Interoperability, Clinical Data, and The Greatest Generation

As a healthcare IT zealot and wanna-be policy wonk, I find myself mired in acronyms, and surrounded (and indulged) by those who understand my rapid-fire Klingon-esque rants on BETOS and LOINC and HCPCS. The larger concepts of interoperability and meaningful use lose the forest for the trees of IHE standard definitions and specific quality measures. Have we lost sight of the vast majority of the healthcare consumers, and their level of understanding and awareness of those larger concepts? Could you explain HL7 ORUs or CCDs to your great-grandma?

I recently visited my 90 year-old grandparents, both remarkably healthy multiple cancer survivors who show no signs of slowing down, and have maintained enough mobility to continue bowling 3 times a week. After an evening of pinochle, my grandma asked me to please help her understand what it is that I DO for a living. We’ve had this conversation before.

“I’m a healthcare technology consultant, Grandma. I work with insurance companies and doctors to help them get all your information.”

Puzzled look.

“When you go to the doctor, Grandma, do they write anything down on paper, or are they using a computer when they talk to you?”

“Oh, they’re always on those computers! Tap-tap-tap. Every question I answer and they tap-tap-tap.”

She illustrates by typing on her lap, and I confirm that she’s a hunt-and-peck person. She stops only after I finish asking my next question.

“Do you have private insurance, or do you use the VA?”

“I have Blue Cross. Your grandpa uses the VA.”

“How many doctors did you have to see for your blood infection?”

“FOUR! Sometimes two in one day!”

“Did they all have to ask you for your history?”

“No – they already had it, on their computer. They even knew about my mastectomy, 30 years ago. One corrected me on the date; I’d thought it was only 20 years ago.”

“Well, Grandma, when you booked your appointment with the first doctor, their computer system automatically requested your medical records from your insurance company. And the insurance company automatically sent your records back to the computer. After the first doctor made notes on your visit, just after you walked out the door, the computer sent an updated copy of your medical records back to the insurance company, and it ordered the lab tests you needed before you went to the next doctor. Then, the lab automatically sent your results to the insurance company AND the doctor who ordered the tests.”

“But the other doctors had the test results.”

“Yes, ma’am. Each time you made an appointment with a new doctor, that doctor’s computer requested your medical records from the insurance company, and the insurance company sent out the most recently updated information. It only takes a minute!”

“Goodness. So, do you build the computer programs that make all that work?”

Eyes wide. THIS impresses her.


Puzzled look again, so I quickly continue.

“But I make sure those computer programs can talk to each other, and that the insurance company can make sense out of what they’re saying.”

“Because if they couldn’t talk to each other, I’d have to haul a suitcase from doctor to doctor with my chart?”

“Yes, ma’am. That’s called ‘interoperability’. There are new rules for how doctors’ computers should talk to each other, and to the insurance companies. And I get to work with the insurance company to do other really cool stuff. I take a look at LOTS of people’s medical records to find patterns that might help us catch diseases before they happen.”

“And what’s that called?”

“Clinical informatics. It’s my favorite thing to do, because I get to study lots and lots and LOTS of information. That’s called ‘big data’.”

“Sweetheart, you lost me with the computer words. But I’m just so happy you’re happy!”

She hugs me and grins, and I finally feel like I’ve found the right way to talk about my passion: through use cases. Although, Grandma would call them stories.

And there you have it: the importance of interoperability and clinical data, through the eyes of The Greatest Generation. Check in next year for an update on whether my definitions stuck!

About the author

Mandi Bishop

Mandi Bishop

Mandi Bishop is a hardcore health data geek with a Master's in English and a passion for big data analytics, which she brings to her role as Dell Health’s Analytics Solutions Lead. She fell in love with her PCjr at 9 when she learned to program in BASIC. Individual accountability zealot, patient engagement advocate, innovation lover and ceaseless dreamer. Relentless in pursuit of answers to the question: "How do we GET there from here?" More byte-sized commentary on Twitter: @MandiBPro.


  • NOW I know I must go back to school !!!! I loved your explanation of your work.THOSE Words I must learn and this computer I MUST conquer !!!!. We are so proud of you. Our LOVE ,PRAYERS and BEST wishes are always with you, as you GO TO THE TOP. GG

  • I love you and GP, too, GG! 🙂 You’re doing absolutely fabulous with your computer. You two are the only great-grandparents I’ve ever heard of who Skype frequently. You’ve mastered the digital age! 🙂

    I’m so glad you liked my story about our talk. You two are quite an inspiration for healthy living. I only hope that munchkin follows in your footsteps, and we all look half as good and stay half as mobile as you guys have done!

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