Early in my medical career I was already thinking about interoperability and I have devoted much of my career to the seamless transmission of patient data to where it is needed most. Fortunately there is a national effort to achieving this. However, the current state of interoperability has been under some scrutiny as of late. Over the past 2 years I have had the pleasure of serving as the Chair of the CareEverywhere council as well as a board member of the Idaho Health Data Exchange (IHDE). It is here that I have truly seen the potential for true interoperability as well as where we need to go to make it a reality. Let me rewind the clock for you about 20 years. I had just been getting ready for college and my parents took me to open a joint bank account. I was excited as I just received my first ATM card. The caveat here was that it only ran on the PLUS network of bank machines not the ones with the Cirrus icon on them. There was no interoperability between networks. Now 20+ years later both networks are still present but they decided that the convenience of the customer benefitted the industry as a whole so they were able to integrate their directories. Now we can have the convenience of using any ATM machine we please. Now, this transformation took more than 20 years. I wonder why this same type of transformation is it expected for healthcare in less than 4 years when it took 20 years for the banking industry to reach this type of integration. Healthcare is very complex. While we have made significant strides there is still a long road to travel and I know my colleagues and I work on this daily. I came across an interesting article really criticizing the current state of healthcare interoperability.
For those of you that work with me know I think of issues in the framework of people, process, and technology. From my perspective this issue is mostly a people and process issue. While I agree that there are some technological limitation the crux of this matter revolves around our ability to adopt a standard that will facilitate the transfer of information to any EHR. Many HIT shops are very complex and have multiple initiative they focus on throughout the year all with the ultimate goal of improving patient care. So from my perspective there are more issues at play than the blanket statement “we can’t talk to one another”.
- Different versions of the same EHR
- Lack of Trust Agreements (Rules of the Road)
- Multiple different standards– which means there is essentially no standard
- competition between health systems in the same geographic location
- competition between vendors
- Different strategic focus of the organization (some organizations don’t feel that exchange is high on their list therefore they don’t build out the functionality- this will prohibit the ability to exchange information)
- HIE functionality (does the HIE view themselves as a repository or a broker of information exchange)
- I know there are others
I guess I feel I have a more positive outlook on the industry. However, I will make one call to the industry– Please define a single standard that will allow all EHR’s to have the ability to communicate with one another. I am happy to participate in anyway I can. I feel that we have made enormous strides this space. While there is a lot of work to do there are very smart people at the table and I am confident that we will see true interoperability in the near future where patients can feel just as safe in the hospital or doctors office as they do at home.