AUTHORS Cindy Sanders
You can get money out of an ATM in Istanbul and watch a movie 35,000 feet in the air on the flight back, but you cannot electronically access your patient’s x-ray taken at the urgent care center two blocks down the street.
What would be totally unacceptable in any other industry has somehow become widely tolerated as ‘business as usual’ in healthcare … but one group is determined that’s about to change. The Center for Medical Interoperability is on a quest to bring healthcare in line with other vertical markets to improve safety, outcomes and cost efficiency.
Ed Cantwell, executive director for the Center for Medical Interoperability, said the 501(c)(3) organization came about as a result of the philanthropic work and strategic vision of the Gary and Mary West Foundation and West Health Institute. Looking at what drives costs in healthcare and contributes to less-than-stellar outcomes within the industry, Cantwell and colleagues were given the task of identifying the elephant in the room.
Zeroing in on the technological disconnect from medical devices to electronic health records, Cantwell noted the team was asked to bring a fresh perspective from outside of healthcare to the problem at hand “instead of conceding defeat from a legacy attitude.”
From the start, Cantwell said the Center has had five guiding motivators to address and resolve:
- High cost: “Technology is in the way instead of in the background,” he said of a lack of efficiency driving costs.
- Preventable deaths: “We lose nearly two 747s a day with about 400 people each,” Cantwell pointed out. “If an airline lost two planes, or 800 people a day, would the public tolerate it?”
- Caregiver burnout: A former pilot, Cantwell said the difference between when he flew regularly 15 years ago and today is unbelievable. Technological advancements guide decision-making and have vastly improved safety. “The systems are interconnected; they wrap the pilot in knowledge,” he pointed out. However, the same cannot be said in healthcare where there has been little effective change in the underlying technology infrastructure over the same time period. Cantwell noted in the absence of data interoperability, providers make calls without all the available information at hand. The current process of attempting to integrate data is cumbersome and exhausting.
- Precision medicine: “If you don’t have true data interoperability, how can you realize the benefits of personalized medicine?” he questioned of applying data to individuals and the broader population health mission.
- Innovation in an application-based economy: “Between Apple and Google, the app-driven economy is fundamentally changing the way you live and is starting to penetrate your wellness,” Cantwell noted. “In general, healthcare has had very little IT innovation, and it’s because access to data is so proprietary and so hard to hook into that it doesn’t attract investors. There’s not an underlying uniform infrastructure so innovators are shunning healthcare because it’s just so hard.”
Creating a Structure for Success
Cantwell said in every other vertical market – including the highly competitive cable, phone, financial, and airline industries – data has been made available to drive advancement. “That interoperability and data exchange allows for a level of wisdom that drives productivity and outcomes,” he pointed out.
Not only is communication difficult among healthcare entities across the continuum of care, but it is often hard to share data even within a single practice or health system. With so much of the equipment being proprietary, one device or piece of technology can’t ‘talk’ to another without the purchase of middleware. “Why do I need to pay for an interpreter? Why can’t you just speak the same language?” Cantwell questioned. “In many ways, the hospitals and health systems are just being held hostage.”
To change that, the core staff of the Center has spent the last few years studying other vertical markets. “There was one common denominator,” Cantwell said. “Each has the benefit of what we call a centralized lab.”
He noted these successful industries have created a non-profit made up of leading companies within their sector and have challenged the CEOs to support the non-profit by serving on the board and bringing in their technical staff to come together and agree on a fundamental architecture that is both vendor and member neutral.
Taking a page from these industries, Cantwell noted, “In mid-2012 we started building a lab for healthcare with a focus being on the seamless exchange of information.” Incubated in California, the Center is in the process of moving to its permanent home in ONEC1TY in Nashville.
The impressive members of the Center’s board represent nearly one of every eight dollars spent in healthcare. In addition to the founding chairman, Michael Johns, MD, the board includes the top executive from a host of academic, for profit, and not-for-profit companies and organizations including HCA, Robert Wood Johnson Health System, Cedars-Sinai Health System, LifePoint Health, Community Health Systems, Ascension Health, Scripps Health, and Vanderbilt University, University of North Carolina and Johns Hopkins Schools of Medicine, among others.
“We’re using the industry leaders and their procurement power and technical advisors and a dedicated R&D organization that will work within the ecosystem to develop a data interoperability platform and make it available free to the ecosystem and then become the test and certification body for it,” Cantwell said of the Center.
The Center is focused on five core platform requirements to achieve interoperability:
- Plug-and-play so that when two independent pieces are connected, they self-configure how to talk to each other with minimal or no human intervention.
- One-to-many communication where once a device or system is certified as being conformant with reference specifications or set of standards, it can be used with similarly certified devices without additional testing.
- Two-way data exchange enabling data to flow in both directions for feedback loops and automation.
- Standards-based options that use open, as opposed to proprietary, solutions in reference architectures, interface specifications and testing.
- Trust so that users have the confidence that interoperable systems will be safe, secure and reliable.
Calling the work to be done both “a moonshot and a marathon,” Cantwell said the Center has a very aggressive goal to have the basic components in place within two years. After that, he said the function of the Center would be to build strong governance that encourages continuing innovation. “You’re not going to be able to keep healthcare out of an app-based economy forever,” he said. “Once it tips, you’re not going to be able to stop it.”
Improving interoperability holds great promise both in terms of patient outcomes and increased cost efficiency. However, Cantwell noted, success has even broader implications for the overall health and wellbeing of the country. “With healthcare (spending) at nearly 25 percent of the GDP, if you take even 10 points out of that, you could almost fund all the other social issues that are threatened,” he pointed out.
Cantwell concluded, “I think as a nation, it’s time. It’s time as consumers, we demand more from our healthcare system.”