Is HIT interoperability in the nature of healthcare?

By Edmund Billings, MD
12:09 PM

Anyone who understands the importance of continuity of care knows that health information exchange is essential. How are we supposed to cut waste and duplication from the healthcare system and truly focus on patient welfare if doctor B has no idea what tests doctor A conducted, or what the results were?

The predominant proprietary HIT vendors know this, yet have engaged in prolonged foot-dragging on interoperability and even basic data interfacing. Yes healthcare IT is their business, but interoperability is not in their nature.

As we’ve seen before, the problem is with the business model.

The proprietary business model makes the vendor the single source of HIT for hospital clients. Complexity and dependence are baked into both solutions and client relationships, creating a “vendor lock” scenario in which changing systems seems almost inconceivable.

In the proprietary world, interfacing with third-party products is a revenue generation strategy and technical challenge; the latter, though unnecessary, justifies the former. When we go looking for the reasons that healthcare is a laggard compared with other industries, this single-source model—the obstacle to much-needed competition and innovation—is a primary culprit.

To be fair, provider organizations, with little if any incentive to exchange patient data before the advent of Meaningful Use, haven’t shown much collaborative spirit either. In the fee-for-service model, why would a healthcare organization let patients slip from their grasp? Health reform is finally mandating needed change, but when will proprietary vendors actually enable the interoperability hospitals and practices soon have to demonstrate?

Recent rumblings from Washington, DC, suggest the feds are losing patience.

“If we do not see sufficient progress or … our policy goals for standards-based exchange are not being met, we will revisit these more specific measurement limitations and consider other policies to strengthen the interoperability requirements…,” Farzad Mostashari, National Coordinator for Health IT, said last week at the 2013 Academy Health National Health Policy Conference. “I want there to be no question about the seriousness of our intent on this issue. [The] bottom line is it’s what’s right for the patient and it’s what we have to do as a country to get to better healthcare and lower costs.”

Even before Mostashari’s comments made the news, rumors were flying of Cerner and McKesson working on an agreement to make their EHRs “interoperable”. Framed as a technical development in the world of health IT, the potential Cerner/McKesson agreement is nothing more than a business decision—an attempted differentiator—driven by the success of Epic.

In fact, the technical interfaces and open standards are well established. There is no great technical interoperability challenge that requires the coordinated efforts of two industry heavyweights. We should recognize Cerner and McKesson for making tentative steps toward openness, but casting this as some kind of technical breakthrough does nothing to advance the cause.

Indeed, when Cerner CEO Neil Patterson recently told a joint public hearing organized by the Office of the National Coordinator that “no single vendor” can meet all the needs of a provider, he was talking about Epic.