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Expert Commentary: Interoperability

The interoperability hang-up H

When it comes to information exchange, how should precedew should precede what. By John Kelley

ealth information technology (HIT) has always held the promise of reducing costs and medical errors, improving effi and enabling better patient care. However

20 billion ingful nd es to

(HIT) has ucing costs effi ciencies However, in

2011 physicians and other healthcare professionals haveionals have even more reason to adopt HIT: The nearly $20 billion in federal incentives for demonstrating meaningful use. Providers responsible for selecting and implementing HIT to qualify for incentives should make educated decisions and be sure to select technology that meets their needs today and well into the future. For those of you having a need to exchange health information outside your own organization’s four walls, it is important to not only be aware of interoperability, but to fully understand the concept and what it means for effec- tive information exchange.

day ving tside ortant o fully r effec-

While interoperability has long been an industry buzz word, true interoperability, which allows for broad and seamless sharing of patient information between HIT systems, has yet to be achieved. This is because the in- dustry has allowed itself to prematurely get embroiled in lengthy debates about what information should be exchanged (let’s call this “content interoperability”) before we have even resolved the issue of how that information gets exchanged (let’s call this “transport interoperability”). This has delayed content innovation, and has left us with a better-than-nothing approach to content sharing. The industry needs to agree on transport interoperability in order to expedite the much more critical content interoperability discussion.

ustry buzz broad and

ween HIT use the in- embroiled should be

to be spending an inordinate amount of time discussing the data, when we don’t yet have a suitable, effective way to get it back and forth to one another.

to be spending an inordinate amount of time discussing the data, when we don’t yet have a suitable, effective way to get it back and forth to one another

Resolve transport discussion, innovate on content If the healthcare industry can agree on a standard way to move patient data from system to system, the conversation can then turn toward developing platforms that enable exchange of comprehensive health informa- tion between organizations, applications and systems, regardless of the content size, type and format. Consider this analogy: Fed Ex delivery personnel just look at the outside of packages and get them to their destinations; personnel don’t care what’s inside the packages. Similarly, we in the healthcare industry should fi rst be concerned with the logistics of shipping patient information before we delve too deeply into the content of the package and what to do with it. Today, we seem

32 February 2011

To look at another analogy: It seems as though we are trying to invent e-mail attachments before we even have e-mail communications. Early platforms for e-mail were created so two parties could send simple text back and forth. Now, people throughout the world can send attachments, MP3s, pictures and video via e-mail to anyone in a matter of seconds. The healthcare industry is building the attachments (i.e., EMRs, PHRs, clinical alerts, etc.) before we have set up a good mechanism, network or platform for transporting them.

Content-oriented debates have included: Who should own the content? Who should store the content? What kind of content should be shared? What kind of security should be wrapped around the content? We pay a high price for this often fruitless debate. Today, there is no consensus as to the best transport method. One reason may be because many vendors are more concerned about fi guring out ways to collect tolls on the transportation of patient information, which can tend to shut down innovation on the content side. The end result is that content value is lacking, pro- viders don’t have easy access to all the patient informa- tion that exists and quality of care suffers.


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