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GUEST BLOG: Let’s Think About the Deeper Implications of the Interoperability Push

November 23, 2015
by John Lee, M.D., CMIO, Edward Hospital
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Dr. Lee shares his perspectives on why standards-based interoperability needs serious rethinking

In 1929, the Great Depression decimated the American and world economies.  To a large extent, the debacle stemmed from unstructured and unreliable financial and accounting practices.  It was extremely difficult for even "experts" to discern the financial health of any given enterprise.

In response, a series of events was initiated that sought to bring order to the chaos. In the 1930s, the American Institute of Accountants (AIA) worked with the New York Stock Exchange and the newly minted Securities and Exchange Commission (SEC), to regulate and bring order to an accounting environment that had previously been relatively unstructured.  In 1936, the term "generally accepted accounting principles" (GAAP) was first used by the AIA. In 1939, the SEC mad a fateful decision to rely on the private sector to establish and maintain GAAP.

In the following decades, there have been changes to the details of what constituted "GAAP," but there has been a persisting principle.  The government largely allowed the private sector to govern its own accounting principles.  There have been tweaks and nudges by the government, but there was no wholesale governmental takeover and guidance of what "GAAP” is.

John Lee, M.D.

Fast-forward 85 years: we are in the midst of a healthcare spending crisis that is threatening to strangle our economy.  Moreover, our spending isn't helping our population get any healthier. Just as the crash of 1929 resulted to a large extent from a lack of financial clarity, much of our crisis results from providers not having the right information they need at the time that they need it.

A big part of the problem is a lack of interoperability. And a big part of the interoperability problem is a lack of standards.  When a technology professional speaks of standards, the initial thought is that this refers to such things as common vocabularies and governance so that there are rules of the road for data (in this case, health data).  Conventions such as HL7, FHIR, CCD, LOINC and RxNorm are examples of such standards.  Recently, there was a convening of IHE (Integrating the Healthcare Enterprise), HIMSS (Health Information Management and Systems Society) and AHIMA (American Health Information Management Association).  The result was a white paper that framed out how these organizations felt that health data should be collected, organized and disseminated.

However, the standards "problem" also entails measurement.  How is it that we decide a system is truly "interoperable?"  More practically, how do we measure the shades of “interoperability gray”?  To start tackling this problem, major vendors convened recently at the Keystone Summit to start building the infrastructure of this measurement.

To my knowledge, these two groups have not converged into a single, unified effort.  My hope is that the providers who are trying to create the tools, will be coordinating with the vendor group that is coordinating to create the measurement.  They can hopefully take their cue from that group of accountants in the 1930s who worked to create their own standards, warding off the imposition of standards fully controlled by the federal government.  If they don't, I fear we will find ourselves mired in regulatory quicksand that will make Meaningful Use look like bureaucratic child's play.

John Lee, M.D. is CMIO at Edward Hospital in Naperville, Ill., and is board certified in emergency medicine and clinical informatics.


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