Innovation Pulse: A better road to data interoperability?
In the national discourse about interoperability, much of the focus is on enabling a doctor using one electronic health record to access patient information residing in a different hospital's EHR, even when another vendor built it.
But is that really the best way to give doctors the data they need?
"Having the government mandate interoperability is completely wrong," JaeLynn Williams, president of 3M Health Information Systems, told me. "I think we should let the market drive it – and the market says physicians want a single workflow."
That workflow does not have to be directly in an electronic health record, either, and in all likelihood it won't be as the industry moves beyond its initial digitization and into what many are hailing as the post-EHR era, wherein new platforms come to market that enable clinicians to more effectively follow their patients.
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If you picture the EHR as one piece of a software stack, rather than the entire application, these technologies are a layer of abstraction above the EHR and essentially reach down to get that data.
"That's what clinicians want. They don't care about interoperability," said Stuart Hochron, MD, chief medical officer at mobile collaboration platform maker Practice Unite. "They want the information."
I'm going to group a bunch of tools together, for simplicity's sake, and christen them as part of a new breed of software delivering that patient data.
Practice Unite and 3M, with its workflow tools, are in there. Others include par8o, with its boldly-marketed "operating system for the entire healthcare industry," ExamMed's newly-minted "universal healthcare technology platform" and the TapCloud smartphone app, which the company calls "a powerful overlay to an EHR."
Overlay. That's the operative word and, indeed, while ExamMed and par8o are more about reaching and tracking patients they also, for lack of a better term, overlay EHRs and other software systems.
It's important to explain that, rather than being direct competitors, these vendors are a representation of emerging technologies that more closely tie clinicians with patients in a way where all parties have access to relevant data. Hospitals could implement and use two or more of them. And they are just a few of the countless innovators coming to market.
[See also: Interoperability: Just ahead or still far off?]
Make no mistake: None of these are going to take over the world and solve today's existing interoperability issues alone. Instead, what they have the potential to do is create pockets of interoperability that might not get us to the Holy Grail of any doctor being able to see all the records of any patient – but might land us somewhere close enough.
Take par8o, for instance. Lancaster Regional Medical Center is using the platform on top of multiple vendors' EHRs from triage to tracking patients' next steps in care outside its own facilities, according to Lancaster Regional CEO Russell Baxley, to essentially tie together various providers in the area with specialists, patients and payers. Other par8o customers such as MGM Resorts and Mt. Sinai in New York also have the potential to enable wide regions of information interoperability.
An industry misguided?
The Office of the National Coordinator for Health IT is at the epicenter of all this. Its 10-year roadmap to interoperability ambitiously aims for the end point of a learning health system – which is, in my opinion, a noble goal and one worthy of the federal government's efforts.
But not everyone will agree with me on that, of course. When I asked Williams if she thinks that the government should back off its efforts to drive standards that fuel interoperability, she cut to the chase: "I would say 'yes.' We're relying too much on standards."
Baxley didn't pull punches either.
"I think we played it out all wrong to get to where we need to be. There's nothing pushing anybody toward true interoperability," he said. "The incentives and the penalties are placed on the wrong people. The only way we'll have true interoperability is when the penalties are placed on the EHR providers and bonuses offered for those vendors to make their systems interoperable."
This new crop of platforms won't supplant ONC's work, of course, but they could soar right on by.
"The ability to capture data selectively and share it opportunistically in ways that empower the clinician will surpass any plans to create huge data warehouses and EHR-to-EHR interoperability," predicted par8o co-founder Adam Sharp, MD.
Indeed, as more and more pockets of interoperability expand outward, we inch ever closer to that broad-accessibility of data that so-called interoperability promises. But will that be close enough to nationwide interoperability to affect the care delivery improvements we all want?
"I think regions are good enough," 3M's Williams said. "We have pieces of interoperability that exist right now. I believe that we are a lot closer than we think."