Interoperability Needs Action, Not Talk – #HIMSS13 Blog Carnival

When you talk to people outside of healthcare about the value of healthcare IT, you will often get a response that healthcare IT is fantastic because it makes it so easy for medical data to be shared with who needs the data when they need it. Those of us in healthcare IT know that this is far from the reality of what’s possible with healthcare data today. This is really unfortunate, because the promise of technology in healthcare is to make the movement of data possible. We’re currently missing out on the benefits of this promise.

I don’t know about the rest of you, but I’m sick and tired of hearing the excuses for why healthcare data can’t be shared. We’ve heard them all: privacy, security, data governance, payment model, etc etc etc. Yet we go to the HIMSS Interoperability Showcase and see that the technology to start sharing data is there, but what seems to be missing is the willpower to push the data sharing through despite the challenges and naysayers.

Maybe Farzad is on to something when he called for EHR vendors to do what’s “Moral and Right.” There’s no more moral or right thing someone can do in healthcare than to make healthcare data interoperable. It’s not only EHR vendors that need to do this, but hospital institutions and doctors offices as well.

We need some brave leaders in healthcare IT to step up and start sharing data. No, I don’t want an announcement at HIMSS that a healthcare organization has partnered with a vendor to start sharing data. I don’t want a new organization formed to assist with healthcare data sharing initiatives. I don’t need another book on the challenges of HIE. We don’t need a session on HIEs and data sharing standards. No, we need brave organizations that say that sharing healthcare data is the right thing to do and we’re making it happen.

I’m not suggesting an organization should do anything ruthless or reckless. I’m suggesting that healthcare organization start DOing something as opposed to talking about it. The time for talking is over and the time for DOing is here. Healthcare data interoperability won’t happen until we make this choice to DO instead of TALK.

I’m not even asking for a healthcare organization to start sharing all their healthcare data everywhere. In fact, I think that’s another failed interoperability strategy that we seem to keep trying over and over. If you try to solve all of our healthcare interoperability problems in one major project, you’ll end up doing nothing and solve none of the problems.

Instead a successful interoperability strategy will focus on sharing one meaningful piece of healthcare data while still keeping in mind that this is just the start. Connect the healthcare data end points with that one meaningful piece of data. Once you make that connection, others will start to wonder why that same process can’t be used for other important and valuable pieces of healthcare data. This is exactly the push that healthcare interoperability needs. We need departments and providers jealous of other departments and providers that are sharing their data. The same principle of jealousy can apply across institutions as well.

Yes, this will take a forward looking leader that’s willing to take what many in healthcare would consider a risk. Imagine a hospital CIO whose stuck trying to explain why their hospital is sharing data that will help doctors provide better care to their patients. Imagine a hospital CIO explaining why they’re driving healthcare costs down by lowering the number of duplicate tests that are done because they already have the data they need thanks to interoperable healthcare data. I’d hate for a hospital CEO to have to explain why they’ve reduced hospital readmissions because they shared the hospital data with a patient’s primary care doctor.

Maybe implementing interoperability in healthcare isn’t such a brave thing after all. In fact, it’s a brave thing for us not to be sharing data. Why aren’t we holding our healthcare institutions accountable for not sharing data that could save lives, lower costs, and improve healthcare? Why are we ok with non-profit institutions worrying more about profit than the real stakeholders their suppose to be serving? Are we really so far gone that healthcare organizations can’t do something so obvious: sharing healthcare data?

Think of all the other major healthcare initiatives that would benefit from being able to share healthcare data where it’s needed. Meaningful Use, Obamacare (Affordable Care Act if you prefer), Clinical and Business Intelligence, Mobile Health, ACO’s, population health, etc could all benefit from healthcare institutions that embraced interoperable healthcare data.

Who’s going to take the lead and start doing what we all know should be happening? It won’t happen by #HIMSS13, but over cocktails at HIMSS I hope some hospital CIOs, doctor groups, EHR vendors, and other medical providers come together to do what they know is the right thing to do as opposed to just talking about it.

