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?

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