The Interoperability Imperative

This article originally appeared in Healthcare Information Management & Communications Management magazine:

Call me a “fan boy” but I couldn’t wait to get my hands on Apple’s iPhone 6. Having written about the disruptive potential of digital health platforms, I was eager to play with apps designed for the new HealthKit platform (and that took advantage of the iPhone 6’s many built-in sensors). Even before I began to explore the functionality of the first HealthKit enabled app that I installed, I was struck by how it easyit is to share data among these apps. I simply indicated during the installation process which data elements I wanted to read from and write to the HealthKit repository and I was done. If only the sharing of my personal health data across the various health IT systems in which it is stored was so easy!

Interoperability, like innovation, is one of those words that has become so overused that it risks oblivion in buzzword hell. Equally concerning, it is a term that few people outside the health IT community use and care very little about. Yet, interoperability (or, perhaps, more correctly, lack of interoperability) has proven to be a major impediment to realizing the full potential of health IT.

Karen DeSalvo, Director of the Office National Coordinator for Health Information Technology (often referred to as the ONC) in the United States, has made impassioned pleas about the interoperability imperative at various events since she was appointed less than a year ago. At the annual HIMSS conference, held this year in Orlando, Ms. DeSalvo told attendees:

“We have made impressive progress on our infrastructure, but we have not reached our shared vision of having this interoperable system where data can be exchanged and meaningfully used to improve care.”

A similar situation exists in Canada. In a brochure advertising an interoperability workshop scheduled to take place in October 2014 (before this article is published), ITAC Health offers the following summary:

“For years the Health ICT industry in Canada has struggled with the challenge of interoperability. Application developers are faced with a dizzying array of standards, jurisdictional requirements and legacy environments.”

At the annual American Health Information Management Association (AHIMA) conference held this year in San Diego, Ms. DeSalvo observed that healthcare data “must be plug-and-play. It’s not helpful if it just sits there idle.”

I was intrigued by Ms. DeSalvo’s choice of words. To be useful, Ms. DeSalvo contends, healthcare data must be able to move to where it is needed. This notion of data liquidity, which the Institute of Medicine defines as “the rapid, seamless, secure exchange of useful, standards- based information among authorized individual and institutional senders and recipients”, captures the essence of what we are trying to achieve when we talk about interoperability.

So, how do we achieve data liquidity? Dr. Doug Fridsma, Chief Scientist at the ONC (and soon to be President and Chief Executive Officer for the American Medial Informatics Association (AMIA)), contends that tackling this challenge “from the top down isn’t going to work.”

In a HealthITBuzz (the ONC’s blog) post earlier this year, Dr. Fridsma offered insights on how to achieve interoperability on a large scale. These insights were gleaned from a Software Engineering Institute report entitled “Ultra-Large Scale Systems: The Software Challenge of the Future.” He notes that the characteristics of ultra-large-scale systems described in the SEI report have “an eerie similarity to the challenges we face in the overall health IT industry.”

“Ultra-large scale systems are not about a single software application, or a couple of applications working together, but rather an ‘ecosystem’ of interacting software systems,” notes Dr. Fridsma. These systems “cannot be managed ‘top down’ in a monolithic way, but will require a coordinated, decentralized way of meeting local needs, while keeping all of the systems working together.”

This notion of ecosystem is reflected in the ONC’s 10-year vision for an interoperable health IT infrastructure. This vision is based on what the ONC refers to as “five critical building blocks”

  1. Core technical standards and functions
  2. Certification to support adoption and optimization of health IT products and services
  3. Privacy and security protections for health information
  4. Supportive business, clinical, cultural, and regulatory environments
  5. Rules of engagement and governance

These building blocks are similar to the key enablers that Canada Health Infoway lists in its Pan-Canadian Digital Health Strategic Plan.

Ken Stevens, VP, Healthcare Solutions, Intelliware Development
Inc. and Co-Chair of the ITAC Health Interoperability and Standards Committee, offers what I think is perhaps the best summary of the interoperability imperative. Commenting on one of my posts on the eHealth Musings blog, Ken writes:

“Interoperability and data mobility have a huge impact on whether innovation is even possible …. Wherever valuable data is accessible through simple open standards, innovation will flourish.”

What are your thoughts on the interoperability imperative? How can we achieve data liquidity? What needs to change?

First impressions of Canada Health Infoway’s new CEO

Like many people in the Canadian Digital Health community, I was quite surprised this past June when the board of directors for Canada Health Infoway announced that they had selected Mr. Michael Green as their next President and Chief Executive Officer.

Uncharacteristically, I have had little to say on this appointment and have told anyone who asked that I had not yet formulated an opinion. After contemplating the matter and having had the opportunity to speak with Mr. Green, I am now ready to answer the question that so many readers have posed since the announcement in June: What do I think about Mr. Green’s appointment?

Read the rest of the article at Technology for Doctors.

