While I was at the Partners for Healthcare conference Grahame Grieve gave an impassioned talk about the life cycle for interoperability, the hype in the media at that time, and the fact that true progress would only be made once we had passed what I like to term “the other side of the expectation hump”.
For the past two years the media has been replete with stories about interoperability and the changes that need to occur to “fix the healthcare system”. The big EMR vendor’s pledged allegiance to interoperability with each other at HIMSS ’16. ONC came out with bold statements and forward-looking projections, and the government started to flex their muscles; offering their skills to solve the problem, if private industry could not find a workable solution.
Today the rate of media about interoperability has decreased, and much of what is now being said is repetition built on stories from the past year. What we’re not seeing is actual success stories where real progress has been made to solve a specific problem. Even national efforts such as Sequoia and CommonWell Health Alliance have little to report in terms of true semantic interoperability, and have instead focused on the number of connections within their networks.
We have literally years of work in front of us to realize the dreams of HITECH, and victories will be hard-won. Today we can exchange meaningful use summaries which contain a dearth of information related to actual patient care. This approach does not meet the clinical continuity of care use cases that my company focuses on, such as oncology and transplant referrals, nor does it meet the needs of many other clinical settings.
What will it take for things to change?
First, we need to realize that while there will be a combination of public and private entities involved in providing interoperability, the most important advocates remain the caregiver and the patient. Patients gain access to their data and more control over their health whereas caregivers gain efficiencies in time and cost. Everybody else is simply a spectator, albeit often with a strong opinion and financial gain at stake.
Second, the government must be seen as having an important role to play without imposing socialized medicine. Without some level of federal compulsion there are few reasons for administrators within hospitals to lose revenue by sharing data. It is simplistic to believe that value based reimbursement will fix this problem in just a few years. There will need to be enforcement actions against anti-competitive practices as well. Bringing a focus to “data blocking” has been a good start, but the problem is far deeper and harder to solve.
Third, private companies must encourage care settings to move to new protocols such as FHIR. This is going to be tough. After all, if you have 70 to 100 HL7 v2 messaging feeds it probably isn’t cost-effective to migrate them all in a short period of time. Furthermore, ig they work today and the interface teams understand and can maintain them, so why make trouble?
EMR vendors can help out in this situation by providing migration tools and professional services at reasonable cost. If they can discontinue their legacy product development and demonstrate current technologies they stand to win anyway.
Fourth, we desperately need to redefine our concepts of privacy in an age where the very concept is under threat. The questions we must ask ourselves include “is healthcare data sacrosanct?” as well as “can I really trust any healthcare system in an age of massive hacking?”. These are meaty social issues that urgently require extensive discussion in congress and the community.
Finally, the faithful must continue their work in building new technologies for use in healthcare. Organisations such as HL-7, DICOM, and IHE must continue to explore standards development so that we can all share the benefits of collective ideation as we progress down the expectation hump for interoperability.