I’ve recently seen a number of blogs and articles dealing with the question of interoperability.  The question everyone is asking is – how do we achieve greater interoperability as part of ARRA/MU criterion and certification?  Good question!  Let’s first examine a couple examples of current activity.

Recently the IHE (Integrating the Healthcare Enterprise) conducted its connect Ithon near Chicago.  Herman Oosterwijk of OTech, Inc. blogged on the results (http://www.otechimg.com/blog.cfm?id=8074807823115642477&goback=%2Egde_95620_member_211019991).  Herman indicates that the number of attendees was flat from the previous year after several years of growth.  He speculates on the reasons for this, and among them are vendor’s ability to keep up with changes, the venue of informal vs. formal testing, standards complexity and vendor participation motivation.

Herman is concerned that perhaps we have hit a plateau with respect to vendor ability and enthusiasm for interoperability.  Good question!

In another blog, I read with interest on the speculation regarding a pending announcement between Cerner and McKesson on a collaboration on Health Information Exchange (HIE) interoperability (http://searchhealthit.techtarget.com/news/2240177518/Cerner-McKesson-cooperating-for-HIE-interoperabilitys-sake?li=644047&utm_medium=EM&asrc=EM_USC_20621228&mo=1&utm_campaign=20130212_Cerner%20and%20McKesson%20to%20take%20on%20Epic_&utm_source=USC&Offer=NewsAlert).  Don Flukinger, News Director speculates that perhaps as soon as the upcoming HIMSS there might be an announcement regarding such collaboration.  The objective would be to tie together Cerner’s strong EHR position with McKesson’s RelayHealth HIE to improve interoperability between environments.

From the blog, it appears a key motivation is competitiveness with Epic.  Epic certainly enjoys some competitive advantage in the ability to share information between facilities through its EpicCare Link and Community Connect offerings.  Secondarily though is the advantage of improving interoperability for ARRA/MU compliance purposes – a very compelling reason. 

In another article, Kyle Murphy, PhD, addresses the “Value of structured data to interoperability, meaningful use.” (http://ehrintelligence.com/2013/02/04/value-of-structured-data-to-interoperability-meaningful-use/).  Dr. Murphy references a blog by Dr. Doug Fridsma, Chief Science Officer and Director, Office of Science & Technology in which he refers to standards as “the practice of normalizing how data is captured in a structured way,” and “the crux of the issue is the ability to improve data capturing activities by clinicians while avoiding increasing workflow burdens on these providers.”  The ONC’s focus is on “enabling the integration of these instruments into EHRs so that duplicate data entry is reduced throughout the workflow, and most importantly, the data collected is comparable and more useful across multiple groups—from researchers, clinicians, payers, and public health agencies to patients and their caretakers.” 

Hence, there is need for determining how data is structured to enhance the ability of systems to interoperate.

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While these may appear to be unrelated, I think there is a key thread running between all of them that is important to achieving interoperability, as well as a missing link.  My takeaways from these discussions are as follows:

•   Standards are not easy and may become complicated if they attempt to address too much
•   There continues to be an underlying issue in all these initiatives that relates to the reality that vendors classically do not like collaboration as they fear it will limit their competitiveness
•   The lack of standards is counterproductive to initiatives such as ARRA/MU that are meant to improve PHI accessibility for the purposes of lowering costs and improving healthcare
•   Interoperability is key to assuring that capturing data for EHR’s is simple and productive enough for clinician acceptance

My answer to the $64,000 question?  Having lived through the ACR-NEMA efforts to create a means for image interoperability (DICOM), a major factor in securing vendor cooperation is building demand through insistence in Request for Proposal (RFP) and other requirements specification documentation on the inclusion of interoperability between systems.  Just because Cerner and McKesson create an initiative for interoperability doesn’t make it so.  Applying competitive pressure on them by insisting on it as a necessary system requirement will be further incentive for vendors to address it.  This is a better motive for cooperation than being forced through legislation to do so.

My concern is how to mobilize and incentive facilities to include interoperability in requirements specifications.  Facilities need to concentrate more on their requirements and less on vendor rhetoric about how one system can do it all.  Formalized requirements and vendor evaluations are one means for accomplishing this.

As always, your comments are welcome.