The above blog post is my submission to the #HIMSS13 Blog Carnival.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

21 Comments

  • There is no focus or even intent for interoperability to exist in the health IT realm right now because there was no focus by our government to establish standards. Instead, the push for MU and EHR adiption at all costs, to the detriment of physicians and patients, has been the focus. Subsequently, there is opportunity lost now as there are myriads of different EHR (even ones from the same vendor, like Epic that don’t talk to each other… and no, Care Everywhere with Epic does not work…the metro hospitals and clinics that use Epic in Portland, Oregon do not work with each other). I’ve mentioned on my blog that the technology is there…for instance, Mirth is a great open source solution that easily queries your database and converts to any tour of messaging protocol, but the attitude from various partners is that they don’t want to reveal propriety information, privacy issues, or other types of questionable excuses. You are right, there is no willpower to change. However, in the absence of a leadership role where no one wants to share is where the government steps in and sets the rules, provides the infrastructure, and then market forces take over.

  • Great post! And great comment by Dr Chen.

    In the Hi-tech world, there are a number of organizations that would take charge of a standards situation like this — IEEE, ANSI, W3C come to mind — and work with the industry to resolve compatibility issues. The most successful resolutions come without government interference, except where shared limited resources such as radio spectrum allocation are involved.

    There seems no be no equivalent organization. Not AMA — its focus is making money off CPT codes. Not NIH — its focus seems limited to biotech, and it’s a government institution. The EMR industry itself needs to recognize this problem and establish its own EMR Interoperability institute, given authority to use any and all resources to resolve current and future issues of this nature. But as Dr Chen implies, this is not likely to happen.

    Among the issues to be addressed should be platform neutrality. I once received a CD with Xrays on it. Should just be able to pop it into my Mac and open up several pdf files, right? Wrong! EMRs seem wedded to the closed Microsoft model — only obtuse binary spoken here. Along with resolving this single issue would come simplicity — the Mother’s Milk of innovation, and critical to managing inherent complexity.

  • The Hippocratic Oath states: “What I may see or hear in the course of the treatment or even outside of the treatment in regard to the life of men, which on no account one must spread abroad, I will keep to myself holding such things shameful to be spoken about.”

    Saying, “There’s no more moral or right thing someone can do in healthcare” than to “start sharing (patient) data,” is a direct violation of the Hippocratic Oath.

    This blog network has correctly noted the coming doctor revolt. Certified health IT will drive Hippocratic Oath-abiding doctors out of health care, or, more preferred, doctors will drive certified health IT out of health care.

    Tim
    13,033 days

  • Hi All

    There is a substantial amount of work being done on the Standards and Interoperability Framework. You can visit http://www.siframework.org to learn more about what ONC and CMS are doing on this.

    In fact in HIMSS 2012 – last March, we did demonstrate the interoperability capabilities in a live environment and in fact it was done when Dr. Moshtashari was present.

    With the Connect and Direct standards in place, I believe there will be a good start for interoperability features being adopted across the board by early 2014. MU II requirements also will expedite the process.

    Having said that, I would not deride or take away the credit that has to be given to ONC and CMS for making a start on Electronic Health Records which has to be in place before you can talk about interoperability. We all know of a time when we had to go into the bank or call them to send a wire; over the last few years we can all do it online from our accounts. It has taken the financial industry 20+ years to get to where we are now.

    Its a matter of 12 to 24 months when you will see effects of interoperability to a great extent.

  • Dr Chen hit the nail on the head; this huge drive to implement EHRs without having sufficient standards in place has caused a huge problem, because retrofitting an EHR to meet certain newer standards can be very difficult – especially if a vendor designed the EHR to not share data. Many EHRs use peculiar, very old database systems or methodologies that make it very hard to create external links, and there are not many EHRs with open APIs designed for data sharing or for adding specific technology for certain specialties.

    Tim – It seems to me that today’s HIPAA goes well with the ancient Hippocratic Oath. The oath as shown talks about not spreading what a doctor has learned ‘abroad’. My interpretation of this (no, I’m not a doctor) is that it has nothing to do with making sure that other clinicians can’t have from you the information they need to treat your patient, but rather that appropriate privacy standards apply. A doctor, for instance, can’t sit down in some eatery and openly talk about a patient (complete with name).

    David – I’m guessing that if I popped that CD into a PC (with typical software installed), I’d probably be able to view the images. But maybe on MAC’s it may just be harder to get the right software due to Apple restrictions. Or maybe the MAC in question just does not have any decent image viewers installed.

