In a recent message I got from EHNAC, they had this great image at the start of their email:
Then, they had this line below it which really caught my attention:
Interoperability has been an important topic in healthcare for over a decade. Are we there yet? No. Are we closer than we were? Absolutely.
No doubt, EHNAC’s real message here is that they’re working hard on healthcare interoperability and they’re seeing progress. A look at the EHNAC Officers and Commissioners shows they have some great people working on the challenge that is healthcare interoperability. Although, I couldn’t help but ask myself the question:
Are we nearing the end of the healthcare interoperability tunnel?
Or maybe in a more direct way…
Are we ever done with healthcare interoperability?
The simple answer is that healthcare interoperability is never “done”. At least not if you define it as all of the information being exactly where it needs to be at any time across any system. At least I don’t think it will ever be “done” in my lifetime. The good news is that we don’t have to be “done” for interoperability to provide value. In fact, there are a lot of healthcare data exchanges that are providing value in healthcare right now. The challenge is that there are still holes in health data exchange that are frustrating to patients and doctors.
The Mountain Analogy
The way I see it, healthcare interoperability is more like climbing a mountain. If you’re a hiker like me, you know the experience of hiking up a mountain. As you’re hiking up one of the steep climbs you think to yourself, I just have to make it to the top and then I’m almost there. Then, once you reach the top of that climb, you’ll often find that there are still many more climbs ahead of you to get to the top. Plus, once you finally get to the top of the mountain, you realize there are hundreds of mountains out there to climb.
Sounds a lot like interoperability no? Once you fix one piece of interoperability, it often opens the door to 5 other things that need to be fixed or implemented. Much like hiking a mountain, you just keep “climbing” as you knock out one challenge after the next until you have a great interoperability solution that fixes a specific problem. However, along the way, you come to realize that there’s still hundreds of other interoperability solutions that are needed.
When you’re hiking, the fact that you have 100s of other mountains to climb shouldn’t stop you from finding joy and satisfaction in the mountain you did climb. We can say the same for healthcare interoperability. Just because there’s still a lot of work to do doesn’t mean we shouldn’t celebrate the successful interoperability that’s happening today. We should celebrate that we’ve made it up one interoperability mountain. Eventually you’ll have a lot of interoperability mountains you can celebrate. In fact, many organizations are there today.
Where is Healthcare Interoperability At Today?
As I thought about this idea of reaching the “end” of the interoperability tunnel, I asked Lee Barrett, Executive Director and CEO at Electronic Healthcare Network Accreditation Commission (EHNAC), what he thought about where we were on the journey to interoperability. He aptly pointed out how HIMSS has defined the 3 stages of interoperability:
HIMSS explains interoperability today as the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and present that data so that a user understands the data and can fully use it in their treatment and operations decisions. There are three stages that they describe for HIT related to interoperability. The first is foundational interoperability where one system receives data from another but no interpretation of the data is required. The second is structural interoperability which includes defining the message format standards for uniform movement of data. The last stage is semantic interoperability where two or more systems can exchange and use the information.
Barrett also shared these other perspectives on where he sees us making progress on the interoperability roadmap.
Much is occurring to implement the infrastructure and frameworks for this seamless data exchange and ability for patients to have access to their complete medical records. However, with all of the excellent work occurring in the industry on implementation, much is still required to gain the adoption percentage needed to recognize the benefits of an interoperable health system.
For example, under the 21st Century Cures Act with TEFCA as a primary enabler of interoperable data exchange, it will take two to five years for Qualified HIN’s (QHIN’s) and all Participants to become operational. This timeframe includes assuring that FHIR API’s are integrated in EHR platforms, in hospitals, health plan portals, mhealth applications and many other ecosystem components. ONC, CMS, Sequoia, Carequality and many others are providing the roadmaps and legislation along with engaging and promoting public and private sector collaboration as significant work is ongoing with use case development of Argonaut and DaVinci.
The privacy and security of all of this data exchange is critical across the entire implementation framework. The industry is excited about the successes that are occurring and the fact that the roadmap is being implemented. Working in partnership between the public and private sectors is how we will continue to execute rapidly against the roadmap and build the infrastructure to enable interoperable data exchange with a major focus on the patient.
Obviously, the topic of healthcare interoperability is extremely complex and challenging. If it weren’t, then we would have solved it decades ago. I agree with Barrett that we’re making real progress on the exchange of healthcare data and that’s something to celebrate. We’re having conversations today that we couldn’t have even considered 5 years ago.
The disconnect probably comes when you hear about companies like Epic sharing hundreds of millions of records every month and then a patient goes in for an X-ray where the results can’t be shared with their network of providers. It’s a tough dichotomy to celebrate the millions of health data exchanges happening every day and still acknowledge that there’s so much more work to do with many patients suffering from lack of interoperability.
I agree that there’s a light at the end of the today’s healthcare interoperability tunnel. Although, I’m certain that once we get into the light we’ll find new tunnels, rivers, mountains, and cliffs on the other side we still have to navigate. Celebrate the progress we’ve made, Yes! But acknowledge there’s still more work to be done to really improve a patient’s experience and the care they receive.