Let’s Stop Talking About Interoperability and Just Make it Work

Last week, more than 40,000 people descended upon Chicago for the annual conference of the Healthcare Information and Management Systems Society (HIMSS). One of the main themes of this massive gathering of healthcare leaders was health IT interoperability. If it feels like you have seen this episode before, it’s because you have.

Joe Ganley, vice president of government and regulatory affairs at athenahealth, says one of the best ways to understand the state of a technology product is to talk to the people who actually use it. U.S. clinicians don't talk about interoperability, he argues. They just want a patient’s data to flow seamlessly within the healthcare ecosystem and to be integrated into an existing workflow.

A perennial theme at HIMSS and other gatherings, interoperability is the idea that disparate IT systems (electronic medical records, practice management systems, claims processing software, etc.) can speak to each other even if the systems are at different locations or developed by different vendors.

Sounds simple enough, right? After all, an email sent from my PC can be received on a Mac, and I can check my bank account balance from my iPad, then pay my credit card bill to a different bank on a smartphone without breaking a sweat. I never think about whether all these various software systems are “interoperable.” It just works.

So why so much talk and so little action about interoperability in healthcare when we take it for granted everywhere else?

Meaningful interoperability has proved elusive in healthcare. The government has taken some extraordinary steps in the last 15 years to first move healthcare systems to digital records, then to encourage and even require interoperability among those systems, and, finally, to try to leverage technology and connectivity to automate healthcare transactions that have been manual and paper-based for too long.

Despite this focus by policymakers and regulators — and the billions of public and private dollars spent on innovation — interoperability remains largely aspirational theme. Maybe we’re focused too much on interoperability as a buzzword rather than a means to improving healthcare. Maybe it’s time to stop talking about interoperability and start talking about what it promises to achieve.

One of the best ways to understand the state of a technology product is to talk to the people who actually use it. And it turns out, if we stop and listen to America’s clinicians, we will hear that no doctor or nurse in America uses the word “interoperability”. They spend little or no time thinking about which data standard is used to send information from point A to point B, which national network facilitated the exchange if at all, or whether some obscure government regulation (or exception) applies to the transaction.

What they want is a patient’s data to flow seamlessly within the healthcare ecosystem and to be integrated into an existing workflow. They want the right information, when they need it, to effectively care for their patient. Then, they want the transactions with insurance companies, such as claims resolution and prior authorization, to be seamless and automated so they can be fairly paid for their work. They just want it to work.

It should be no surprise that real innovation rarely results from government regulation. Public and private investment alone usually are not enough. Game-changing innovation is driven by solving problems for existing or potential users. Introduce an amazing technology product that makes my life easier, and I’ll want more. Solve one problem for me, and I’ll tell you all of my other problems to see if you can solve those too. Put 1,000 songs in my pocket, and I’ll want a phone and a camera too.If you give a cat a cupcake, he’ll ask for some sprinkles to go with it.

Clinicians in our country face extraordinary administrative burdens, particularly in the ambulatory setting. Ask any doctor trying to run a practice and they will tell you about the endless burden of processing what should be simple transactions, or the difficulty getting patient data from another care setting, or the endless bureaucracy associated with getting paid fairly for their services. Pretty soon, clinician burden will become clinician burnout, which researchers estimate costs the U.S. healthcare system as much as $4.6 billion per year.

The private sector should compete like crazy to offer real solutions to these challenges. Those who solve the biggest problems at scale by building the best solutions — seamless, adaptable, intuitive, easy to use — will win.

To be clear, there will still be obstacles.

First, there will always be some who view IT systems as a way to create walled gardens — to protect market share by using data hoarding to keep patients “in the system”. This is not only bad for healthcare, but also a bad business bet. One needs only to look at other industries to see how open ecosystems beat walled gardens time and time again.

Secondly, there will be some who look at seamless connectivity in healthcare as less of a strategy and more of a compliance matter. They do so at their peril. Those who go no further than the letter of the law will lose to those who take a broader view of their customers’ needs.

Finally, there’s a risk that the government, understandably frustrated by the lack of progress, will bring too heavy a hand of regulation — trying to specify exactly how information should flow, and when and why. These kinds of overly prescriptive policies often carry unintended consequences that stifle innovation. So far regulators have shown restraint, putting in place frameworks and guardrails that should allow innovation to flourish. My hope is that they will wait to see what happens in between those guardrails.

If we do this right, if we listen to clinicians and patients and build solutions that improve their healthcare experience, we’ll be using technology to create a truly thriving healthcare ecosystem that delivers accessible, high quality and sustainable healthcare for all.

The bad news is HIMSS will have to come up with a new theme!

Joe Ganley is vice president of government and regulatory affairs for athenathealth.