Let’s Beat the Dead Horse of Healthcare Data Interoperability

220_221 “…C’mon over here Ron and let me show you what I’m doing to take advantage of some of my time off.  I’m going to add a whole new wing here…rip out these walls; …and…ah…of course, re-wire it.  Are you going to make it all 220? …..Yeah, 220…221…whatever it takes…”

Ok, can you name that 1983 classic?  If you’re of my generation, I’m sure you got it right away: Mr Mom

When I think about healthcare data interoperability, my mind does go to this quote.  Why? Its because that electricity standards have been around for many years that the idea that someone might say 221 volts instead of 220 is actually funny.  While some other countries vary a bit (hence the adapters needed in Asia and other places) everyone has made peace with standardization to make everyone’s life easier…and products more affordable.

Unfortunately as I wrote in April and August of last year, healthcare just hasn’t been able to embrace this level of standardization and it is killing health information exchange efforts and – more importantly – new innovations to improve the quality of our healthcare overall.  For example, HL7 “standards” allow for lab results to be contained in discrete values, a text report, an embedded PDF report, or an NLE segment (not to mention any custom built “Z” segments).  For me, that’s not standardization at all…and it creates real costs for organizations trying to work with exchanging data.

So since I already wrote about this twice in the last year, another blog post seems a bit like beating the dead horse.  However, I felt compelled to put this out because ONC published an interesting review of the State Health Information Exchange (HIE) Cooperative Agreement Program (the State HIE Program), in December.  It seems that – at least in my circles – it was totally overshadowed by the Sony hacking story.  So I thought I’d highlight it now that we’ve moved on from Sony.

The report was a case study of 6 states along with their successes and challenges.  To my point in the earlier blog posts, I was validated by quotes like the following:

“Stakeholders in all six states reported IT-related challenges, from EHR and HIE developer limitations to lack of interoperability between systems and data capture and quality issues.

“For interoperability, many look to the ongoing development and adoption of data standards as the long-term solution. In theshort term, grantees are encouraging the use of certain standards among their participants and building capability in data translation and in-house teams responsible for data cleaning.”

“Stakeholders in all six statesreflected on the need for truly interoperable systems, currently absent because of lack of adoption and inconsistent implementation of available standards for vocabulary and exchange, variability in document formats, and issues with interface designs. According to grantees, existing standards (i.e., Systematized Nomenclature of Medicine (SNOMED) and Logical Observation Identifiers Names and Codes (LOINC)) are not as complete as they should be, so developing interfaces is not a ‘plug-and-play’ activity.”

Further, a few others have written about the possible long road to interoperability. The AMA has even pushed for dropping penalties due to interoperability issues.

So to continue to beat the dead horse, my suggestion is that the government and other organizations must commit to putting real focus on real data standardization.  It seems that this idea has taken hold at least in some others’ minds as I saw the following quote from the JASON report earlier in the year.

“In order to allow vendors and providers to focus their efforts on interoperability, CMS and ONC should narrow the scope of MU Stage 3 and associated certification to focus on interoperability in return for higher requirements for interoperability,”

My hope is that 2015 brings new focus to re-working MU requirements to really drive data interoperability.  Otherwise, as someone smarter than me said, “Will the 10-year plan turn into a 50-year plan because we are running it part-time?”


Veteran technology professional and manager

Posted in healthcare IT

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