The missing link in interoperability: What patients want

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The healthcare industry speaks of interoperability in broad terms. Nobody hesitates to say that nationwide interoperability is a necessity to boost care quality, outcomes and patient satisfaction.

But amidst all this talk, little progress has been made in connecting disparate systems. Vendors, for the most part, remain disconnected for any number of reasons, and hospitals and health systems aren't quick to adopt health information exchange technologies.

One reason interoperability has been slow to come to fruition is that discussions about a connected health network tend to overlook one key element that is vital to the growth of interconnectedness: What the patient wants.

Richard Helppie, CEO of Santa Rosa Holdings and chairman of the board at Sandlot Solutions, says discussions regarding interoperability don't fully consider what the public needs or wants from such a network.

"Here's the operative question: If the person you love the most is in front of the doctor, what information do you want the doctor to have, and what do you want the doctor to have to do to get it?" Mr. Helppie says.

In a truly interoperable environment, the physician should not need to leave the workflow of whatever system they are using to access other data. The data, he says, should be in one complete patient record, regardless of the data's point of origin, and should be presented to the clinician in a contextually relevant way.

An issue of definitions
Mr. Helppie says the true definition of interoperability has been muddled as it is stretched among vendors, payers and providers. What the industry refers to as interoperability, he says, is just interfacing, "which is an exercise in futility," Mr. Helppie says.

"Most everything that claims to be interoperable, that's interfacing. Interfacing says you know all the sources and all the destinations and you're going to map all of those," Mr. Helppie says. "Interoperability means I use my technology and it sends and receives information to your technology without me needing to do anything."

True interoperability isn't being addressed or considered, says Mr. Helppie. The problem is, few industry players are willing to fully commit to this vision and instead are pushing toward interfacing. This again ignores Mr. Helppie's key question of what the patient wants.

"We have people that are trying to own data, and we have health systems that don't want to share data and health plans that don't want to share or exchange data, and what's left out? What the public wants," Mr. Helppie says.

Business-based barriers
Vendors, no matter their stated commitment to interoperability, still are businesses, and they are operating proprietary systems with little actual incentive to work with other vendors or health systems in a meaningful way.

Vendor competition accounts for one of two key barriers standing in the way of a truly free exchange of information, according to Mr. Helppie. Aside from businesses being businesses on the vendor side, provider competition has become an obstacle as well. The fear for providers is if any hospital can access a patient's information, there is no reason for that patient to return to one particular facility.

For providers, competition doesn't have to be eliminated; rather, its focus should be shifted. "Health systems believe they're going to compete on clinical information [but] what they should be doing…is competing on the basis of how they use the information," Mr. Helppie says.

What's more, healthcare has historically been slow to adopt and implement new technologies and standards. Mr. Helppie says standards regarding interoperability are in development, but the timeline to adoption is in the distant future.

"It may be 10 years before [these standards] are widely used. This leaves the interoperability challenge in the hands of middleware solutions [software that connects other software or enterprise applications] who can solve this problem in six months or less," he says.

Tech is cheap
Business competition is nothing new, but in the context of patient-centered care, the ramifications of operating disparate systems due to system interests can be severe.

What vendors are trying to do, Mr. Helppie says, is make interoperability (or their version of it) fit within the constraints of their technology. As proprietary systems, though, this eliminates the potential for true interoperability.

However, the technology and infrastructure to achieve true interoperability exist today, Mr. Helppie says. And, he adds, it's incredibly cheap.

"We're [living] in a world today where an expensive app for your PDA costs you $5, but we have health systems spending hundreds of millions of dollars and taking years to develop closed enterprise systems," Mr. Helppie says. "As technology got more sophisticated, it's fallen in price."

This, he continues, is an opportunity for incredible growth and progress that can lead the industry toward interoperability — the industry just has to ask for it.

"Healthcare needs to start demanding today's price for IT," Mr. Helppie says. "Leverage the investments made and unleash information from all of the data being used in patient care, operations and claim production."

The need for true interoperability is evident, and the opportunities for health IT are endless. Coupled together, Mr. Helppie says interoperability will be healthcare's next frontier.

"The next horizon [for] interoperability [is] a secure, private and contextually relevant way we can exchange information for the benefit of the patient and for the health of the healthcare enterprise," Mr. Helppie says, adding the future for health IT is limitless. "Look at this from 15 years ago. If you would have described what the iPhone does, very few people could have seen it. That's where we can go with healthcare."

More articles on interoperability:

Plug-and-play in action at the Center for Medical Interoperability
The 3 levels of interoperability in healthcare
Dr. John Halamka: 4 thoughts on MU, information blocking and interoperability

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