Interoperability is the key to innovation. So what's the delay?

Interoperability—the extent to which two or more systems can exchange and interpret information—is mission-critical for the health care industry, yet solutions are frustratingly beyond reach.

Speaking with the Daily Briefing's Dan Diamond, Crimson CEO Glenn Tobin explains what must be done to tap into the information technology revolution that has transformed other industries to solve some of health care's thorniest problems.

Q: These days, the health care industry has a lot on its plate. Where does interoperability fall as a burning issue?

Tobin: It's high on the list, and in the process of going higher.

Thirty percent of health care spending is wasted on costly, redundant, and ineffective care because today's systems cannot provide a complete view of the individual. Often by definition, today's patients are being cared for in different places. They switch hospitals, payors, health systems, and doctors, but their data cannot readily follow them across care settings.

I'd encourage your readers to see the JASON report recently posted by HHS. Karen DeSalvo, who leads the Office of the National Coordinator for Health IT, shared a link to it a few weeks ago.

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And interoperability is not only a problem between different IT vendors—just because two organizations use the same vendor doesn't mean their systems can talk to each other.  The contents of the electronic health care records (EHRs) have to be able to be sent, understood, and processed with their meanings intact, which is complicated by the fact that medical terminologies are not standardized.

At the same time, lots of information in health care involves a narrative; there's a patient story. That's hard to reduce to a discrete set of data that can be passed back and forth.

Q: Why didn't we see this problem coming?

Tobin: Remember that 10 years ago, most records in health care were on paper. Automating the transactions within a single hospital or doctor’s office was a huge task. In 2008, the federal government provided a huge amount of funding to speed up rollout of EHRs. Unfortunately, in 2008, most of the current issues of interoperability were not yet visible to the policy community.  Strong requirements that would have required a more interoperable system were not made front and center. 

I also think that in 2008, the provider community did not have a strong vision of required interoperability, so they were not able to force the vendors to a common set of standards. But of great interest to us at this stage—will a strong community of health systems emerge who will demand a higher standard? Is there any organization that can convene the “EHR Users Association” to ensure interoperability becomes a mandatory and non-negotiable aspect of future technology development?

Q: Why is there urgency today?

Tobin: Entering the world of population health has really brought this issue to a head. To truly understand what drives better health outcomes you have to look across different data sources to assemble a full view of the patient. This is something the healthcare industry has not been confronted with before—providers were reimbursed based on services they provided rather than being paid for performance or for outcomes.

And the insights they need to drive outcomes are very difficult to generate. We are working with health care providers across the country who are trying to access the information from a variety of systems and are frustrated with how difficult it is.

A simple example makes the poignant point: Today, it's almost impossible to know why sick people fall through the cracks and are not receiving the best care; they just disappear and come back later as very, very expensive.

Right now, we think it’s about ten times or one hundred times more expensive than it should be to connect data across systems. And thus the cost of generating these really great, aggregate-level insights of patient populations is too high.  

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Q: And yet, this hasn't proven to be a problem in other data-rich industries. Are there parallels here?

Tobin: Health care is unique in a couple ways. The main one is the people who are doing the paying are not the people who are getting the service, which creates issues from a traditional market view. You also have government funding of EHR vendors through the stimulus program. There's not another industry like this in terms of this weird mix of who pays, who gets the service, and government funding.

But despite the differences, there are many ways we can reap the benefit of approaches in other industries. At the Advisory Board, we are making real progress in a number of important areas. And we are hopeful that federal policy will shift to make “data liquidity” a more universal right within the system.   

So if someone in their garage can create a unique algorithm for understanding something in health care, we want it to be an order of magnitude cheaper and inherently possible to incorporate those new solutions into the legacy EHR workflows.

Q: It seems like barriers to free data exchange are not only impeding interoperability, but innovation as well. 

Tobin: Exactly. I believe that huge innovation can be unleashed if entrepreneurs can access data more cheaply, and have more secure and certain methods to get information back into EHR workflows.   No EHR vendor should be able to block that flow—it is about the health of real people. 

Let's say you were able to get information out and create these novel insights about a certain population or condition. Today, you could store those insights in a database and if somebody would happen to open the database they would see your insights. The other thing you could do is get that same insight to a nurse on duty who then knows to do something different and makes a difference in the life of a patient. The value delivered by the latter approach is huge; by the former—modest.

These are very different pathways in terms of how a health IT system needs to work. You can't have mass innovation until innovators can get their insights into the care process in the moment and for the right clinician. What we should be trying to do is free this up because right now, we're stuck.



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