Interoperability Should But Will Not Happen

Fee-for-service medicine doesn’t provide the incentive for sharing information. Accountable care and integrated care models have native incentives for having complete information and sharing that only amongst themselves.

For as long as I can remember everyone in healthcare has been talking about “interoperability”. The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act (ARRA) of 2009 was to promote adoption and meaningful use of health information technology.

Interoperability was a key component of this in many minds. That is to say, share healthcare data/information between providers and hospitals, particularly in different healthcare networks. Many of us enjoy having our information centralized within our networks should we stay within the networks of hospitals and providers within our networks. But if you go outside those networks, your information may not be available to those providers due to a lack of “interoperability”.

The problem appears to be worse elsewhere. Tim Kelsey is the national director of patients and information for the National Health System (NHS) in England. He recently claimed that people’s lives are being “ruined” by the NHS’ inability to join up patient information at a recent speech. The story reports that “Kelsey used the speech to set out several technology priorities for the NHS to focus on following his departure at the end of the year.” He will be taking a new job outside of government in Australia next year.

He is quoted in the story as saying ““What we must not do is what the Americans did, which is build fantastic electronic hospitals in the sky – and not the ability for them to speak to each other.”

Always like those Brits to criticize us Americans 🙂 but it seems they have not fared much better. I don’t know all the ins and outs of the NHS of course but it seems if you have a “national” health system (and I think there are several “NHS” for different parts of the UK), you can share information across that system.

The logic would follow that if you are the Veterans Administration, for example, you could also share information across the “system” or the Mayo Clinic with multiple locations, information would be shared across states and providers. Depending on the information you are looking for, this may be the case. But not always.

And what incentive do hospitals in this country have to share their data? Their information? If a patient is seen outside their network, getting their tests and treatments and surgeries elsewhere, why would they really want to share their records at some cost to do so without any revenues?

Do auto manufacturers or airlines or farmers or any other industry share data based on transactional events they are not required to do so by law with their competitors?

Interoperability always sounds good but why should my lab or hospital share its data with others, even if the consumer, the patient, chooses to go elsewhere for his/her care and perhaps has an emergency where those records could be important for someone to have access to urgently.

Because it is the right thing to do.

But I think this is easier said than done.

With the large number of hospital mergers and acquisitions this decade and those systems now merging with other large systems to form even larger systems, within an “integrated health care delivery system”, this still remains a problem. Growth is a challenge and while those systems will eventually share information system platforms and applications across their systems I am not confident they would want to share it with others.

The average patient can’t fathom why the sharing of electronic medical records is so hard. But those inside healthcare aren’t thrilled either with the state of electronic record interoperability either, but I think we have put up these barriers, largely financial, for a reason and to keep talking about interoperability as a goal we all want is not realistic.

Fee-for-service medicine doesn’t provide the incentive for sharing information. Accountable care and integrated care models have native incentives for having complete information and sharing that only amongst themselves.

We should just stop talking about interoperability because it should but will not happen.