Mike

Health IT Adoption Challenges

One of my favourite sources of information on the health IT market is HISTalk, particularly their daily round-up of health IT news.  In this morning’s summary, the editors cited Dr. Robert Pearl, CEO of the Permanente Medical Group,  and his reasons why health IT is not “widely embraced”:

  1. Developers focus on doing something with a technology they like rather than trying to solve user problems, such as jumping on the wearables bandwagon despite a lack of evidence that they affect outcomes.
  2. Doctors, hospitals, insurance companies, and patients all feel that someone else should pay for technology they use.
  3. Poorly designed or implemented technology gets in the way of the physician-patient encounter.
  4. EHRs provide clinical value, but slow physicians down.
  5. Doctors don’t understand the healthcare consumerism movement and see technology as impersonal rather than empowering.

The editors also offered their own thoughts on this topic, citing the following impediments to health IT adoption:

  1. People embrace technology that helps them do what they want to do. Most healthcare technology helps users do things they hate doing, like recording pointless documentation and providing information that someone else thinks is important.
  2. Technologists assume every activity can be improved by the use of technology. Medicine is part science, part art, and technology doesn’t always have a positive influence on the “art” part.
  3. Healthcare IT people are not good at user interface design and vendors don’t challenge each other to make the user experience better. Insensitive vendors can be as patronizing to their physician users as insensitive physicians can be to their patients.
  4. Technology decisions are often made by non-clinicians who are more interested in system architecture (reliability, supportability, affordability, robustness, interoperability) than the user experience, especially when those users don’t really have a choice anyway.
  5. Hospital technology is built to enforce rules and impose authority rather than to allow exploration and individual choice. Every IT implementation is chartered with the intention of increasing corporate control and enforcing rules created by non-clinicians. That’s not exactly a formula for delighting users.

What are your thoughts?  Do any of these reasons ring true for you?  Would you challenge any of them as incorrect?  Do you have any reasons of your own to add?

Mike

The rise of digital health platforms

Apple has gained a well-deserved reputation for disrupting industries. Witness the impact of the iPod on the music industry, the iPhone on the cellphone industry, and the iPad on the computer industry. Apple’s announcement this past June that iOS 8 (the next release of its mobile operating system) will include tools to manage personal health information has many analysts, journalists, and other pundits debating whether the company can have the same disruptive impact on the health sector that it has had other industries.

You can check out the remainder of this article at Technology for Doctors

Mike

New eHealth Ontario CEO

According to a media release from the Premier’s office, Cynthia Morton has been appointed as the new eHealth Ontario CEO, effectively immediately. Previously, Ms. Morton was a Deputy Minister with the Ontario Ministry of Labour.

David Hallett, currently Associate Deputy Minister of the Ministry of Health and Long-Term Care and eHealth Ontario board member, takes on a new role as Associate Deputy Minister, Pan Am and Parapan Am Games effective September 2, 2014.

Mike

In Support of Hacking for Health

“If you never change your mind, why have one?” Edward de Bono.

Are hackathons useful in the health sector? In an article I wrote late last year, I admitted that I was still “on the fence.” Never one to be comfortable sitting on the fence, I have continued to explore this question and have slowly reached the conclusion that hackathons indeed have a role to play in driving the development of new health IT solutions and perhaps, more importantly, breaking down barriers that impede innovation.

Check out the rest of the article on Technology for Doctors.

Mike

 

Tugging on Superman’s Cape – Contrarian Views Applied to the Digital Health Agenda

I have teamed with my friend and mentor, William Pascal,  to write a series of articles challenging conventional wisdoms about the Canadian digital health agenda.  Here is the first article in the series which sets the stage for the remainder of the articles

“Time spent arguing is, oddly enough, almost never wasted.” ―Christopher Hitchens, Letters to a Young Contrarian

Introduction

What if we do not need new funding for the digital agenda in Canada? What if we no longer need a Canada Health Infoway or similar bodies such as eHealth Ontario? What if we are less concerned about privacy and more concerned about delivering better care? What if the private sector manages all back office operations for the health sector? All these statements are contrary to conventional wisdom, but are they wrong?

What is conventional wisdom? It can be defined as ideas so accepted they go unquestioned. Think about the Wright brothers. If they had listened to conventional wisdom, they would never have even tried to build a flying machine and our world would be a very different place. Think about the impact on society today if Alexander Graham Bell had been discouraged and gave up when he was told that his invention of the telephone had no inherent value by Western Union.

Too often we accept what’s conventional thinking without trying to see what’s possible and available. The real problem with using conventional wisdom as a guide is that we will constantly be behind the curve, safe with the general masses but missing the opportunities to think independently and create something new or change an existing way of thinking. Ten years ago, who would have thought we’d be spending more money renting software than purchasing it?. Fifteen years ago, mobile devices were not viewed as a key enabler of care when we created an eHealth strategy for Canada.

New ideas or ways to address difficult issues almost always challenges conventional wisdom. Inspired by this reality, we have embarked on a quest to challenge, through a series of articles, some of the conventional wisdom that we believe underlies the approaches to the public policy thinking that is driving the digital agenda in Canada.

This paper, the first in our series of articles challenging Canadian digital health conventional wisdoms, provides a high level overview of the challenges facing the health care system, a description of the digital agenda in the healthcare sector, the status of this agenda in Canada, some observations on this journey, lessons to be drawn from experiences in Canada and Internationally and a suggested list of contrarian possibilities that draw into question conventional wisdom. Subsequent articles will explore these suggested different future states.

You can read the remainder of this paper here.

Mike