Recent months have seen a number of initiatives intended to advance interoperability in healthcare. Some see these moves as being -- at best-- baby steps toward solving the system's connectivity challenges, while others say they continue to push the industry down a misguided path.
A group of vendors made a splash at the HIMSS 2013 conference in March when they announced the CommonWell Health Alliance, a collaboration among those involved to make records more interoperable. The Office of the National Coordinator for Health IT also continued its efforts to support interoperability advances when it announced the funding of two data standardization and exchange programs.
I think we are at a moment in time when our industry has a lot of legacy systems that are holding back the kind of care we want to see.
Robert Greenes, M.D.,
chair, Department of Biomedical Informatics at Arizona State University
But Ali Modaressi, director of electronic health record technology at HITEC-LA, said in a session at the HealthTech Council meeting in Chicago that all these initiatives simply try to connect various pieces of the existing health system. Because the healthcare system is so fragmented, building on top of that vastly disconnected system will slow progress.
Part of the problem, Modaressi said, is that IT vendors have no business incentive for making data more portable. Until federal- and state-level payment models incentivize data sharing at the provider level, vendors will have little reason to make their systems more interoperable.
"I think interoperability is happening, but it's very slow. It's frustrating. It's like herding cats," Modaressi said.
It could take several years to get to a point where EHRs and other electronic systems are capable of producing truly standardized data. Modaressi talked about how the Health Insurance Portability and Accountability Act required certain providers to start transmitting some types of claims information using the Electronic Data Interchange standards. However, it took about 15 years for this data set to become standardized. By comparison, EHR data is even more complex.
Robert Greenes, M.D., chair of the Department of Biomedical Informatics at Arizona State University, said during a separate session at the conference that he feels a new approach to interoperability in healthcare is what's needed. Existing efforts to make it easier for enterprise EHR systems to connect will fail to deliver the results the industry needs.
Currently, health information exchange initiatives help, but they don't deliver the kind of interoperability required to foster the use of information at the point of care. Greenes said they typically function by sending a new standardized document from one provider to another. This adds to the process of sending data between doctors rather than simplifying it. Things would be easier if the data was already recorded and stored in standardized forms.
Greenes said he prefers the development of an application-based framework in which providers are able to choose smaller programs designed for specific tasks that would run on more general platforms. The model would be similar to apps downloaded to a smartphone.
"I think we are at a moment in time when our industry has a lot of legacy systems that are holding back the kind of care we want to see," Greenes said. "The vendors aren't necessarily being obstinate, but like providers, they are up to their ears in satisfying meaningful use."
This idea is gaining traction. Greenes said some of the larger integrated care providers like Kaiser and the Mayo Clinic are looking at the potential benefits of an app-based framework. Additionally, Harvard School of Medicine and Boston Children's Hospital researchers Isaac Kohane, M.D. and Kenneth Mandl, M.D. have advocated an app-based approach. They said it would make it easier for individual developers, of which there are thousands, to create innovative solutions at a faster pace than the hundreds of developers employed by EHR vendors.