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Interoperability Oxymoron

April 27, 2018
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I recently saw an article on how one community is addressing interoperability in the Spokane, WA area.  For the Spokane area, this sounds like a good proposition for improving healthcare.  The article discusses MultiCare Health’s move to an Epic EHR, and the ability to then share information with two other healthcare entities (Providence Washington Health & Services and Kaiser Permanente).

A simple web search highlights that there are far more healthcare facilities in the Spokane area than those discussed.  So, while those that are Epic sites will have the ability to share information, it doesn’t necessarily mean that those that might not have Epic will be able to participate. 

Therein lies a fallacies of describing “interoperability.”  According to HIMSS, interoperability is defined as – “the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user."

Interestingly enough, despite all the emphasis on interoperability, it does not seem to be a major priority according to the 2018 HIMSS Leadership Survey.  The results suggest “the following priorities, in ranked order, as most important to them (on a scale of 1 to 7, with 7 as the highest level): “patient safety” (6.0); “privacy, security, and cybersecurity” (5.90); “process improvement, workflow, change management” (5.7); “clinical informatics and clinician engagement” (5.0); “data analytics/clinical and business intelligence” (5.50); “improving quality outcomes through health IT” (5.48); “compliance, risk management and program integrity” (5.47); “electronic health records” (EHRs; 5.46); “culture of care and care coordination” (5.34).” 

That being said, there does appear to be a growing emphasis on interoperability, albeit it seems to be intra-vendor as opposed to ínter-vendor in nature.  Epic’s website lists a number of facilities utilizing their Care Everywhere Network.  Similarly, Cerner has an interactive map showing interoperability.  An older article discusses the limitations of inter-vendor interoperability that highlights the Commonwell Alliance, and the ongoing struggle with Epic’s lack of participation. 

What seems to be missing in all these discussions is the use of standards to improve interoperability. At least one vendor does seem to emphasize standards, referencing both HL7 and FHIR.  As evidenced by the evolution of the DICOM standard for medical imaging, it does take a long time for standards to evolve for practical uses.  True interoperability will depend on two key factors: (1) the ability to apply standards; and (2) the willingness of vendors to cooperate in the use of the standards.  It always amazes me how vendors can hide behind the notion of competitiveness as an excuse for collaboration.  Then again, collaboration can raise fears of coercion and legal issues, meaning vendors must walk a tightrope when it comes to interoperability. 

Establishing guidelines and standards can be an effective way for vendors to collaborate without fear of collusion. One can only hope that this will be the case in terms of EHR’s and enable true interoperability across healthcare entities.  The week’s announcement on CMS’s rebranding of the Meaningful Use Program to emphasize interoperability will be further incentive for the necessary cooperation to achieve real interoperability across the healthcare infrastructure.  Perhaps it will also result in prioritizing interoperability as part of a 2019 HIMSS Leadership Survey.  One can only hope it is so.


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