As the number of healthcare interoperability initiatives continues to grow, tracking and assessing interoperability standards, government regulations, and the various consortiums, alliances, workgroups, and associations becomes a challenge. But undoubtedly, interoperability is the lynchpin to the future of health IT, and has been made a main priority by the federal government.
On November 17, at the New York eHealth Collaborative's (NYeC) 2014 Digital Health Conference, a panel of interoperability thought leaders provided an insider’s view of which efforts are gaining traction, which challenges present the biggest barriers to success, and how these obstacles will eventually be overcome to enable a future of connected health. On that panel was: Kenneth Kleinberg, managing director, The Advisory Board; Brian Ahier, director of standards and government affairs, Medicity (Salt Lake City, Utah); Anuj Desai, vice president of market development, NYeC; Matt Quinn, managing director, East Coast, healthcare and life sciences, Intel Corporation; Jacob Reider, M.D., deputy national coordinator, Office of the National Coordinator for Health IT (ONC); and Mariann Yeager, executive director, Healtheway. Below is an excerpt of the panel discussion, which was moderated by The Advisory Board’s Kleinberg.
Q: Obviously, we’re moving towards need for greater interoperability. But there hasn’t been as much progress as we would have liked. Why is that so?
Ahier: There is a lot going on, so it’s a complicated answer. There are a lot of initiatives underway to help promote interoperability for care coordination. I don’t know if I agree that interoperability is a failure to any extent. We do have a long way to go, but there is a great deal of interoperability that is taking place now. We do have challenges, but it’s because of the success we’ve had that we have these challenges. Five or six years ago, there weren’t so many doctors using electronic health records (EHRs), especially the ones that have standards for interoperability. We’ve seen EHR adoption move the needle so interoperability can be possible. The biggest roadblock is the business case—if your business model is to afford your data and keep a walled garden approach, then that’s what you’ll do, as it makes the most business sense. Now there is an incentive to share information about patients who you’re caring for, so you can improve that care. When you’re a large clinician network, you care very much about what’s happening outside of your four walls. There is still competition for market share, but more of a need to communicate.
Reider: I agree with Brian's core hypothesis. I was one of founding members of the Hixny Health Information Exchange (HIE) [in northern New York]. I remember one of our first board meetings, when a CFO in the community realized the numbers of millions of dollars of revenue his organization would forego by being part of this HIE. So they bit that off, and said begrudgingly that he’s in. I’ve spent time in private sector, so I know that if there is no margin, there can be no mission. So when the market as a whole—not fragments—are motivated to share information, that will be the tipping point.
Quinn: We need to get the word out of good examples and package that in a way that is understandable and consumable by others. Probably the biggest health IT thing that will happen in next few years is the Department of Defense (DoD) and the U.S. Department of Veterans Affairs (VA) investing in health IT infrastructures that I hope will take us into the future. Our soldiers and veterans have systems that are interoperable to the extent that we can use that as levers that could accelerate us and move us forward. That is one where the case for interoperability is solid—its financial as well as its moral.
Q: So you have this new environment that is pushing the exchange of information, but there is also the retail revolution and competition amongst healthcare systems. How does this get reconciled?
Ahier: If you’re still in the fee-for-service world, then yeah, that is a problem. Shared risk drives shared information though, that’s the bottom line.
Reider: This is healthcare; we're not making potato chips. We need to work together, not against each other. We need to keep people healthy, and organizations need to recognize that we're working towards the same goal. It never made sense to me that we compete in healthcare. Maybe that’s naive of me.
Q: Are vendors dragging their feet?
Reider: First off, folks who make software that creates better healthcare are health IT software developers to me, not vendors. So you’re talking about shared risk. These developers are in this, and interested in sharing risk and benefit. If these developers became part of sharing success, instead of just selling services and stuff, what if we could share the developers? Better health equals better payment. That would be cool.
Yeager: We see vendors as motivated to get their systems interoperable. The challenge they have had is in having a high-level national testing program. We're working on dual programs to connect and harmonize our specifications and test cases to support that. Once that exists, they will see the opening, but it’s costly for them to maintain their interfaces, as they’re getting an earful from customers.