Commentary: What about interoperability?

John W. Loonsk

Installed base of non-interoperable EHRs may pose another barrier

The recommendations for Stage 3 of meaningful use are now out for comment. Coincidentally or not, there is a new degree of pessimism about when health IT interoperability will ever be achieved. The issue of progress, or relative lack thereof, on interoperability surfaced just before the election with members from both houses of Congress questioning whether HITECH funding of electronic medical records should be continued without interoperability standards or more rigorous meaningful use requirements in place.

Some dismissed the questions from Congress as election season rhetoric, but at the same time, many industry professionals have again resigned themselves to a long, slow road ahead. Recent, non-political, Congressional testimony suggested interoperability is still another decade away. And there are enough renewed discussion threads of potential “interoperability solutions” by newbies and statements of dispirited resignation by old hands to substantiate a serious trajectory problem.

HIT’s déjà vu all over again

Information exchange and interoperability have long been seen by people involved in health IT as being central to achieving meaningful outcomes with technology. Health IT professionals certainly recognized that providers needed to adopt health IT to start, but they also have long held that the data needed to be mobile and not stuck in a particular IT system or organization for many of the benefits of health IT to develop. Given how vague and ill-defined interoperability can be, and given the sparse empirical evidence for some of these assumptions, it is a little surprising how resolute the professionals are with these conclusions. Perhaps it comes from the practical challenges of trying to support continuity of care, or of working to aggregate data for quality, efficiency, public health, and research purposes, or from simply battling the obstacles to making disparate hospital systems work together.

For many of these same professionals, HITECH and its billions of dollars for health IT were thought to be a potential interoperability game changer. It was the first major national investment in health IT. And with the magnitude of the funding, the “hook” of the meaningful use mechanism, a second generation certification program, and the mission of supporting the needs of health reform, many felt we should have turned the corner on interoperability. Yet for those in the trenches, interoperability is still an uphill grind if not largely elusive. They just aren’t seeing many health IT systems that can easily process information that other systems provide. While information exchange is advancing in some ways, without broader exchange and the interoperability needed to process “foreign” information, health IT can actually act to increase the unnecessary information that a provider has to review rather than help make the provider more efficient.

The corner seems to have been turned on the adoption of electronic medical records, but many remain worried that the same is not true for interoperability. The interoperability trajectory is not proportionally steep, the HITECH tools to accelerate to this goal seem to be receding, and the newly installed base of largely non-interoperable EHRs may now be yet another obstacle to achieving a fully interoperable health IT infrastructure.

LOWTECH?

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