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At iHT2 Boston, Micky Tripathi's Refreshing Take on Interoperability

June 28, 2016
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During a closing keynote presentation last week at the iHT2 Boston Health IT Summit, Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative (MAeHC), debunked certain healthcare interoperability “myths” while offering a positive outlook on the future of data exchange.

The event, from the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group, LLC corporate umbrella), took place at the Aloft Seaport Hotel in Boston on June 23-24, and closed with Tripathi’s Friday keynote on healthcare interoperability.

In addition to his role at MAeHC, a collaboration of Massachusetts provider, payer, and purchaser organizations, Tripathi wears various of other health IT hats: he is chair of the Information Exchange Working Group and co-chair of the Privacy and Security Tiger Team (both of the federal Health Information Technology Policy Committee), a director of the New England Health Exchange Network (NEHEN), and a director and past board chair of the eHealth Initiative. Simply put, when it comes to interoperability and standards, no one in health IT is better well-versed than Tripathi. I compare it to the NBA, when players who consistently can score the basketball are labeled “go-to guys.” For healthcare, Tripathi is the go-to guy for all things interoperability.

Tripathi opened his presentation by asking two questions to the room full of attendees: first, if they believe information blocking significantly exists in healthcare; and second, if they think that the healthcare sector is woefully lagging behind other industries in terms of being interoperable. Predictably, the majority of hands raised in affirmation to both questions. Knowing this would be the likely answer to his two questions, Tripathi moved on in an attempt to debunk these “myths.”

Indeed, looking at other industries, Tripathi noted how he gets Google Calendar invites all the time that don’t sync well in Microsoft Outlook. Or, he said, books purchased at Barnes and Noble don’t play on the Amazon Kindle. He gave several more examples of how in other businesses, companies don’t always “play nice” with one another: Apple isn’t interoperable with anyone; Netflix and Verizon recently had a fight about who should pay for the infrastructure for Netflix consumers, resulting in poor streaming quality; Fitbit has said that it’s not connecting with Google Fit, choosing to create its own network; and finally, consumers can no longer use another coffee cup in a Keurig anymore.

“Interoperability problems are rampant across all industries, public safety included,” Tripathi attested. “I'd argue that [these examples] are no different than what's happening in healthcare. In some ways, since we have higher expectations in healthcare, we are actually doing better. We need to exchange data; other industries might not have to.” Tripathi then touched on how these interoperability issues get “resolved” in other industries, offering the example of universal product codes (UPC) in grocery stores that adopted them after having problems with inventory control. “Grocery stories created UPCs with a bunch of other grocery stores and vendors. They wanted to all purchase the same machines and get value from them,” Tripathi explained.

Thus, as HIE [health information exchange] matures, it is starting to organize itself like other industries, Tripathi said. Now the question becomes, how are these data exchange networks going to form? The early notions were of a single, federal top-down network, and that collapsed as an idea. But now, networks are starting to form, he said. “It’s not about connecting an EHR [electronic health record] to an EHR, but about being a part of a network and connecting a network to a network. That's how the rest of the economy has solved the issue in literally every instance.”

Tripathi pointed to several examples of separate networks forming and connecting in healthcare today. He brought up the eHealth exchange for government data, the Mass HIway for local, state-based, lightweight exchange in Massachusetts, Surescripts, for e-prescribing, DirectTrust for secure email, and Carequality as an emerging framework that allows query-based exchange among different participants. “We have so many different ways to communicate with one another based on the kind of communication we want, so we have different networks—just like any other industry. The original notion was to have one way of health information exchange, but there are very few examples where that has worked,” Tripathi said.

He continued, “What type transaction do you want to make? DirectTrust is nationwide interoperability of secure email, and it doesn’t do anything else. But it's something that has been carved out from the broader picture.” This is different than the all-or-nothing approach, or “HIE 1.0,” in which data would be dumped into a repository for everyone to be able to use for multiple purposes, Tripathi said.

Tripathi then noted how the marketplace is just beginning to see solutions for point-to-point query exchange, so a provider can query someone else’s system to get a record document, and then query another system. Carequality and CommonWell are starting to solve this problem, Tripathi said, adding that pretty much every major vendor except Epic, NextGen and GE are on board. And regarding Epic’s exclusion in these interoperability frameworks, Tripathi reminded folks that while there is not yet interoperability between CommonWell and Epic (Epic’s Care Everywhere product is for Epic users only), looking at other industries as a precedent proves that it will eventually happen in healthcare, too. “These are the beginnings of a nationwide network to solve the point and retrieve issue,” he said.