Interoperability? Yes, for value’s sake!

When we talk about connected care and interoperability, we tend to do so within an outdated framework that prioritises ‘medicine’ over ‘health’. We shouldn’t get stuck there, writes Dr Charles Alessi, HIMSS International chief clinical officer.
By Charles Alessi
04:15 AM

There is a misconception that the terms health and medicine are interchangeable, but they describe very different concepts and states.

Health has been subject to whole series of definitions and WHO defined health in the Alma Ata declaration in 1978 as follows: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”. It is called the Alma Ata declaration as this was the place WHO were then meeting – now Almaty in Kazakhstan.

But is this the best definition? I am a male who has less than perfect eyesight – although well corrected and also perhaps not the most abundant crop of hair. Does this mean I can never attain the “complete physical, mental and social well-being”?  

Realising the full health potential of every human, everywhere

A further attempt to define health came from Huber et al and was published in the British Medical Journal in 2011 as: “The ability of an individual to adapt and self-manage in the face of physical, mental and social challenges.” This goes further to satisfy the aging male with imperfect eyesight and one who is follicly challenged, but is this the best we can do? I think the HIMSS view on health is far simpler and, in many respects, better: “To realise the full health potential of every human, everywhere.”

All this matters because reaching the maximum potential of health possible is where we all want to be and medicine is one of the mechanisms employed to hopefully ensure we remain there. Medicine is of course only part of the story. We have come to realise that other factors outside of the biomedical world also have significant impact upon wellbeing and make up most of what determines how we feel about ourselves, as well as our health. Determinants like where we live, our jobs and wealth, as well as our sense of meaning and purpose in life, sense and participation in our community, together with managing our riskier health-related behaviours like smoking make up a significant part of what determines who we are and how we feel.    

As populations in the world are ageing, the challenge to medical systems is intensifying as the link between ageing and multi-morbidity is well recognised. The typical 65-year-old tends to have more than one long-term medical condition and the number of diseases people over 85 live with tend to be four or more. This puts an enormous strain on our medical systems as they have to manage more and more care. The financial consequences of this are also enormous which is leading the payor of healthcare, be they insurance companies or governments, to advocate the movement from “volume” meaning payment by activity and intervention to “value” meaning payment by outcome and by promoting health rather than promoting medical intervention.  

Striving for value-based care

As these new value-based systems start to emerge, the importance of preventative medicine is also increasing. It is in my interest as a health provider operating within a system that promotes health to ensure that as many of my population as possible are healthy as against an activity based system where payment is solely attributable to medical interventions on the not so healthy.  

Modern health and care in a value-based system is also not only administered in the more old fashioned ways we know so well, in a consulting room between a physician and a patient, but also in places like schools, gyms, workplaces and social clubs given that all these places are where some of the non-health determinants of wellbeing are played out. Even in the purely biomedical space, people tend to aspire to receive treatment in places which are convenient and accessible to them in different geographies. We really have no alternative but to proceed to digital transformation as all this requires a “single version of the truth” and there is no way we can deliver this unless we somehow converge the written medical and health and care notes in a magic capsule contained within a time and place machine.

We also need to ensure that all the various records held by numerous people in a variety of places interconnect and do so using a taxonomy which is common enough for them to be usable and intelligible when combined in a single record. This record can of course be augmented by people’s own data associated with their wearable devices and with the emerging internet of things data which will very soon be multiplying. 

What will an interoperable world look like?

I suggest that it is that the deployment of solutions to ensure we have interoperability is the urgent need and indeed the technical aspects to achieve this are already here and in some places already being used to develop interoperability exchanges. Not surprisingly the main obstacles we have to address are not technology, but people. Furthermore, we should not be educating people on how to deploy these technologies, but breaking down the various vested interests that are delaying the full deployment of these solutions. 

The implications of all of this are profound as we know that accurate and timely access to personal information is a major determinant of outcome should that person require care.   

This blog was first published in the latest issue of HIMSS Insights. Healthcare IT News and HIMSS Insights are HIMSS Media publications.