  • Tim,
    The key to sharing the patient data isn’t sharing it publicly, but sharing it with other providers who also adhere to the Hippocratic Oath and want to provide the best care possible to the patient. Certainly there are a lot of ways that interoperability could be a weight around doctors necks, but if done right it can be something that makes doctors lives better.

    R Troy,
    Actually DICOM images are a pain to open on most systems without specialized software. I think that’s what David is referring to.

  • John,

    Not one of the ‘widely’ supported formats, but I had no trouble finding a viewer for Windows and another for MAC – both free, but I’ve no idea how good they are or whether they can be used with other software – so point taken.

    I do agree with what you said about the Oath. And I’d point out that medicine is not the only profession where protecting ‘client’ data is of heavy importance though of course there is no Oath in banking! 🙂

    Ron

  • We’re currently in Beta on a solution to allow sharing of patient records with two key features 1) Does not require custom integration with EMR and 2) Does not require custom integration with doctor/hospitals.
    We developed software that’s going to be launching in March for the home health market to provide better communication between care stakeholders. They also wanted better access to patient records. After learning that integration with the likes of Epic would be impossible (my wife is a meaningful use expert), we figured out a radically new approach that allows access to all the patient records regardless of EMR and hosting institution (yes – sounds too good to be true, but you’ll say “why didn’t I think of that” when you see how). We’ve been keeping it under the radar as we’re currently focusing on our initial release for home health. We’re looking for development feedback and early adopters for the patient record piece, which is slated to release in April.

  • Carl,
    I checked out your website and I got a warning for a Trojan Horse in one of your javascript files. Might want to check that out.

    I’m always interested in new methods. I think the two main problems I’ve seen with all of the solutions is getting the data in the system and getting patients to care. You might have the second problem partially solved with home health (since chronic patients care more, but are a smaller market). Getting the data is much harder.

  • Ah, one of the great topics in the EHR world – interoperability.

    I’ve said all along, if this is what the government really wanted, they would have just “forced” everyone to use the government funded & developed open source EHR. Then everyone would be on the same format.

    But, that wasn’t done.

    Can anyone think of why EHR A doesn’t want you to open EHR B’s info?

    That’s right, it would be too easy for you to switch EHRs.

    Standards do exist in the EHR world, the problem is these standards aren’t very standard.

    Version X of the standard isn’t compatible with version Y.

    On the Mac OS vs Windows issue mentioned above – if your CD actually had PDF’s on it, you should be able to open them on anything…with a pdf viewer. BUT, I suspect that the person who burned the CD may have done things correctly and encrypted that CD since it has PHI on it.

    It is a curious question as to why EHRs are MS-centric. I’ve often wondered why more aren’t open source-centric. Probably the reason is simply, that’s what was easiest to deal with. Nobody is going to get fired for choosing to create this new system on the MS platform, but they might get fired to going open source.

  • Imagine a nation standardized to 120 VAC power but with (as of 2-18-13) 3,965 “Certified” sizes and shapes of electricity “interoperability” portals.

  • # John Lynn – The version we have available for access is the Alpha and has a few issues. We’ve been focusing on the full release that is due March 1st (all security holes patched).

    You are very correct, patients don’t care. That’s where Health Vault and others are failing to gain their adoption. However, the families of those receiving home care or in senior housing DO care. Once they see the value of it for their loved ones, they may see the value in it themselves.

    Getting information is tricky. At first I just thought “hey, we’ll get an API from Epic and it’ll be easy”, but then I learned the reality of that. As I picked my wife’s brain on meaningful use, I learned that the patient portal is mandatory. Being familiar with Mint.com, we figured out how to take the same approach with the patient portal to gather that data. It’s not perfect yet, but it’s leaps and bounds beyond anything available right now.

  • Carl,
    I’m interested to see what you’ve done. I’ve loved Mint’s model and could see something like it working in healthcare. Especially since MU is requiring a patient portal.

  • […] John Lynn, founder of the HealthCareScene.com blog network, shared his call to action for true interoperability both in strategy and leader. Aasia Nazir broke down all the benefits of interoperability, highlighting researcher Janice Walker’s paper, “The Value of Health Care Information Exchange and Interoperability.” Scott Rupp took us on a journey through interoperability vis-à-vis HIMSS in the Electronic Health Reporter blog. […]

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