First Person Perspective on Interoperability

AEGIS invests a lot of resources in support of advancing interoperability of electronic health information. The AEGIS DIL provides an unparalleled platform for helping EHR vendors, exchanges, standards organizations, and certification bodies test for interoperability and standards conformance.

But there is one critical aspect of interoperability that no technology can fix – that is, the inertia of organizations who do not want to make their systems and data interoperable.

I was unpleasantly surprised last year when an extended family member was admitted to the ICU of a regional hospital for treatment of the same problem that had already happened six months earlier. After three days in the hospital, speaking to my relative's doctor, I asked if he had received the records from the relative's earlier hospital stay in a neighboring town served by a very large competing hospital system. He said he had not, but they would request the information. When I spoke to the ICU nurse about the same topic the next day, he said they were waiting on the fax to come through.

So I asked, "Does this mean you do not exchange health records electronically with the other health system?" He laughed and said, "No – they use Epic, we use Cerner – and the two systems can't talk to each other. So we call over there and then wait for faxes to come through, or they call us when they need our records." As you can imagine, knowing what I know about electronic health information exchange and all that AEGIS is doing to support it, this was extremely frustrating news to hear.

I first wrote about this episode nearly a year ago, and the question I have for our industry and government peers remains, disappointingly, what's taking so long?

I read a lot of articles and hear a lot of talks about why interoperability is hard – sometimes even claims that it's virtually impossible. But the reality is, as AEGIS, some EHR vendors, health information exchanges like the eHealth Exchange, standards bodies like HL7, and HHS ONC are demonstrating, interoperability is totally possible today.

Technology is not the barrier. It can't be. If you attended HIMSS 15 in Chicago this year as AEGIS did or if you participated in any of the numerous industry events across the country that focus on interoperability seemingly every other week, you know that's true. There are, in fact, a number of different ways to solve interoperability from a technical perspective. We at AEGIS happen to believe there is a right way and several less ideal ways. But all of that is beside the point which is that what's really standing in the way of interoperability is a willingness to make it happen. Personally, I have a bad feeling that when some people and organizations point to technical barriers, they are really seeking to distract from political, corporate, legal, and other kinds of roadblocks that to date seem much less easily breached than anything on the technology side. So what will it take to move the needle?

The package of government incentives and disincentives around Meaningful Use is the current approach, but that's not going to work in all cases. Unfortunately, no one has so far identified a natural market-driven reason for interoperability; i.e., "follow the money" doesn't seem to lead to a clear justification for interoperability, at least not today. Eventually, patients will probably demand interoperability – even if they have to retain and transmit the data themselves. But right now, the demographics that use the most healthcare and therefore have the biggest hammer to wield in forcing interoperability are not the most electronically progressive. In 5-10 years, that's all going to change. I hate to think we might need to wait that long.

If interoperability happens sooner, it will likely occur when the healthcare industry decides to do it because it's the right thing to do. Legal issues around data ownership/stewardship, privacy, and other matters will be worked out. Providers will shift from a view that it's their prerogative not to share "their" data to a view that data sharing is what's best for the patient.

In the meantime, we will continue to make the technology as good as it can possibly be.

Source: AEGIS