ONC12 speakers address interoperability challenges

The Office of the National Coordinator of Health IT (ONC) recently held its 2012 annual meeting. While much of the day was spent celebrating health IT achievements, the speakers also addressed the ongoing challenges.

Further pushing on Meaningful Use (MU) needs to happen “not at some mystical point in the future but right now. Meaningful Use is great but without interoperability you are not creating the comprehensive promise” we’ve all been assured of, said Sen. Mark Warner (R-Ga.).

The HITECH Act, part of the federal stimulus plan, was initially thought to include about $27 billion in health IT but now ticks north of $30 billion. “That’s some serious dough,” said Warner. “Here we are four years after stimulus and while progress has been made, we need to put our foot on the accelerator even more. We recognize that it requires all of us to get into our discomfort zone if we’re going to get this done.”

A self-described “telecomm guy,” Warner said there are lessons healthcare can learn from the telecommunications industry. “Back in the 1980s, projections were that at the end of 35 years, 1 percent of Americans would have cell phones. Thirty years in, there are north of 300 million phones in the U.S. and over 6 billion in the world. That explosion took place because before we built out all of the cool apps, the FCC [Federal Communications Comission] set very strict standards for interoperability so that all systems developed could talk to each other.”

Warner discussed four challenges to interoperability:

1. The enormous number of legacy systems.
2. HIPAA requirements, “while terribly important, make this exchange of information more difficult because of appropriate privacy concerns.”
3. “Even if we can get around the HIPAA challenges, we have an enormous lack of economic incentives for those who are currently collecting data to share it.”
4. The rapid changes in medical technology and procedures and the associated complexity in billing.

Many industries make their money not on the actual product, but on the associated accessories and billing, Warner said, including for such products as cell phones and credit cards. "This practice is exponentially more challenging in a field like healthcare, he said. That is yet another challenge "to having a truly robust, interoperable system."

“I absolutely believe that interoperability has to be the standard,” Warner said. “We’re $10 billion into this $30 billion investment. It’s easier to get Republicans and Democrats to agree than it is to get software engineers to agree on a common system. Someone has to say perfect is the enemy of the good and this is the standard.”

Just before the meeting, John D. Halamka, MD, health IT guru and CIO of Beth Israel Deaconess Medical Center in Boston, blogged that interoperability will dramatically increase by 2014. That's due to MU Stage 2 providing the technology, policy and incentives to make interoperability real, he wrote on his blog, Life as a Healthcare CIO.

He wrote that he looks forward to a future where no patients will have to face paper-based, uncoordinated care. "With certified technology, standards and incentives to share data among providers and patients, 2013-2014 will usher in a new era of interoperability."

Do you agree that we will soon enter a new era of interoperability? Please share your thoughts.

Beth Walsh, editor

Clinical Innovation + Technology

bwalsh@trimedmedia.com