My Take: Interoperability Falls Flat

Prior to flying to Chicago for the annual Healthcare Information and Management Systems Society (HIMSS) Conference, I had a lot to do. More than 40,000 health IT professionals, vendors, policy makers, investors and other stakeholders gather for educational sessions, speeches, exhibits, interviews and social events. And lots and lots of walking.

Along with preparing my presentations, packing and sorting through various meeting requests, I had one critical priority: band practice. My band is preparing for a large (for us) gig at the end of May for our high school reunion.

As with prior events, we welcome guest performers to sit in with the band and as a result, we’ve had a range of people showing up to practice in my basement. Each comes with a guitar or bass, plugs into one of my amplifiers and we start making music. Given the distinctive sounds of some of the songs, we will often use effects pedals with our guitars to get the right tone. Each pedal contributes to the overall sound, easily swapped depending on who is playing what, simply by re-routing cables. While we may obsess over the sound, the one thing we don’t fret over is the setup. We just plug and play.

A few days later I found myself in Chicago, walking the exhibit halls and touring the Interoperability Showcase, where vendors highlight the flow of information from one application to the next. To the casual observer, one would think that the industry had fully embraced interoperability.

But, the truth is actually more complicated.

Earlier this month, the Office of the National Coordinator for Health Information Technology (ONC) released a report saying it is “increasingly concerned about” what it views as unreasonable interference and information blocking coming from both vendors and providers. It noted in particular that a few entities had too much control over electronic health information.

The report said that “current economic and market conditions create business incentives” for certain entities to control electronic health information and limit its availability. It pointed to 60 reports of this practice in 2014. Though no specific companies or “bad actors” were named, the report also included several recommendations to increase the exchange of EHR information. The ONC’s recommendations include creating new transparency obligations for developers and new certification requirements that strengthen surveillance of health IT capabilities and pushing for a national governance framework for health IT exchange with clear principles regarding interoperability and information sharing.

How do we reconcile the seemingly contradictory views between the ONC and the broader health IT industry? Health care is evolving quickly, and the requirements many sought when implementing systems have changed dramatically in the last few years. When Meaningful Use (MU) was born out of the Health Information Technology for Economic and Clinical Health (HITECH) Act in 2009, users sought systems to help document visits between providers and patients. Accountable care organizations (ACOs) did not exist, and outside of integrated delivery networks, few engaged in alternative payment methods (APM) that focused on value or outcomes. Even some of the MU Stage I requirements, such as the requirement to share data with patients by burning them a CD, appear quite dated now.

With value-based care, new priorities have emerged: data sharing, care coordination, patient engagement, and predictive analytics. In addition, consolidation among providers and overall convergence in the industry has accelerated the need for interoperability, not just for electronic health records (EHRs), but also for medical devices, wearables and more.

Ultimately, the broader question is, “How can systems keep pace amid such rapid change?” ONC has said it will work with the US Department of Health and Human Services (HHS) to explore whether creating new conditions of participation in federal health programs is feasible or if a more traditional enforcement agency should take a leading role. The ONC also said in the report that requiring more transparency from developers regarding business practices that could interfere with the exchange or use of electronic health information “would be an effective, market-based approach to preventing many types of information blocking.” In particular, it highlighted enabling customers to access, discuss and share information on vendors.

While there is a role for government to set and enforce rules and point the industry in the right direction, I believe market forces will likely dominate. I can pull any guitar off my wall and plug it into any combination of amplifier and effects to suit my needs. If something does not sound right, I can quickly swap it out. If something goes wrong, I can easily identify and fix malfunctions. Therefore, I don’t buy products that don’t harmonize with the other elements of my system.

Health systems are beginning to shop for technology the same way, both for EHRs and medical devices. The Center for Medical interoperability will assist hospital and health systems as they and broader health care stakeholders advance interoperable practices across the system. With greater needs to connect applications and facilities to meet new payment models and operational challenges, hospitals and health care systems are sending a message to the industry that they intend to buy products that are proven to be interoperable and, in some cases, interchangeable. Industry efforts, such as the CommonWell Health Alliance, which is creating a vendor-neutral platform to advance effective health data exchange, are responding as well.

While I cannot predict how soon health care technology will play well together, the good news is that our band is sounding pretty good. I am also confident that if my friend Pete shows up with his Telecaster, or Dave arrives with his 1949 Gibson J-45, they can join in without missing a beat.

—By Harry Greenspun, M.D., Director, Deloitte Center for Health Solutions, Deloitte LLP

via Health Care Current