Interoperability Challenges (VA, DOD, Epic, CommonWell) – Where Do We Go From Here?

The state of healthcare in the United States is fairly well known with the US healthcare spend between 17-18% of the GDP. It is one of the most expensive countries in the world for healthcare. America is also one of the few developed nations not to have a universal healthcare scheme, and one of the main barriers is interoperability challenges.

As we have just finished celebrating veteran’s day, one of the challenges in our federal system is interoperability. In order to provide these veterans with proper healthcare, the Veterans Association and the Department of Defense each proposed an update to the way medical records were stored. The proposed system involved purchasing or customizing an existing an EMR software, which would allow doctors to access patient files far more easily.

This would make it easier for veterans to switch doctors without having to worry about taking large amounts of paperwork along with them. It would also allow doctors to give their patients the best care possible without having to worry about red tape and legal hoops they have to jump through. While this makes sense to everyone, a decision has been made to have two separate systems.

We are also having the same discussion in the commercial EMR space recently where representatives from Cerner asked Epic to joing the CommonWell Health Alliance. Based on my experience Epic has done a great job at exchanging data with other Epic customers. At the request of the customer, Epic will work on creating interoperability with other non-Epic systems. The challenge is the need to create a special request for data sharing every time an Epic customer wants to communicate with a non Epic facility.

The House of Representatives have questioned the VA and DOD decisions to create these separate EHR systems. This makes perfect sense since I am also questioning the decision myself. What should have happened in this situation is the VA and DOD should have come together to collaborate on one EHR system. At the same time, the federal government should step in to create a standard for interoperability and mandate that we move towards collaboration.   If you think about the impact that meaningful use had on transforming the healthcare sector’s move towards digital, I believe the government could have the same impact on interoperability if they made it a requirement.

About the author

David Chou

David Chou

David Chou is the Vice President / Chief Information & Digital Officer for Children’s Mercy Kansas City. Children’s Mercy is the only free-standing children's hospital between St. Louis and Denver and provide comprehensive care for patients from birth to 21. They are consistently ranked among the leading children's hospitals in the nation and were the first hospital in Missouri or Kansas to earn the prestigious Magnet designation for excellence in patient care from the American Nurses Credentialing Center

Prior to Children’s Mercy David held the CIO position at University of Mississippi Medical Center, the state’s only academic health science center. David also served as senior director of IT operations at Cleveland Clinic Abu Dhabi and CIO at AHMC Healthcare in California. His work has been recognized by several publications, and he has been interviewed by a number of media outlets. David is also one of the most mentioned CIOs on social media, and is an active member of both CHIME and HIMSS. Subscribe to David's latest CXO Scene posts here and follow me at Twitter


  • Waiting for rational regulatory structures to catch up with reality, particularly in a rapidly-changing technology-heavy sector can be incredibly frustrating. I agree that we should not have to wait for more complete interoperability, and for that reason I founded Flow Health, which creates a patient-centric integrated longitudinal record across health care provider, payor and EHR silos, and provides applications (and APIs for other applications) that plug into this universal patient data layer to enable next-generation data sharing and care coordination, today.

  • While integration of HL7 documents might be a first step in interoperibility, I believe a platform capable of storing ANY formatted data will be the future. I also believe that privacy and security to the element level should be built-in, not an after thought to the development of this platform. I propose a platform based on what can be called a ‘patient data custodian’, an entity responsible to the patient and stakeholders for management of patient data storage and retrieval. Thru rules, data access can be managed by who and what an endpoint is using it for. As Alex says, this can be the platform from which to develop future EHR apps that have interoperability built-in. Only then will the efficiencies of HIT be truley realized.

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