One of the biggest challenges in healthcare IT today is a lack of interoperability: the ability for systems to truly communicate, regardless of maker or location. It’s a seamless transfer of data that we take for granted in other industries, like in finance where any ATM can give you money no matter where you bank, or in telecommunications, where a cell phone can receive a call no matter the wireless carrier.
An even closer comparison might be made to commerce. Think about what happens when you place an order online through Amazon: The information electronically transfers from Amazon to the supplier, to the warehouse, and then to the shipping company, where it is confirmed and races back to notify Amazon. The charge goes to your credit card or PayPal account, the money is automatically deducted, and payment is sent to the supplier. Nobody has to print out a single document along the way; all of the systems are connected, and the transaction is completed seamlessly, like magic, right?
No so fast. There are always obstacles.
The reality is that for even these industries, interoperability didn’t (and doesn’t) just happen by magic. There is a defined workflow and a technical blueprint that outlines how the different systems fit together; an industry-wide consensus on how data should flow. The healthcare industry does not fully have this benefit—not yet. But it needs it.
Interoperability is important to healthcare so patient health information can be available to different stakeholders including facilities, doctors, pharmacies, labs, payers, even patients themselves — wherever they are and whenever they need it — in order to ensure a safe and effective delivery of care. And while the Office of the National Coordinator (ONC) for Health Information Technology has laid out its own interoperability roadmap to advance the electronic exchange of healthcare data, there are still barriers that need to be addressed.
1. It's starting slowly.
The foundation of future interoperability is based on past and future HL7 standards. HL7 version 2 has the foundation of the message types we need to exchange. This is the standard most commonly used in healthcare. HL7 version 3 is used for summary type information exchange in the form of CCD and CCA documents in an xml format. The latest HL7 initiative FHIR (Fast Healthcare Interoperability Resources) is trying to put it all together. The message types in a common workflow, with the latest real-time transport protocols and security required by HIPAA.
2. It’s complicated.
Part of the challenge is that healthcare information is more complex than, for example, that of consumer products. With various procedures, surgeries, supplies, insurance coverage and Medicare, the workflow is trickier to define. That’s been further hampered by discord regarding how data should be transmitted, and a lack of proper infrastructure to support the transmission nationwide. A necessary technical component — namely API management that will allow data to be transmitted on request — is also missing.
3. It’s easier for the big guys.
A large entity like a hospital system likely has robust data centers and systems bolstered by multimillion dollar IT budgets, and thus the ability to comply with ONC directives and create interoperability…if only inside of their own universes. Creating these types of systems can be difficult for smaller providers like ambulatory surgery centers (ASCs) due to the cost, and the required expertise. With small budgets, and a small IT staff, they sometimes rely on older technology like fax, or try to come up with custom solutions and interfaces, rather than adopting a truly interoperable solution. This is one of the reasons you often see large providers buying up smaller hospitals and specialty units like surgery centers; small facilities often have no choice but to merge into larger systems, or risk going out of business.
4. Not everyone wants to share.
Technology providers aren’t wired to want to interface with their competitors. They create proprietary platforms with the intention of making it difficult for other entities to access their data, keeping clients loyal to their products and information locked in siloes, unable to connect outside the branded circle. The key to changing this is external incentive: without pushback from the outside (from clients, governmental agencies and centers themselves), interoperability development becomes a secondary driver and we continue with closed systems that share little, if any data.
At SourceMed, we work to build applications that are fully interoperable with ONC standards. We are also focused on partnering with other technology providers to create interoperable, end-to-end solutions for ASCs. In this way, the growth of interoperability becomes our burden to bear, so that ASCs can focus on what they do best - providing convenient, high quality surgical care
As the healthcare industry moves from fee-for-service to value-based models that are built on collaboration and information sharing, interoperable technology solutions will be to everyone’s advantage. While there’s no silver bullet to magically solve the challenges that exist, SourceMed will be ready, and we’ll be sure that our ASC customers are too.
