I spent Monday, Nov. 9, at the 5th Annual World Healthcare Innovation & Technology Congress in Alexandria, Va. There were plenty of impressive presentations about progress on interoperability, especially within integrated delivery networks. For instance, representatives from the University of Pittsburgh Medical Center talked about their focus on a semantic interoperability solution from a company called dbMotion to make the multiple health IT systems used within their integrated enterprise talk to and understand each other.

But once the discussion shifted to regional and state integration, I would say the enthusiasm was tempered by a steely-eyed realism about the difficulties ahead, involving standards, financing and policies.

During a keynote panel on interoperability, speakers were asked to name their "favorite" obstacle to interoperability, and, of course, business sustainability was mentioned several times. For instance, Craig Schneider, director of healthcare policy with the Massachusetts Data Consortium, noted that despite his state's well-publicized successes in health IT, he would urge other states to exercise caution when moving forward on HIE plans. There's a danger, he said, of using HITECH funds to develop something that won't be self-sustaining. He admitted the funding being made available is exciting, but he asked if you get millions from the federal government to help build an HIE, what happens two years down the road? You don't want to build something just to have to take it apart again later. The Bay state is looking to leverage the success it has had in developing a network to lower administrative costs, the New England Healthcare EDI Network (NEHEN), to help pay for clinical HIE, Schneider said.

Laura Adams, the president and CEO of the Rhode Island Quality Institute, stressed that getting organizations to agree to share data remains a challenge. Groups that are "natural enemies in the wild" have to be brought together by a focus on the patient safety and public health benefits of interoperability. She said transparency and making bad behavior public is sometimes needed to get cooperation. Adams noted that states should consider putting more effort into building "social capital" for projects rather than putting the main focus on financial capital. That type of effort has paid off in small states like Rhode Island, where all the major healthcare stakeholders can fit in one conference room. Rhode Island has made great strides in e-prescribing and is moving ahead on a statewide HIE. In states like New York and California, herding the cats is a much more difficult task.

What is your "favorite obstacle" to interoperability?