The Interoperability Elephant in the Room

As all healthcare IT professionals know, over the last several years there have been incentives to adopt electronic health records (EHR) systems. While it probably amazed most other IT professionals that there needed to be incentives to move away from paper records, nevertheless it was a necessary and driving force. Most everyone got on-board and by the end of 2013 “…nearly 8 in 10 office-based physicians had adopted some form of an electronic health-record…”. So “Great job healthcare industry! Now the systems are in place to share data, reduce costs and mine insightful analytics”, right? Wrong! There are still major interoperability issues preventing the value of these systems from being realized.

Since there was so much opportunity in the market all the major vendors have been jockeying for position and market share for the initial implementation and beyond. Those who were deeply involved in the EHR implementations all realized that different EHR brands really weren’t able to share data very well. Additionally, even much of the data in the EHR were proprietary codes that had to be translated to be meaningfully used in another system. There has been a lot of “fist shaking” aimed at EHR vendors for not making their products more interoperable. While a good deal of “the venom” probably should be aimed at the EHR vendors, the interoperability problem is much wider and deeper than that. For example, the HL7 “standards” for sharing data are loose enough that even sharing HL7 messages between two systems requires some analysis and translation to make them truly apples-to-apples. Additionally, the proliferation of medical devices that aren’t in-sync with other systems is a major problem that hospitals have to deal with today.

Even projects that would seem to be reasonable are struggling with interoperability. Take for an example, just exchanging health data between the Department of Defense and Veterans Administration. After more than a year, , a recent study from the federal General Accounting Office (GAO) showed there is still a struggle for what was described as, “…both departments would work on developing or purchasing new EHR systems that meet industry-wide interoperability standards, and create an interface between them to exchange data on the 16 million active duty and veteran patients they serve…”.

On the hopeful side of things, there are some signs that some people are hearing the concerns. There is a group of EHR vendors that created CommonWell and is piloting a project for interoperability. There is also some recent talk from ONC that some focus will be put onto interoperability. Wherever it comes from and whoever helps drive it, easier sharing of healthcare data is desperately needed. It is possible today, but it just takes a lot of work…and isn’t “sexy” so it hasn’t gotten the attention it truly deserves.

Business Cliche of the Day (followed by the real meaning): We need to manage expectations – “You need to tell the customer something that they won’t like”


Veteran technology professional and manager

Posted in healthcare IT
One comment on “The Interoperability Elephant in the Room
  1. […] and data that looks similar but is semantically different. As mentioned in my previous post on interoperability, we still have a long way to go in the area of health information technology (HIT).  In that post, […]

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