How would I characterize the state of health information technology (HIT) interoperability? We can measure progress by the kinds of complaints people make about it.
Five years ago, with the passage of HITECH Act, we complained that not enough providers had adopted EHRs. Three years ago, we complained that we didn’t have sufficient interoperability. Now we complain that the user experience for interoperability out of the box isn’t good enough.
It is worthwhile to take a step back and survey the landscape.
We’ve made a lot of progress in automating certain kinds of clinical transactions in EHR workflow. These transactions include electronic prescribing as well as delivery of lab results, discharge summaries or text-based radiology reports. These capabilities are on a trajectory to match what we’ve done in this country relative to financial administrative transactions. And the volume of these transactions is huge: McKesson alone performs more than a billion such transactions a year on behalf of the providers we serve.
Given that progress, why do so many people seem to think that interoperability is insufficient? Because three jobs aren’t getting done right now. First, cross EHR, out-of-the-box access to patient records is hard. Second, we have huge variation in terms of how well EHRs can receive patient information, incorporate data and deliver elegant clinical workflows. And third, we don’t have true person-centered interoperability — where providers can provide optimal care and population health across settings regardless of where episodes of care were performed and regardless of the health information technology used in those episodes of care.
So what’s the state of the nation in driving towards true person-centered interoperability? We at McKesson have made some significant progress:
- We power more than 150 health system-led health information exchanges. These provide an integrated person-centered longitudinal record serving the patient, providers and population health.
- We’ve been founding members and the service provider to the CommonWell Health Alliance. We deliver patient identity and linking services as well as document locator and retrieval services. These services make health data available to individuals and providers regardless of where care occurs.
- We are sponsors and founding members of the just-announced Argonaut Project, which focuses on accelerating the development of the necessary standards and data services needed for HIT interoperability.
Based on this progress, where do I think the industry should focus in order to achieve our vision of interoperability?
First, we need overall industry agreement, across the private and public sectors, across providers and vendors, that health information should be centered around the patient and not around the specific EHR system used at specific settings of care. Health system CEOs should think “How I can ensure a healthy population?” rather than “How can I keep this patient data mine?”
Second, we need more use of open APIs to support full vendor neutrality. An API is an “application program interface.” It’s a set of rules you use to build a software program that runs on a specific piece of hardware. Some APIs are proprietary, meaning you use them to build specific software programs that run only on specific pieces of hardware. Imagine having a smartphone that only connects to one app developer. Your phone would not be so smart.
By switching to public APIs for HIT software, the rules to extend the HIT would be open and common to all, meaning apps built following those open and common rules could run on any compatible system. That approach would be similar to downloading and using an application on any smartphone or tablet. Healthcare providers would have a general purpose EHR system with some basic functionality, but they could expand that functionality by adding applications that were built using the same open and common APIs regardless of vendor.
Last, we need to accelerate access to vendor-neutral nationwide patient linking and record location built into the HIT products and services that providers use on a daily basis. Because patient care is not limited by EHR vendor, only looking up patients on a point-to-point basis will not get up to person-centric interoperability.
The road to health IT interoperability is widening with new lanes opening up all the time. The question is not whether we’ll get there, but when we’ll get there. In its report, Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap (PDF, 2.6 MB), HHS’ Office of the National Coordinator for Health Information Technology proposed that by the end of 2017 most patients and providers should be able to “…send, receive, find and use a common set of electronic clinical information at the nationwide level” across the continuum of care. And should we activate on the three areas I mentioned above, it will be sooner than you think. we could get there sooner than you think. That will be great news for health system and hospital CEOs whose organization’s strategic future depends on it.