It was an excellent discussion Tuesday during the Health IT Summit in San Francisco, sponsored by the Institute for Health Technology Transformation (iHT2, our sister organization, under the Vendome Group corporate umbrella). During the first day of the Summit, being held at the Park Central Hotel in downtown San Francisco, I moderated a panel entitled “Interoperability: How Close Are We?” with my fellow panelists Bill Beighe and David Watson.
Beighe is CIO of Physicians Medical Group of Santa Cruz (California) and of the Santa Cruz Health Information Exchange (Santa Cruz HIE), and David Watson is CEO of the California Integrated Data Exchange, or CalINDEX. And both have years—even decades—of experience with building health information exchange and information system interoperability. Both also understand at a very deep level the complex and difficult challenges facing not only the architects of health information exchange, like themselves, but also the challenges facing all healthcare IT leaders these days, around both health information exchange specifically, and interoperability and data exchange more generally.
What’s more, it’s clear that the attendees at iHT2 on Tuesday afternoon, understood those complexities and challenges, as well.
At the outset of the session, we conducted an instant poll of attendees. I asked them the following question: “On a scale of 1 to 10, with 10 being the most difficult, how difficult do you think it will be to achieve true, industry-wide interoperability in U.S. healthcare in the next five years?”
Here were the responses: 8 percent said “1”; 4 percent said “7”; 17 percent said “8”; 25 percent said “9”; and fully 46 percent said “10.” And if one were to take the top three most difficult choices—from 8 to 10 on a scale of 1 to 10—fully 88 percent of Health IT Summit attendees assessed the difficulty of achieving true interoperability in U.S. healthcare in the next five years as posing very significant difficulty, expressed as an 8, 9, or 10, on a scale of 1 to 10.
As Bill Beighe, David Watson, and I agreed, that survey result was aligned well with the challenges facing those currently working on health information exchange and interoperability. Indeed, Watson, as CEO of California’s statewide HIE, admitted that it remains difficult to get the leaders of many hospitals and medical groups statewide across California, to actively participate in sharing data. And Beighe noted that in Santa Cruz, he and his colleagues have literally spent decades building trust among all the stakeholder groups in their community, in order to create a foundation for data exchange. As a result, that foundation has been built—but, he noted, it literally took decades to get there.
At the same time as all this foundational work has been happening in HIEs across California and everywhere else in U.S. healthcare, questions have arisen as to what exactly needs to be exchanged, and why. Because, clearly, interoperability for its own sake is as irrelevant as health information exchange for its own sake. On that, at least, everyone can agree.
Now, as to how to help push things forward, I asked Beighe and Watson whether they felt that the current push on the part of federal healthcare officials in the direction of interoperability—including the release last October of the final Interoperability Roadmap from the ONC (Office of the National Coordinator for Health IT), and the announcement during the HIMSS Conference by HHS (Health and Human Services) Secretary Sylvia Mathews Burwell of a major new federal initiative around data-sharing and interoperability—had been helpful to date. Watson opined that, absolutely, the federal push had been helpful so far. He also noted that, when not only the ONC, but also CMS (the federal Centers for Medicare & Medicaid Services), which can use the power of payment to effect change, gets involved, industry leaders listen.
Still, the ability to share live data between and among clinicians, patient care organizations, and other entities in healthcare, remains challenging on all levels, Watson and Beighe noted.
What’s more, they agreed with my contention that many priorities are jostling for prominence right now. For example, many clinician and executive leaders in healthcare believe that a major priority of data exchange should be the sharing of smaller, more “atomic” bits of data, over the sharing of CCDs and other larger containers of patient data. That certainly was one facet of what Ida Sim, M.D., Ph.D., a professor of medicine at the University of California San Francisco (UCSF) had been talking about in her presentation just before our session. Dr. Sim, in her talk, entitled, “Beyond There’s An App For That,” had discussed “atomic” data (her term), and had put her discussion of such data into the broader context of healthcare apps, including consumer-facing and clinician-facing ones. Just what kinds of data will prove to be most helpful to physicians in practice, going forward? Mobile health apps, Dr. Sim noted, could end up being gateways for the sharing of key, smaller pieces of data between and among patients, their primary care physicians, their specialists, and others, as needed, going forward.
So the push towards true interoperability could move forward along a number of dimensions at the same time. Still, traditionally understood health information exchange retains a strong rationale, as long as leaders from the various stakeholder groups in healthcare can unite to push it forward. That, too, of course, remains problematic and loaded with obstacles. For example, Watson noted, many employer leaders do not see the value of supporting health information exchange, including financially, even though HIE can be a major facilitator of cost containment via the appropriate sharing of data at key points in patient care delivery.
So we inevitably will all continue to sit in complexity around all of this, both because people on all sides of the multi-sided table see things very differently when it comes to interoperability, and because interoperability inevitably means different things to different people, in the most practical ways.
And yet, and yet, even after a discussion of all the challenges and obstacles involved, in the end, both of my fellow panelists expressed overall optimism when it comes to the future of health data exchange and interoperability. Beighe, for example, predicted that significant strides towards true interoperability will in fact take place in the next five years. And if anyone should have a good basis for such an assessment, it is he, as he has in fact spent decades working to push forward authentic interoperability, in the context of community and regional health information exchange development.
So inevitably, there is a split-screen aspect to this, with everyone agreeing on the Tuesday of iHT2-San Francisco that the challenges ahead will be very difficult, but at the same time also agreeing that there was/is reason for some optimism. In any case, the next few years appear to be ripe for change and forward evolution, even as the obstacles to forward evolution remain a present as ever. Fortunately, with industry leaders like Watson, Beighe, and Dr. Sim, and many others, pushing ahead in different spheres and areas of endeavor, it’s hard to believe that things won’t have changed significantly in the next five years. As I said in concluding the panel discussion, one can look to the Greek myth of Pandora and her box. After all, after opening a forbidden box and unleashing all the vices in the world, Pandora ended up with one thing remaining in that accursed box: hope.