Lesson: Interoperability can't be forced

Look to cable companies, banks, oil and gas for approaches
By Anthony Brino
10:38 AM
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William Check, NCTA's chief technology officer

When a health IT consultant described the "Tower of Babel"-eqsue barrier she encounters coordinating disparate EHR systems to a panel at the Health Innovation Day conference, William Check, CTO at the National Cable & Telecommunications Association, perked up.

“What you just described could have been the cable industries,” said Check, a veteran of GE and Mutual Broadcasting. “It’s amazing the parallel here.”

Back before cable companies were competing with Netflix, their IT was as unwieldy as hospital IT is today, probably a bit more so considering Moore’s Law.

Telecom companies had different systems in different cities and backend systems different from their frontends, Check said said.

When high-speed cable came to market, the problem presented itself again, with different vendors having different technologies that ultimately made everything harder for consumers and the companies.

[See also: Gladwell on interoperability and war.]

Along with the industry group CableLabs, the companies said: “We’ve got to come up with an industry standard to make this work,”and developed a single specification for the cable modem, called DOCSIS,  Check recounted.

In the Twitterverse, some conference goers wondered if CableLabs’ standards development story is really right analogy for healthcare. It would be “like Epic and Allscripts colluding,” argued Nick Dawson, a consultant who’s worked for McKesson and Bon Secours Health System.

Either way, Check’s greater point, echoed by others, may stand: Whatever the government’s intentions or role in creating standards, the will has to come from industry.

The financial industry created many of its standards for processing and later digital systems with just a bit of government cajoling, said Stephen Katz founder of Security Risk Solutions. Back when you could write checks on just a piece of paper, banks realized they needed to know which bank to send a check to (not to mention ensure it wasn’t fraud) and so the Federal Reserve ended up creating routing codes.

[See also: Lack of interoperability stalls progress.]

Likewise for the standardization of ATMs, credit cards and other financial products. “By and large, progress and standards were industry-driven,” Katz said.

Perhaps the main interoperability lesson for healthcare from other industries is  it can’t be forced, although that’s not to say the government’s leadership isn’t needed. Just as much as interoperability progress may come from standards as increasingly aligned financial incentives for providers, who ultimately decide which IT products to buy — making sure it’s not profitable to hoard patient data, as past national coordinator Farzad Mostashari, MD, liked to say.

One example is oil and gas, said Sid Fuchs, CEO of MacAulay-Brown, an engineering company servicing federal military and intelligence agencies.

“They’ve come a long way because they have a driver called profit, and they want to minimize the time it takes to drill an oil and gas well and get it out of the ground,” he said.

In healthcare, interoperability may very well come “when you see data sharing as a competitive advantage,” he argued.