Achieving true interoperability is a David vs. Goliath battle

March 20, 2015 in Medical Technology

David vs. Goliath is one of my favorite stories. A scrappy young kid beats a big soldier in an epic battle. How did David do it? By approaching the situation from a different perspective. David didn’t accept the premise of the battle and therefore was able to change the game, securing a victory over his bigger and more dominant opponent.

As the CEO of a best of breed healthcare IT vendor, I sometimes feel like I’m fighting Goliath. But despite the challenges, I’m proud to be part of an organization that fights for a different perspective and wants to change the game. U.S. healthcare needs more Davids: people and vendors who use their agility to execute innovative ideas that advance healthcare delivery and improve outcomes. But without a truly interoperable environment, we may be left with just a few Goliaths.  

Rep. Michael Burgess of Texas has begun circulating a draft bill aimed at improving EHR interoperability and if it’s successful, it will be a game changer. The bill proposes a new 12-member advisory committee that would replace both the Health IT Policy and the HIT Standards committees. It also includes a mandate for open and complete access to health data as well as the inability for EHR vendors to block interfaces from other qualified EHR vendors.

While previous regulations like the HITECH Act were a step in the right direction, they were ultimately too vague and left too many loopholes that could be exploited. The standards and requirements from the HITECH Act became a series of check boxes that vendors scrambled to check, but that did not result in actual interoperability. This new bill has all the right elements to start making a big impact towards improved interoperability in U.S. healthcare.

The issue of vendors blocking interfaces from other vendors is something that must be addressed. Can almost every EHR vendor share health information in secure and universally accessible formats? Yes. Are EHR vendors actually allowing other vendors to access and use this information? No.

While vendors never take a stance against interoperability publicly, in reality and behind closed doors, some vendors have a vested interest against a more interoperable environment: the Goliaths. A lack or even a perceived lack of interoperability means that bigger EHR vendors can maintain more market share and convince hospitals that using more than one EHR solution is too difficult. The easier it is for EHRs to interoperate with each other, the more options hospitals will have to find new and different solutions to meet their needs. 

A single vendor EHR strategy has the biggest negative impact on direct care providers. EHRs should be designed for the clinical encounters and workflow of the care setting where they are located.

I hear from emergency clinicians all the time who are frustrated by sorting through long menus and pick lists in EHR systems that were designed for an inpatient environment, and I imagine clinicians in other specialty areas of the hospital have a similar experience. We have seen a market shift in the past 12 to 18 months towards more best of breed and specialty EHR systems as care providers are starting to demand solutions that are designed for their particular clinical setting. Improved interoperability will continue this momentum and ensure that clinicians have the tools they need to provide the best care possible.

While I hope that this draft bill is proposed to the legislature and eventually passed into law, either way I welcome the opportunity for a more open and honest conversation about the issue of interoperability.

We need to be driving towards patient-centered healthcare and the only way we’re going to get there is through true interoperability. There are two enduring outcomes from any clinical encounter: the impact on the patient’s health and the documentation of the event.  True interoperability will improve both of these outcomes. 

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