Interoperability & What To Do About It

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Having recently returned from HIMSS, I was struck by not only by what was "hot" at HIMSS, but what wasn't. For the first time in years, electronic health records were not the focus. Interestingly, the industry has largely moved on, and EHRs have become table stakes. Everyone has to have one and the question is not whether you do, but what your EHR will do for you. Mind you, EHRs will continue to be a vibrant market as the industry consolidates around the "Big 3" — Epic, Cerner and Allscripts — but the focus will be on the question: “Are you connected?" The key concerns of decision makers will be connectivity and interoperability between systems, not necessarily integration, which is more focused on one system or internally.

What interoperability looks like Glen Tullman

Without connectivity and interoperability, you can't use the information and the new applications coming to market to fundamentally bend the cost and quality curves and to innovate in other ways. One good indication of this new focus was Allscripts' purchase of dbMotion, the Israeli company which was trailblazing in interoperability.

I first came across dbMotion during a visit to University of Pittsburgh Medical Center, or UPMC as it's known across the industry. UPMC is big enough that it had to address the problem our industry faces: namely, that it uses Cerner for its hospitals, Epic for its employed physicians, and Allscripts and others for many of its affiliated and unaffiliated ambulatory physician practices. The challenge was how to, in that environment, provide one view of the patient for its physicians. Their answer was dbMotion, and it worked.  I became a believer. And this interoperability solution, working today, allows UPMC and many other organizations to provide care coordination across their hospitals and their network.

There is unfortunately an urban myth circulating among far too many healthcare CIOs that for their organization "we need one system" when the real answer is "we need one view of the patient."  Ultimately, the key to solving the issue of information silos in healthcare is not one mega uni-base because, in my view, the nature of the needs in healthcare information technology will rightly continue to evolve. A logical future trend for HIMSS will be about systems that can help an organization master genomic data, lab and diagnostic images, or the IBM Watson-like systems for decision support and big data, both understanding the complexity of these systems and how to get them to work together. That is one reason why HIMSS is investing millions in a future interoperability lab in Cleveland…to bring the industry together on this issue.

Interoperability's ubiquity in other industries

While healthcare has generally been inwardly focused, I like to use examples from other industries to predict where we are headed. Despite efforts from some pretty big banks who tried to develop their own ATM networks, we have a fully integrated money transfer system today. No more driving around to see if your card works in an ATM like I often did when I was young. Now cash is available at any ATM in almost any country! 

And Bloomberg, perhaps the most sophisticated and successful of decision support tools for an end user, draws data from more systems than you can count. However, the best example may be computers themselves. If you are in the C suite, you'll probably remember purchasing your first computer and being asked the question, "do you want a modem too?" Most people answered no because there wasn't anyone to connect to and if you did, there wasn't much to say. But over time, computers became pretty common, and connectivity was standard. The demands of consumers, along with industry agreement to some basic standards, forced computers to seamlessly connect. And then the question shifted from, "Do you have a computer?" to "what will your computer do for you?" Today, our world isn't about if you have a computer or which one you have, but rather what apps you have and how they deliver value for you.

Delivering on the promise of interoperability

So, how does an organization deliver on the promise of interoperability having invested millions in EHRs? 

First, don't buy new stuff until your other systems work together. Ask up front to see examples of where vendors are working together. The CommonWell Alliance is a great step forward. 

Second, insist that vendors follow standards.

Third, invest in sophisticated tool sets that allow you to not be captive to any vendor. You want to ensure you can invest in anything you need to and it will be plug and play. Legacy vendors (think mainframe) will be bypassed open systems.

Moreover, with the coming changes in care models, government regulations and payments, CEOs should focus on the future with a new set of questions:

  1. How do we become the most connected…to our providers and to our customers, only some of who are and will be patients?
  2. How easy are our systems to use, both for our physicians, nurses, care providers and patients? The standard of comparison should be what your patients use in their everyday life on the web.
  3. How mobile are we?  In Silicon Valley, they say "Mobile First," which means everything needs to begin with a phone, which is a good lesson for patient connectivity. It's no longer about your website.
  4. Is your organization's Care Coordination on the inside and Patient Engagement on the outside?  

One final note for CEOs as you envision the future: Increasingly, healthcare systems will become systems of health that serve intelligent health consumers. These intelligent, connected consumers don't want to be a patient, a chronic care case or a diabetic. They want to be treated as a consumer in every way.  And that, increasingly, will look more like other areas of our economy than our healthcare system of today.  And it will all begin with connected, interoperable systems that provide communities of health and tools, used by physicians, nurses, care providers and patients directly, to stay healthy.  That's good for all of us and it all begins with smart IT. 

Glen Tullman served as CEO of Allscripts from 1997 through last year and now is Managing Director at 7wire Ventures, which focuses on investing in healthcare, education and energy.

More Articles on Interoperability:

Health IT Interoperability: How Far Along Are We?
CommonWell Health Alliance Brings Health IT One Step Closer to Interoperability

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