Nobody is explicitly opposed to interoperability in healthcare IT. That would be like opposing the eradication of poverty, hunger or child slavery. People of goodwill – providers, payers, vendors, regulators – just can’t argue against it. The potential benefits are too clear.
Nobody says interoperability is bad, only difficult. There are legitimate concerns (and real complexity) around data security, semantic consistency, and patient matching, to name just a few thorny technical issues.
That said, the not-so-secret truth is some vendors are more resistant to interoperability (or make it more difficult) than others for purely business reasons, while some vendors work hard to make interoperability a practical reality for provider organizations. It’s this inconsistency of effort, more than technology, that’s driving government regulators to act.
In her statement accompanying the release of ONC’s “interoperability roadmap,” HHS Secretary Sylvia Burwell said, “It’s time to free up [healthcare] data so patients and providers can securely access their health information when and where they need it. A successful learning system relies on an interoperable health IT system where information can be collected, shared and used to improve health, facilitate research and inform clinical outcomes.”
This is a grand vision for what one might think of as “macro-interoperability.” But let’s consider for a moment “micro-interoperability” – interoperability at the local level, which impacts clinicians and patient care in a very tangible way – because it can inform our thinking about attaining that macro-level national vision.
Micro-interoperability can be readily seen within the community hospital, where the priority is to integrate multiple systems under one roof and forge a unified, intuitive user experience for the clinicians who rely on those systems every day. Hospitals have been doing (or at least attempting) this for years, with varying degrees of success. Here are three observations from ground level that are worth bearing in mind as the broader healthcare IT macro-interoperability undertaking gains momentum.
1) Standards are bricks; systems are structures. Standards such as HL7 have been foundational to interoperability among hospital systems for decades. But ultimately a standard’s practical utility depends upon how it is put to work; in other words, it’s all about execution. A hospital creating an interoperable environment needs a system that integrates and interfaces with multiple third-party systems bi-directionally; that manages data transport and connectivity; and that provides normalized and standardized data. The mere existence of a technical standard doesn’t get you there.
2) Remember the user. If, as IEEE says, interoperability is the “ability of a system or a product to work with other systems or products without special effort on the part of the customer,” then that puts the user squarely in the center of the issue. There’s no meaningful interoperability without ease of use. We’ve seen this at the hospital level – for example, with physicians’ reticence to adopt EHRs. It surely won’t get any easier at the macro-level, where interoperability has a multitude of user constituencies and, therefore, significantly more complex usability issues.
3) “One for all” is not a recipe for IT success. And speaking of EHRs, they may offer a cautionary tale for those designing the healthcare IT interoperability superstructure of the future. History tells us most monolithic systems, such as EHRs, eventually get too big for their britches; “software bloat” sets in and new functionality suffers. For example, physicians’ needs were literally an afterthought since, prior to the governmental requirements for Meaningful Use, almost every physician in the country used paper for a majority of their workflow. So while “interoperability” is built into some EHRs, optimal physician workflow support (and usability) typically is not. A broad healthcare IT interoperability framework runs the risk of bloat.
Industry headlines say the push toward macro-interoperability technical standards is on in earnest. As this very publication, Healthcare IT News, reported recently, “some believe the momentum is right – at long last.” We’ll see. If so, it’s worth bearing in mind the experience of hospitals, which have been pursuing practical interoperability for years. Some are achieving their micro-interoperability goal: a unified patient care environment that gives all constituents, including physicians, an extremely satisfying and productive user experience. Here’s hoping that’s where the push for macro-interoperability ends up, as well.