that require interoperability, or the technology that demonstrates that is it achievable? One important factor sometimes overlooked is the lack of a sustainable business model for health information exchange that is centered around patients, Charles Jaffe, MD, CEO of Health Level Seven International, told Becker’s Hospital Review in a previous interview. Hot topics like information blocking and pointing fingers at which big-name vendors do and don’t contribute to advancing interoperability tend to overshadow this overarching and more difficult issue.
4. That’s not to say positive byproducts of the increasing discussion around healthcare interoperability aren’t widespread. Evaluations like the KLAS Interoperability Report, which could impact public perception of EHR vendors, has placed more pressure on them to stretch their interoperability capabilities as far as they can. While the ONC has worked to release a final interoperability roadmap, many states and regions have taken data exchange matters into their own hands, incentivizing providers to link up, adopt standards and share information by offering them a broader view of patient care across the continuum. On one hand, it could be said that efforts like these don’t amount to true interoperability — exchanging patient data and being able to meaningfully use and access it. On the other, they are slowly laying the infrastructural and regulatory groundwork that will be necessary when fully realized interoperability comes along.
5. The change is slow coming, and incentives aren’t bountiful, leading to understandable frustration with the industry’s progress in interoperability. “From my perspective, the improvements in this are at best marginal. As I talk with healthcare organizations trying to connect their systems with each others, it still seems like a tremendous amount of work and custom fees and consulting to really make things work between vendors, products and services,” says Scott Becker, JD, publisher of Becker’s Hospital Review.
6. It’s fair to say interoperability isn’t getting worse. But the drawn out process to move interoperability forward — and the associated pain points with doing so — eclipse the positive ground that is gained in incremental steps. It’s a slow process, but the persisting discourse helps move healthcare closer to where it should be.