The first-known use of the term “Interoperability” according to Merriam-Webster was in 1965. Interestingly, other first-known-use terms from that year include:
- “Pseudosophistication”—false or feigned sophistication
- “Underreact”—to react with less than appropriate force or intensity
- “Future shock”—the physical and psychological distress suffered by one who is unable to cope with the rapidity of social and technological changes
While the term “interoperability” was initially defined for information technology or systems engineering services to allow for information exchange, a broader definition takes into account social, political, and organizational factors that impact system-to-system performance.
What does interoperability really mean?
Practically interoperability is the task of building coherent services for users when the individual components are technically different and managed by different entities. As mentioned in this blog a few weeks ago, in 2009 the HITECH Act gave healthcare organizations a roadmap for creating a health IT ecosystem in which health information could be readily exchanged. Meaningful Use (MU) Stage 2 requirements included common standards and implementation specifications for electronic exchange of information. MU also included a definition for a common dataset for all summary-of-care records including an array of structured and coded data to be formatted uniformly and sent securely. Any EHR technology that meets the demanding certification testing requirements must be able to send and receive standardized information with other certified EHRs.
In the past, providers seeking MU attestation were required to demonstrate, and EHR vendors to support, the actual exchange of structured care summaries with other providers, including across vendor boundaries and with patients. MU Stage 3 set as its target the establishment of an interoperable health IT infrastructure to promote:
- Provider to provider exchange through the transmission of an electronic summary of care document
- Provider to patient exchange through the provision of electronic access to view, download, or transmit health information
- Provider to public health agency exchange through the public health reporting objectives
The healthcare industry has made advancements in the 8 years since the HITECH act legislation. EHR adoption is widespread and the use of electronic prescriptions, lab results, and claims are used by nearly all providers. As Dr. John D. Halamka and Micky Tripathi recently stated in the New England Journal of Medicine, “No other sector of the U.S. economy of similar size (one sixth of the gross domestic product) and complexity (more than 5000 hospitals and more than 500,000 physicians) has undergone such rapid computerization.”
With certified EHR adoption among office-based physicians exceeding 80% and 95% for hospitals, has this health IT ecosystem created “pseudosophistication”?
Getting the right information to the right person at the right time can be a matter of life and death. Unfortunately, anyone who has been a patient or cared for a patient understands that it’s simply not happening today. Furthermore, the healthcare industry is now shifting from a fee-for-service model to a value-based model of reimbursement. Given this monumental paradigm shift, has the industry “underreacted” in the recent past?
Many in the healthcare industry, both clinicians and payers alike, see increasing urgency for the need to share data to develop a more comprehensive view of the patient’s health. At the same time, readiness remains flat. A 2015 survey of senior executives found that less than 20 percent rated their organizations highly capable of interoperability. Yet nearly 70 percent rated interoperability as their most urgent business need for the next 3 years, with real-time data access close behind.
Are we experiencing “future shock”?
We now need data sharing that is truly interoperable, beyond the limitations many providers experience today. Interoperability needs to be flexible in moving beyond silos to combine clinical, financial, and operational data. We need to minimize any special effort required by clinicians and consumers to request and retrieve actionable, specific information in the appropriate format. Exchanged data should be consumable rather than simply adding more clinical data to existing clinical data.
Data from across the care network drives performance improvements and influences physician behavior. Robust interoperability helps networks find the relationships between care quality and cost. Complete data identifies patients with gaps in care for timely intervention, and aggregated information leads to new insights for high-risk populations. Patients, providers, and technology vendors alike play a role and must work together to make health information electronically and securely available when and where it is needed to support the health and well-being of all patients.
Just as the term “interoperability” emerged in 1965, the popular daytime soap opera “Days of Our Lives” debuted on NBC. Known for its complicated and shocking plot lines, the drama chronicled the fictional trials and tribulations of modern American families. During the 1970’s, the show was recognized for tackling controversial and important subjects of the time. It isn’t a stretch to liken the important topic of interoperability, along with the very real trials and tribulations we face in pursuit of health data sharing, to a modern-day soap opera.
Eddie Hedrick has more than 30 years of experience in the fields of information technology systems and health care. Hedrick provides strategic leadership and management for short and long-term goals related to Health IT aligned with Fresenius Medical Care enterprise strategy. He previously served as Vice President, Product Development for Acumen Physician Solutions.
Photo from www.canstockphoto.com
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