Why Do We Want Interoperability?

pattern-1013507_1280A lot of time and attention has been put into the notion of interoperability by almost every stakeholder in the healthcare system. Those interested in the issue include patients, providers, vendors and the government. Why has interoperability received so much focus, though? It may be possible to answer that question by stating that interoperability contains a large element of the common good.

Defining interoperability can be challenging, but a definition adopted by HIMSS in 2013 offers a good, comprehensive version: “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.” Putting that into even plainer English, interoperability is the movement of data as expected and without hindrance. Ultimately, that likely expresses the expectation of many, individuals want data to be where it needs to be without a hassle.

Depending upon an individual’s role within the healthcare system, that individual may have a different perception as to the importance of interoperability. Patients want data moving without thought because patients expect seamless transitions in care. If a patient is traveling or goes from one provider to another, the medical data should be there. Other industries have mastered the ability to allow data to move around, but healthcare is still working on that issue. As such, the patient viewpoint on interoperability is that it should just exist.

Providers, much like patients, likely want to have all information about a patient available. For example, if a medication has been administered in one setting and a patient presents elsewhere, the subsequent provider wants and needs to know what has already been done in order to avoid a very easily preventable error. Additionally, providers want to know a patient’s full history, which may be more easily obtained from previous records than from the patient. The provider viewpoint on interoperability is that it forms a basis for good care and ensuring all data is available.

Electronic medical record and other healthIT vendors may see interoperability as either a product challenge or potentially an impact on business. Clearly, the healthcare industry relies on vendors of products to build those products in a manner that permit interoperability. All the wishes for interoperability will go for naught if the tools being used are not set up to support it. That being said, are the right incentives in place? That question may be a bit unfair to the vendors because, optimistically, vendors are not necessarily trying to create public harms. Accordingly, the vendor viewpoint on interoperability may be a bit muddled, but at the end of the day should be favorable.

Given those potential viewpoints on interoperability, why is it so important? Interoperability is considered an essential element to succeeding with value-based care and/or population health, the government is turning its attention to the matter, and increasing patient demand. From the industry perspective, the value-based care and population health reasons are likely the most compelling drivers for wanting interoperability. Value-based care forms the basis for many alternative payment models, which is where the healthcare industry is quickly heading. If the right data are not available to understand how a provider is performing, then the likelihood of success decreases and in turn puts financial pressure on the provider. The government is also related to the push toward alternative payment models. The government, specifically the federal government through Medicare, is causing a seismic shift in the reimbursement system. The government wants these efforts to work, which means that all tools must be aligned. Rumblings have suggested that if interoperability is a problem, then the government may force the outcome it wants.

Ultimately, interoperability, to a large degree, comes down to having a fully unified healthcare system where data is always available. Thinking of the banking industry, this is true of account information because an individual can readily access it through an online account or at an ATM, for example, and then be able to access that money from almost everywhere too. Similar examples can readily be pulled from numerous other industries. The question continually comes back to why should healthcare be any different.

As suggested above, solving the interoperability conundrum comes down to a common good. Arguably everyone wants patients to be able to receive the best care possible. That means having data available and on hand.

Hopefully, this post results in an open dialogue about the issue of interoperability. I will be presenting at VITL Summit 16 on this same topic and welcome comments and thoughts that I can incorporate into my presentation. Please post in the comment section, email me, or engage on Twitter. If we can all focus on the issue and begin to reach a consensus understanding, that would be a good outcome.

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About Matt Fisher

Matt is the chair of Mirick O'Connell's Health Law Group and a partner in the firm's Business Group. Matt focuses his practice on health law and all areas of corporate transactions. Matt's health law practice includes advising clients with regulatory, fraud, abuse, and compliance issues. With regard to regulatory matters, Matt advises clients to ensure that contracts, agreements and other business arrangements meet both federal and state statutory and regulatory requirements. Matt's regulatory advice focuses on complying with requirements of the Stark Law, Anti-Kickback Statute, fraud and abuse regulations, licensing requirements and HIPAA. Matt also advises clients on compliance policies to develop appropriate monitoring and oversight of operations.
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3 Responses to Why Do We Want Interoperability?

  1. ebukstel says:

    Interoperability is not just the exchange of information, but it is also the standardization of test dictionaries, lexicons, and in fact, the way physicians characterize and observe symptoms, and disease. Consider a physician office performing a lab test in their “Physician Office Laboratory.” Interoperability would demand that potentially years of results from a group of medical devices be transferred to an Epic or Cerner system at the hospital (and codes normalized w/ CBC and Chemistry) tests at the hospital. This information would also be normalized w/ similar tests from Quest and Labcorp, when the remote POL tests are then transferred to a specialist seeing the same patient. This use case is not extreme, but demonstrates the complexity of transferring and making interoperable a simple lab test amongst 4 different groups. I have yet to see a FHIR example able to deal with this scenario.

  2. Pingback: HIE Answers - Why Do We Want Interoperability?

  3. Pingback: Why Do We Want Interoperability? - 4Medapproved HIT Answers : 4Medapproved HIT Answers

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