Interoperability ‘not the goal’
Connectivity between healthcare providers has been a sharp focus for IT initiatives since 2004, and the concept has assumed many forms
An idea can change a lot over eight years and while the intent of interoperability remains essentially the same, its application has split off in various directions since 2004, when the Bush administration called for establishment of electronic health records, universal connectivity between healthcare providers and named David Brailer, MD, as national health information technology coordinator.
EHRs remain a work in progress, though Brailer is long gone from his post and interoperability has meandered down divergent paths of connectivity. Over that time, new initiatives have sprung up as well, such as meaningful use, accountable care organizations and ICD-10 conversion. The lofty regional health information organization concept originally proposed has been largely scaled down to smaller health information exchanges.
All of these developments are part of a natural evolution for interoperability, which Robert Connely, senior vice president of innovation and strategy for Salt Lake City-based Medicity characterizes as "a stairway" of progress.
"Ten years before Bush started the EHR initiative there was the community health information network (CHIN) program," he said. "When CHINs started, connecting physicians together was seen as a good idea, but it had a cost barrier. Then the Internet took off and connectivity was a zero cost item. Then they appointed Brailer and the intent was to bring together technology and longitudinal data. Now it's the interoperability barrier and we will soon hit the semantic barrier. For every 10 years of progress we hit another riser in the steps."
Ultimately, interoperability is "a key capability, but not the goal," Connely said. "What we need to do is improve quality while managing costs. We need to prevent hospital readmissions and use touch points across the continuum to drive and mold behavior."
Patching archaic gaps
Despite the realization that antiquated systems cause information silos and disrupt connectivity, there are many smaller hospitals that aren't in a financial position to invest in new IT infrastructure, said Paul Burke, director of revenue cycle technology for Chadds Ford, Pa.-based IMA Consulting. Even so, he said there are low-cost options that can help improve their interoperability.
"There is still a lot of dated technology in the business office and organizations need to get additional functionality out of their old systems," Burke said. "The smaller community hospitals that are struggling haven't been able to put the resources into it. But there are boutique firms out there that can fill that need by bolting on additional applications for extra functionality."
New York City-based Infor specializes in helping hospitals expand their data interchange capabilities through a product called Cloverleaf. This middleware product is designed to blend with HIE products into a single platform.