Today I had a really interesting chat about healthcare interoperability with Mario Hyland, Founder of AEGIS. I’m looking at a number of ways that Mario and I can work together to move healthcare interoperability forward. We’ll probably start with a video hangout with Mario and then expand from there.
Until then, I was struck by something Mario said in our conversation: “Healthcare interoperability is not a point in time. You can be interoperable today and then not be tomorrow.”
This really resonated with me and no doubt resonates with doctors and hospitals who have an interface with some other medical organization. You know how easy it is for your interface to break. It’s never intentional, but these software are so large and complex that someone will make a change and not realize the impact that change will have across all your connections. As I wrote on Hospital EMR and EHR, API’s are Hard!
Currently we don’t even have a bunch of complex APIs with hundreds of companies connecting to the EHR. We’re lucky if an EHR has a lab interface, ePrescribing, maybe a radiology interface, and maybe a connection to a local hospital. Now imagine the issues that crop up when you’re connecting to hundreds of companies and systems. Mario was right when he told me, “Healthcare thinks we’re dealing with the complex challenges of healthcare interoperability. Healthcare doesn’t know the interoperability challenges that still wait for them and they’re so much more complex than what we’re dealing with today.”
I don’t want to say this as discouragement, but it should encourage us to be really thoughtful about how we handle healthcare interoperability so it can scale up. The title of this post asks a tough question that isn’t being solved by our current one time approach to certification. How do we achieve continuous healthcare interoperability that won’t break on the next upgrade cycle?
I asked Mario why the current EHR certification process hasn’t been able to solve this problem and he said that current EHR certification is more of a one time visual inspection of interoperability. Unfortunately it doesn’t include a single testing platform that really tests an EHR against a specific interoperability standard, let alone ongoing tests to make sure that any changes to the EHR don’t affect future interoperability.
I’ve long chewed on why it is that we can have a “standard” for interoperability, but unfortunately that doesn’t mean that EHR systems can actually interoperate. I’ve heard people tell me that there are flavors of the standard and each organization has a different flavor. I’ve seen this, but what I’ve found is that there are different interpretations of the same standard. When you dig into the details of any standard, you can see how it’s easy for an organization to interpret a standard multiple ways.