The Office of the National Coordinator for Health Information Technology (ONC) just released what it calls “A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure.” The directive generating the most attention calls for “a common set of electronic clinical information…at the nationwide level by the end of 2017.” According to ONC, the common data set would consist of about 20 basic elements, such as patient demographics and lab test results.
At first blush, the ONC directive is a small step in the right direction, but sets the bar awfully low. Rest assured that vendors will consider 20 basic elements the maximum data set, not the minimum. A more effective approach would, for example, specify vocabularies (LOINC, RxNORM), document types (JSON, XML) and transport mechanisms (HTTPS or other TLS) to be used when sending or receiving data instead of focusing on the data elements themselves.
The much larger problem is continuing to allow vendors to act as the proverbial fox guarding the henhouse. Vendors simply cannot be trusted to form coalitions or standards consortiums, which offer just enough data crumbs to claim interoperability, when the rich insights that caregivers and consumers need to access across multiple disparate systems are still buried in their silos. The next time an HIT vendor comes to you waving the flag of interoperability, ask them if that includes being interoperable with their own proprietary database or data source. If the answer is yes, be afraid. Be very afraid.
In fact, interoperability capabilities exist right now that go far beyond what the ONC is discussing. Clinicians can have anywhere, anytime live access to rich insights across multiple different data systems in a single workflow regardless of their location or that of their patient. How do I know? It is my business. I help clients achieve interoperability every single day. And the reality is that for years, leaders in mHealth have rolled up their sleeves to solve the issues that the ONC announcement is now touching on: leveraging existing infrastructure; empowering individuals via custom workflows; focusing on value, simplicity, modularity, privacy and security.
Yet health systems’ increasing will must be matched with appropriate incentives to insist that their vendors do what is right. True interoperability is ready now. Why aren’t we collectively forcing the issue? For starters, too many providers – my clients among them – suffer from a form of HIT vendor Stockholm syndrome. They are worn down into submission, cold and scared in a corner, whimpering, “Will my vendor let me do that with my data?”
The answer should be an emphatic YES – because it is their data. A united coalition, standing together, can drive this change. But this coalition must consist of those who are being punished for HIT vendors’ failures. Consumers, employers, payers, health systems and governments must align on the intended outcomes and methodologies far beyond the discrete data-element definitions of what is considered interoperability. Otherwise, we will wind up with a new round of lowest-common-denominator approaches that don’t live up to their promise like so many HIE initiatives.
The best we can hope for is that the ONC proclamation will finally spur an era of “Meaningful Interoperability” that changes the culture and develops real financial incentives for doing the right thing on behalf of consumers, caregivers, health systems and society at large. Focusing on standards alone is not enough. And, given the ONC’s overall HIT strategic vision, we can only hope the era of “Meaningful Mobility” emerges as well to help interoperability take flight and prompt a truly seismic shift in how we care for others.