Why Interoperability Initiatives are Accelerating

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Industry efforts to achieve interoperability have exploded in recent weeks, as several initiatives are working toward ways to advance the exchange of healthcare information.

Most recently, HL7 convened a strategy meeting in Chicago to bring together stakeholders to discuss gaps in interoperability efforts and ways to bridge those gaps. Earlier in October, a dozen major vendors of electronic health records systems agreed to a set of interoperability metrics in order to measure their progress. Other interoperability initiatives have been announced recently, some of them pairing diverse industry stakeholders.

One of those leading the charge is Micky Tripathi, presdent and CEO of the Massachusetts eHealth Collaborative. Tripathi and three other industry experts helped to craft the standard interoperability measurement tool that will be used to gauge EHR vendor progress toward interoperability, and he led and moderated a recent KLAS Keystone Summit on how to measure interoperability and ongoing reporting.

Tripathi this week answered questions on the burst in activity in the healthcare industry toward achieving interoperability.

What is causing this dramatic spike in widespread interoperability initiatives? Are they all working on the same problem, or different facets of the same problem?

This is just a reflection of market maturity.  EHRs are now in place for most providers.  You couldn’t even seriously talk about interoperability before this.  But now that EHR use is above 90 percent for hospitals and more than 70 percent for ambulatory physicians, they are ready to now tackle interoperability, and they’re getting an added boost from rapid growth in so-called advanced payment models (ACO, PCMH and others), which create pretty strong motivation to be interoperable. 

The healthcare industry is very fragmented and much more complicated than other sectors, though, so it takes a lot more collaboration to get anything standardized in healthcare than it does in almost any other industry. 

These initiatives that are starting to spring up reflect growing market-based, bottom-up demand for interoperability.  The fact that there are many of them just reflects that healthcare is very diverse and fragmented, and different collaborations of stakeholders are trying to figure out how to best generate momentum for industry-wide solutions.  This is the market finally starting to work its magic to improve healthcare.

Do you view these separate announcements and initiatives positively? Are they working toward the same purpose, or is there a need for further collaboration between these efforts?

Yes, I view them very positively!  All maturing markets have a period of restless jockeying for momentum among different coalitions and groups before they settle into industry-wide conventions and standards, and health information technology is no different.  We need this experimentation to allow the market to figure it out. 

The government will almost certainly get this wrong if it intervenes in a heavy-handed way.  The market is moving quickly to solve interoperability problems, and as difficult as it is sometimes, we have to be patient.  Smartphones and app stores and email and the Internet didn’t happen overnight – we just weren’t paying attention when they went through their chaotic phases.  The reality is that it’s been only a few years since we’ve really been in a position to have meaningful interoperability.  Pretending otherwise is like complaining that we didn’t have mobile banking before we had cell phones.

What is compelling these recent efforts? Is it just the common perception that something needs to happen, or are industry participants feeling time pressure to make something happen in the next few months?

Demand for interoperability from providers is what’s driving this. This comes from:

* Rapid acceleration of accountable care (CMS will have moved 80 percent of its payments to these types of outcome-based structures by 2019).

* A growing feeling among clinicians that team-based care and interoperability are fundamental to a basic standard of care.

* Generational change in physicians who have higher expectations and better technology understanding than their elder professionals.

* Growing political pressure from the executive and legislative branches.

* And finally, higher expectations from patients who are experiencing cost-shifting to out-of-pocket payments and comparisons with the service levels that they are used to in other retail industries.

The history of markets, and especially network economies like we’re talking about here, goes through an initial chaotic period where you have many players and approaches, and they’re all battling it out to become a market leader. Inevitably, a shakeout occurs, and the relatively few players left standing find that it is in their interest to cooperate in certain areas.

This is how phone networks developed (in 1910, there were over 1,000 independent telephone networks in the U.S.) and how ATM networks cooperated to create global interoperability.  We’re now entering that phase in healthcare IT, and if it follows the pattern that we’ve seen in every other industry, these seemingly disparate efforts will rapidly snowball and build momentum fast.

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