Healthcare Interoperability: Who's The Tortoise?

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Gary_EL,
User Rank: Ninja
11/22/2014 | 10:13:17 PM

What is need to drive interoperability

I get all of my heathcare at Hospital A. Anything any practitioner from Hospital A does is immediately available to all my other providers at Hospital A. But, the info isn't available to any provider who isn't affiliated with Hospital A - even those providers that are fully contracted by my insurance company.

Obviously, Hospital A is in no big hurry to change this. Who wants competition?

So, this is one case where standards may not "bubble up." This is clearly a case for a government mandate.

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Alison_Diana,
User Rank: Author
11/24/2014 | 9:57:37 AM

Re: What is need to drive interoperability

Ah, but you forgot the patients' role here, @Gary-El! Now we -- consumers -- are paying more and more for healthcare, are accustomed to the Amazons, the myriad online travel sites, and other disruptive online/app tools available for practically every other industry -- there is a 'bubbling up' of demand from patients for the same treatment by their healthcare providers. Now these same healthcare providers are being forced to focus on population health, on engaging with patients when they are consumers (not sick patients), and this relationship demands a two-way street. So those providers that respect patients' time, that stop demanding forms in triplicate, that share information with other providers (specialists, second opinion doctors, physicians out of and in area, etc.) will - through word of mouth and rating sites - eventually reap the rewards of this openness.

Will it happen tomorrow? Of course not. If I've been seeing Dr. T for years, am I going to stop, simply because she doesn't work well with others? No. But I will tell you, when I look for a new specialist, how they work with others and how they share information is part of the equation.

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fpoggio600,
User Rank: Apprentice
11/26/2014 | 10:07:59 PM

Interop should start at home

Re: "Government agencies and facilities demand interoperability.."

BE CAREFUL WHAT YOU WISH FOR...
Many providers, journalists and bloggers call for the government to set a fixed standard for interoperability, just like the government set a standard in 1880 for the width of railroad tracks. Here's how that came about and where we are today.

The standard for the distance between railroad tracks is about 5.5 feet and has been for over 100 years. This width also determines the maximum height of a railroad car (via center of gravity) and the maximum width of the car. So why did the feds pick 5.5 feet? Well it goes all the way back to the width of ancient Roman roads. The Romans were the first real road builders and they set it at 5.5 feet because that was roughly the size of two chariots passing each other. That measurement was used to build roads around the world for 2,000 years. And in the 19th century it was adopted by some railroads, while others had larger or smaller widths thus causing untold 'inter-modal' problems. At the request of many railroads the government promulgated the 5.5 ft. into law over 100 years ago.

Today if we could increase the width by just one foot we could easily increase transportation productivity by 25% and reduce energy consumption. But alas we can't, we're locked into a nice tight government standard for infrastructure.

So if you want to really slow down information technology advances a good way to do that is have the government set a 'standard'. Be careful what you wish for!

And here's more real examples...

If you think commercial industry is a heaven of smooth interoperability, next time you are at the airport take a long look at the screen that comes up for the ticket agent. Believe it or not they still use 'character filled green screens' running under state of the art operating systems like Windows XP and then type in cryptic codes to get you a seat change. Then if you need to change flights to another carrier they actually have to PRINT out a ticket that you take to your new carrier. Now that's what I call interoperability! Why can't healthcare be more like that?

And if the government is so big on interop why did it take two weeks to bring up the Chicago FAA center when it was crashed by a crazed worker? Bet you do not know that you can't take an air controller from the NY Center and move him to Chicago or LA or any other FAA center without a 3 month retraining program!

So let's make sure we get ONC and CMS to define what interop should be...

Frank Poggio

The Kelzon group

Kelzongroup.com

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Alison_Diana,
User Rank: Author
12/1/2014 | 10:14:40 AM

Re: Interop should start at home

You raise some very good points, @fpoggio600. To be honest, I don't want the government to set standards. I would MUCH prefer that the healthcare industry -- and I mean that in the broadest sense possible, across all components of the vast sector -- works together to come up with its own set of standards. From what I've seen, voluntary, industry-created standards typically are much better than anything mandated by the feds, and I cannot imagine it would be any different in the case of healthcare interoperability.

Just think about how the feds wanted EHRs to deal with Ebola: They asked EHR vendors to come up with tweaks to specifically address Ebola, rather than figure out ways for EHRs to quickly adapt to ANY situation, whether it's Ebola, swine flu, anthrax, MERS, a disease I haven't heard of, or a 200-car pile-up. That type of closed-minded, illness-specific thinking is contrary to everything any industry needs today, contrary to every type of software development or digital transformation -- yet policy wonks in DC are forcing EHR developers into this mold. For one, how many top developers will want to work in an industry that mandates this approach? Two, how much will this cost EHR developers? Three, how much will this cost healthcare providers, per illness (although I believe the Ebola "fix" was free)? Four, will anyone die while they await a specific EHR module? Five, what happens if multiple conditions arrive at the same time -- flu and a 200-car pile-up, for example?

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