Party lines, flowing faucets, and fixing interoperability

This article was originally posted on Becker’s Health IT & CIO Review.

David Lareau is CEO of Medicomp Systems of Chantilly, VA.

Dave Lareau

My grandparents lived in a small town in Massachusetts amongst a large French-speaking population.

When I’d visit, I would always be fascinated with their telephone party line. A party line – for those of you that don’t recall life without cell phones – was a reduced-priced telephone circuit that subscribers shared with multiple other homes. When you picked up your phone to place a call, you never knew if the line was available or if someone else was using the party line for their own call.

Sometimes my grandparents and their party-line cohorts liked to pick up the phone just to start random conversations with whoever happened to be on the line. It wasn’t unusual for someone to attempt to initiate a chat with a fellow party-line subscriber, only to quickly realize that a conversation was impossible because one person only spoke French and the other only English.

When I think about the state of interoperability today, I often reflect on my grandparents’ party line. Everyone on the party line was connected via shared telephone circuits, but because of language barriers, communication was sometimes difficult, if not impossible. In healthcare, we continue to lay groundwork to connect providers and share clinical data, yet certain barriers still make the exchange of actionable clinical data difficult, if not impossible.

Understanding today’s interoperability circuits 
In many cases, providers are sending data to other providers, but using formats that fail to enhance clinical decision-making. A clinician may receive a big batch of data, but often it’s highly disorganized and filled with duplicate information. To be useful, the recipient must wade through gigabytes of details and manually filter out what’s relevant, then correlate the information with the correct patient in the appropriate section of the chart.

Not all interoperability challenges are technical. In fact, thanks to wider adoption of standards and protocols, including Direct messaging, FHIR and CCD, plus the proliferation of health information exchanges (HIEs) across communities, we have much of the plumbing in place for secure data exchange. We even have technology to intelligently identify, interpret and link various medical concepts and map them to standard nomenclature, such as ICD-10, SNOMED, RxNorm, and LOINC so that the shared information is useful to clinicians at the point of care.

Why then, does interoperability continue to be such a struggle? A key reason is that many providers and vendors are scared to run water through all those nicely-laid interoperability pipes.

The fear factor
Fear continues to stand in the way of many interoperability initiatives. Many vendors have traditionally resisted opening up their systems for clinical data sharing, fearing it would make it easier for clients to replace them with competing systems. In reality, hospitals are slow to switch from one EHR to another, given the complexity and expense of today’s large HIS implementations. In the ambulatory care world, however, these fears may be more valid.

Health systems fear that sharing patient medical histories with the health system across town puts them at risk of losing market share. In addition, some worry that competing organizations could use shared records to extrapolate confidential details about patient volumes or the number of procedures performed.

Both vendors and health systems also fear that when patient data is forwarded electronically, it increases the risk of inadvertently disclosing confidential patient information in violation of privacy laws.

The financial factor
Even when the interoperability pipes are already in place, individual providers still have work to do to make their processes and systems interoperability-ready. Investments in existing infrastructure may be required, along with changes to long-standing clinical workflows. Healthcare providers operating on tight budgets may perceive interoperability updates of limited financial value, especially when compared to investing in a revenue-producing piece of equipment, such as a new MRI.

Assuming fear and finances are slowing the interoperability faucets, what can be done to fix things?

Bring on the carrots and sticks
Whether you love or hate the Meaningful Use program, you can’t deny the huge impact it has had on driving EHR adoption. According to the CDC, 87 percent of office-based physicians and 96 percent of hospitals use at least a basic EHR, up from 48 percent and 12 percent respectively in 2009, the year the Meaningful Use program legislation was passed.

While other factors have also helped drive EHR adoption, Meaningful Use’s mix of financial incentives and penalties have certainly contributed to the program’s success. If the government, as the country’s largest payer, wants to drive interoperability to improve care coordination and patient safety, reduce care costs, and enhance outcomes, then perhaps we need to consider implementing some sort of carrot and stick program. Alternatively, we need resourceful entrepreneurs from the private sector to flesh out the economics of interoperability and develop solutions that deliver adequate monetary benefits to encourage all stakeholders open their interoperability faucets and let the data flow.

My grandparents’ party line was fun because you never knew who or what might be on the line when you picked up the phone, or if communication would even be possible. That might have been acceptable for yesterday’s phone circuits, but we all deserve better when it comes to sharing potentially life-saving clinical data.