“The times they are changin’”

The role of interoperability continues to evolve
By Bernie Monegain
12:00 AM

Anyone who has ever been to the Interoperability Showcase at the HIMSS Annual Conference and Exhibition has probably caught a glimpse or two of what interoperability means to healthcare.
As we all know, interoperability is what makes data exchange possible between entities - hospital to hospital, doctor to doctor, doctor to hospital and vice versa. Unless disparate systems can connect - interoperate - vital patient data is trapped in one system - one electronic record. Yet, not one of us would ever expect to whip out a credit card and not be able to use it at any store. So, it seems, in spite of all the years of hard work and attention devoted to interoperability, healthcare remains behind the times.
But not for much longer.
The Global Center for Health Innovation opened last month in Cleveland giving new hope for both healthcare innovation and a scrappy Midwestern city - and, not the least, yet a new push for interoperability. Within the center, on the top floor, is the HIMSS Innovation Center. As the name implies, the center is focused on innovation, but first and foremost, it seems to be dedicated to the concept of interoperability - something that HIMSS has been advocating and promoting for many years.
"As a leader in interoperability, standards and harmonization initiatives, we want to further our cause to bring quality safety, cost effectiveness and access to care through the best use of information technology," HIMSS President and CEO H. Stephen Lieber told the audience at the center's ribbon-cutting ceremony last month.
Interoperability will be front-and-center every day in at HIMSS Innovation Center.
HIMSS has not been alone championing interoperability. ONC's former chief Farzad Mostashari has been among the most indefatigable of champions, using the bully pulpit to help push interoperability forward. He believes the times are a-changing to push efforts forward.
"Most vendors really do see it now as part of their self-interest to be as interoperable as possible," he told me in an interview about a year ago. "But we still hear a lot of complaints from providers that their vendors are putting up what they believe are artificial roadblocks to them being able to share information, to participate in health information exchange."
Really? This no time for "artificial roadblocks." If what Mostashari has heard from providers is accurate, that kind of obstructionism is wrong. It has to stop, and we believe it will. It's inevitable.
"It's a shared responsibility," Mostashari said of interoperability. "Fundamentally, we have to reduce the cost and complexity of interfaces through standards and implementation guides. The vendors have to really be able to do Stage 2."
He explained that meaningful use Stage 2 requires "a huge step up on interoperability."
Mostashari and many other industry leaders assert that interoperability is within reach - and perhaps sooner than some think.
"I think it's not going to happen by itself," Mostashari said. "It's going to need a lot of work on the part of the vendors, but also for us to help provide examples, tools forums, education. This is the year where implementation happens for Stage 2.
At a meeting of AMIA a year ago this month, Charles Jaffe, MD, CEO of standards development organization HL7 described a "circle of blame" regarding interoperability - one that involved government agencies and regulators, hospitals and healthcare systems, technology vendors, clinicians, academicians and, even standards development organizations, such as HL7.
"The policy always preempts the technology," Jaffe asserted.
Just as there's no crying in baseball, there should be no blame in interoperability. It's time to pull in the same direction.
In testifying before a the federal Health IT Policy and Health IT Standards Committees about a year ago, Neal Patterson, CEO of Cerner, one of the largest and most influential EHR companies in the country, told members of the panel that data liquidity is a "moral obligation" for health IT vendors.
We couldn't agree more. It is not only a moral obligation, but also a smart move. The times are changing.
A couple of months later Patterson was on stage with executives from McKesson, Allscripts, athenahealth, Greenway and RelayHealth, announcing a new EHR vendor organization - Commonwell Health Alliance - dedicated to interoperability.
Interoperability is coming. The winds of change are pushing it forward, propelled not only by technological advances, improved standards and know-how, but also by a growing understanding and acceptance that it's the right way to go. There's no stopping it with real or artificial roadblocks.