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Gaining Perspective on Interoperability

February 17, 2014
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Interoperability is one of those “buzz” words that gets people in the healthcare industry “oohing” and “ahing;” a word that seems linked to the future of this new healthcare.

No doubt, everyone is talking about it these days. At the HCI-DC 2014 in Washington, D.C., new national coordinator for health IT, Karen DeSalvo, M.D., outlined her five-point plan to reach interoperability, which she said will be one of her top goals for 2014.

DeSalvo’s plan includes: increasing end-user adoption of health IT; establishing standards so the various technologies can speak to each other; providing the right incentives for the market to drive this advancement; making  sure personal health information remains private and secure; and providing governance and structure for health IT. Coming from New Orleans, where DeSalvo helped turn the city around after the healthcare system was devastated by Hurricane Katrina, the new ONC head gave reasons to be confident in her plan, which admittedly faces daunting odds.

While the basic concept of interoperability—getting technologies, such as electronic health records (EHRs), to communicate with each other— is a fairly simple one, achieving it involves great complications that can be tough to grasp.

But last week, at the same conference at which DeSalvo outlined her plan to achieve interoperability, Malcolm Gladwell, journalist, bestselling author, and speaker, spoke about the subject through a different lens, giving the audience lessons on interoperability from outside of healthcare.

During his keynote, Gladwell, if only for a few minutes, was able to simplify an intricate problem. Gladwell admitted he is no expert himself on either healthcare or interoperability. But for me—and perhaps other audience members—that was okay. Sometimes, getting perspective from outside the spectrum in which you’re working will give you greater knowledge about said subject going forward.

Gladwell spoke about using synergistic warfare technology to defeat your opponent; how to efficiently ship cargo; and the evolution of digital music as his historical references on interoperability.  While the three examples are completely different and totally unrelated to healthcare in a vacuum, they all apply to interoperability in their own sense and through a unique perspective.

The deeper lesson that Gladwell offered, beyond giving examples of how interoperability has worked in other industries, was that the current problem in American healthcare is more than just getting technologies to talk to each other—it begins at a level above that, involving culture, framing, and consequence.

It was its culture that led the Israelis to act with a sense of urgency, Gladwell said, as they learned how to make warfare technology interoperable to defeat the Syrians in the Bekaa Valley Turkey Shoot, an incident in the Lebanon War of I982. If the U.S. understood that it was in a genuine crisis and acted with a greater sense of urgency, perhaps the goal of greater interoperability could be achieved, said Gladwell.

It was the proper framing of a problem that led Malcolm McLean, an American transport entrepreneur, realize that he could revolutionize modern shipping if he just correctly framed what the problem was. “Success is only possible by an act of reframing,” Gladwell said. “Only when people who can think about the right way to solve something, can they solve it.” If the U.S. agreed on a frame for the growing healthcare problem in the country, perhaps the collective effort could lead to greater interoperability, said Gladwell.

And according to Gladwell, it was consequence that led those in the music business to realize that the digitization of music was a money-maker for the industry, as music was no longer a prison to the device from which it was played. If we didn’t make the mistake of thinking that innovation is specific to an individual invention or a device, perhaps we would be closer to reaching interoperability, said Gladwell.

In healthcare today and in the future, achieving interoperability will be a necessity— as meaningful use and accountable care organizations (ACOs) are becoming a reality, compliance will require higher standards of interoperability and connectivity. And although HIEs have been designed to promote connectivity, the creation of health information exchanges does not automatically lead to interoperability.

Make no mistake—there are real-life challenges that stand in the way of health IT interoperability, and the work of DeSalvo and others will certainly help fight those challenges. But for a broader, more unique perspective on what it might take to reach true interoperability, listening to what Malcolm Gladwell had to say might be very helpful in its own right.