Before getting into Healthcare Information Technology, I spent considerable time in the world of wireless communications and medical devices. I now find that I am coming across similar challenges as I did in my prior life. Back in 1999, we were talking about interoperability in wireless systems and creation of new standards to solve that disconnect. Fast-forward to 2014 and I Hear talk of interoperability with Electronic Medical Records (EMRs) and Health Information Exchanges (HIEs) and creation of new standards to solve the inability of these systems to share information.
Interoperability is an age-old problem - it has a long and cultured history dating all the way back to Homer and The Iliad! The mythical Chimera solved its interoperability problem by having the head of a lion in front, the head of a goat in the middle and the head of a snake for a tail. Of course, there are more recent examples from industrial domains such as in communication, computers and software and even the military. What we can learn from solutions for interoperability in these other fields is to not try and solve the problem of interoperability through new standards. I cringe when I see the term “interoperability” in close proximity with the term “standards”. Interoperability is about working seamlessly. I might even say that it is not a technical problem at all! Interoperability is an organizational issue caused by poor processes, bad assumptions and negative attitudes.
In a lot of ways, interoperability issues in Healthcare IT are further perpetuated by how one of the leading bodies in our industry, Healthcare Information and Management Systems Society (HIMSS) defines interoperability as existing at three levels – foundational, structural and semantic. Using this encompassing definition, it is not hard to see why our industry wants to marry the two terms together. And every failed effort leads to the desire to start-over; to follow this definition with a new (or evolved) set of structures - standards. By the time we get done with that, we lose steam to tackle perhaps the most important piece – the real meat of interoperability. The key goals of interoperability should be in making sure that there is full understanding of context, sender and intended recipient. In addition, the focus really needs to be on measures to make sure that both sides can actually understand each other rather than just ensure they speak the same language - which is what standards do.
Now, lets put all this into the current context of the media coverage around lack of interoperability and the dialogue that has transpired around that in the last couple of months. Some of it has been overblown in terms of blaming entities as being solely responsible for this. I would say that the Healthcare IT industry as a whole needs to feel responsible for this. We need to stop creating an environment which perpetuates this problem - creating new silos (other umbrella standards) such as CommonWell which includes Cerner, McKesson, AllScripts, athenahealth and Greenway, and Carequality which includes UnitedHealth Group, Walgreens, Surescripts and Kaiser Permanente. These kinds of activities take us further from our goal. Instead, we should assess what needs to be done post Meaningful Use (MU) II and really focus our efforts on establishing certificate authorities that would provide the recipe for interoperability testing.
If we are going to get an ATM for the healthcare industry, the MU III mandate has to be focused on interoperability and we have to curb our desires to add or extend standards. In line with that, I wholeheartedly support the recommendations made to the ONC by the Health IT Standards Committee.