Interoperability: Ripe for disruption?

Interoperability has, well, interoperability problems. Standards are being developed but EHRs are still under-delivering. And once data sharing picks up, more challenges will arise than we understand today. Multiple tipping points are ahead.
By Tom Sullivan
07:08 AM
interoperability ripe for disruption

Interoperability as it stands now is a point in time. But what the healthcare industry really needs is a continuous ability to exchange health data among providers.

Mario Hyland, founder and senior vice president of, explained what that means: A hospital using one vendor’s electronic health record might be able to exchange data with another hospital running a different vendor’s EHR platform today – until one or both of those hospitals upgrade to a new version of the software, that is.

After that, there is no guarantee that they can swap records and, instead, all likelihood they'll have an interface problem.

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Call it a newfangled government-funded planned-obsolescence upgrade cycle. EHR vendors can sell software that hospitals use to earn meaningful use reimbursement incentives despite widespread usability issues and then those vendors can essentially turn right around and sell upgrades or entirely new EHRs to customers needing a product that qualifies as actual modern software. The circle loops onward.

Such a low interoperability bar does not make for rapid progress. The existing scenario, however, does ripen the entire interoperability realm for disruption.

“We’re at the cusp of interoperability challenges. We’re not almost there, we’re not halfway,” Hyland said. “We don’t even know what we don’t know.”

Network effect? Not soon enough
There is a general consensus that the industry is headed toward a scenario wherein enough hospitals and networks are effectively sharing data with competitors that even the stubborn holdouts will have to cooperate or risk losing patients, falling behind in care services they can deliver, lacking data for population health and value-based payments. That will trigger an inevitable tipping point, the argument goes, after which any providers that want to survive will have to make themselves and their data interoperable.

That network effect may very well happen at some future point. In the meantime, however, there are more pressing challenges.

[Read more Innovation Pulse columns]

The chief obstacle is existing provider-vendor business models and the lack of any carrot for sharing or stick for not sharing,” said Brian Murphy, an analyst for HIE Strategies and Technologies at Chilmark Research. “Any carrots or sticks have only been nibbled around the edges so far.”

Interoperability won’t reach the mainstream without widely agreed upon and indeed deployed semantic, data model and data definition standards, according to Mike Restuccia, CIO of Penn Medicine.

“Until then, as evidenced by the rapid migration of health systems and providers toward integrated solutions such as Epic, Cerner and Allscripts interoperability will continue to lag in adoption and under-deliver in meeting expectations,” Restuccia added.

In the here and now, though, hospitals are getting impatient by the reluctance of others to share data without a committed financial incentive or reimbursement, said Doug Brown, managing partner of Black Book Research.

“The catalyst is the benefit hospitals, systems, commercial payers and payviders will gain from the exchange of data,” Brown added.

The coming disruption
Building on that, Mariann Yeager envisions multiple tipping points on the road in front of healthcare providers. Yeager is CEO of the non-profit Sequoia Project, which oversees the eHealth Exchange and Carequality public-private data sharing collaborative.

The first point, Yeager said, is the availability and implementation of software that is technically capable of interoperability and then, on top of that, would follow sufficient forward momentum among hospitals sharing data. A third would be those business drivers Chilmark’s Murphy mentioned.

None will happen overnight.

“At the current pace and process of which interoperability is being pushed forward, when 35 to 40 percent of all visits result in an interoperability request – as we get to that tipping point more interoperability will be broken than solved,” Aegis’ Hyland said. “We’re going to see interoperability challenges start to skyrocket in a number of ways.”  

Among those challenges will likely be a digital divide of the provider sorts, said Jane Sarasohn-Kahn, a health economist who meets with rural hospitals around the country lately and found that their top concern is internet connectivity.

“I can see a potential digital divide between those who join and those who may lose market share and never recover,” she said. “Without mandate or incentive, most rural providers will find it tough.”

At the same time, patients are growing fed up. They don’t want to carry around paper records, drives or discs from one appointment to the next.

The overarching question, then: When will hospitals, networks and technology providers finally catch on and bring interoperability out of the abstract and into the concrete?

“It starts with CMIOs talking to CIOs,” Hyland explained “and saying they need software to be higher-quality than what exists today.”

Helpful advice for planning to purchase a population health platform:

⇒ Experts explain what to look for when choosing a population health platform
⇒ Comparison chart of 8 population health products 
⇒ An in-depth look at 8 population health software programs

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