The current state of interoperability is not unlike Charles Dickens' A Tale of Two Cities: "It was the best of times, it was the worst of times." In the history of clinical medicine, we have more interoperability than ever before — more electronic data is flowing in more places for more purposes. Yet, there's also more frustration about the state of interoperability leading to more attention across our industry and our country than ever before.
Earlier this year, I had the great privilege of participating in a Bipartisan Policy Center meeting regarding the current state of interoperability. Attending were Andy Slavitt (Administrator of CMS), Karen DeSalvo (National Coordinator for Health Information Technology and the Acting Assistant Secretary of HHS), two sitting U.S. senators and a former U.S. senator. Also among us were a panel of senior leaders drawn from provider organizations, medical specialties, and health information technology. Interoperability is clearly capturing the attention of our nation's government at its highest levels.
While we acknowledge these positive trends, we also recognize that we have yet to achieve universal person-centered interoperability that informs care, drives fully formed decision-making and continues improvement in health care.
Across the healthcare spectrum, these unmet needs create unmet expectations. We have yet to achieve the level of data liquidity and saturation necessary to achieve complete improvements to quality care and clinical outcomes.
WI-FI: In industries where interoperability has evolved, there is either a single driving force in the market (the 800-lb. gorilla) or a consortia of companies that aggregate supply and demand to drive it. With the evolution of the wireless internet, for example, originally a consumer was forced to purchase a base device and a laptop card from the same vendor. Over time, companies came together, created the Wi-Fi Alliance®, agreed upon standards, conformance guidance, and testing labs, and the Wi-Fi Certified™ Program was born. Wi-Fi became a commodity and companies focused their efforts on distinguishing their technology via more value-added services, such as performance. Today, Wi-Fi is built into every aspect of the technology space, and the creators of apps just assume wireless technology as a base component.
What changes are needed?
Some trust the ONC is going to boost healthcare interoperability via a certification program. However, certification programs are floor-based, and by definition, they have to use standards and criteria already developed and in use in the industry, making it an unlikely driver of innovation and next-generation models.
To achieve true person-centered interoperability, we need to raise the ceiling, as well as raise the floor. Following the Wi-Fi Alliance model, innovation to drive person-centered interoperability likely only happens when key actors (health IT developers, provider organizations, etc.) band together to deliberately commoditize interoperability and build it into the the technology they develop. Additionally, we need a new generation of standards that are Internet-based, and work for the mobile app and cloud economy.
In our interoperability journey, we've witnessed numerous key milestones: The HITECH Act, The Direct Project and CommonWell Health Alliance® formation, HL7 FHIR®, The JASON Report, and the creation of the Argonauts. In concert, these industry achievements move us towards the system we envision: patient-centered interoperability informed by a unified view that patients are useful for improving health care quality and outcomes, as well as the drive toward initiatives like precision medicine and learning health systems.
The Wi-Fi example is a useful way to view interoperability in other industries because it underlines that we in healthcare are not alone. The way interoperability plays out in other industries is very predictable, and interoperability is an ecosystem model, such that even if it may be slow, we're still moving in the right direction.
Today, we have a world with higher EHR adoption; we have more nodes in the network and more total value. However, interoperability is not just a technology problem; it's a people, process, and workflow challenge. What more will be required?
The good news is that by doing the hard work as an industry, we'll discover what changes to the clinical workflow are needed, where the standards need to be amended and what UI will be essential. I see a lot of hope and progress on the horizon as business models start to align to move interoperability. We all just need to roll up our sleeves and dig ditches, because only together can we get this done.
Arien Malec is vice president, Data Platform Solutions, RelayHealth. He has a more than 20-year career in healthcare and life sciences. In his current role, Arien addresses improved care and health as well as cost containment through the use of clinical data. Prior to this role, he was a staffer at the Office of the National Coordinator (ONC) as the coordinator for the standards and interoperability framework. Arien currently sits on the Health IT Standards Committee, a Federal Advisory Committee that advises the National Coordinator for Health IT.