One of the current and core issues of the Healthcare Technology field is the goal of making interoperability a standard practice.

Interoperability is an idea that is fundamental to HASA and other HIE’s. It is supported by our collaborators, stakeholders, and data contributors, and affects everyone from administrators to physicians to patients.

What is Interoperability? In a general sense, it is the design of different systems to work together- much like our HIMSS 2018 Community Booth, which includes different sectors of healthcare technology working together!

In healthcare, interoperability specifically describes the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and later present that data such that it can be understood by a user.

In a world where you can use your phone to easily check your bank account, finish your taxes, and have groceries delivered to your door it’s hard to rationalize why many hospitals and clinics are still using faxes to delivered vital information to each other.

It’s easy to embrace the idea of exchanging health information electronically so that practices can ditch the use of faxes and phone calls to gather information, but what is the hold up?

I decided to ask the industry experts from our HIMSS 2108 Community Booth their opinions on the matter.

What is the most promising emerging technology or most significant barrier for the future of interoperability, and where do you see the future of HIE/Interoperability going?

Nance Shatzkin, CEO Shatzkin Systems

“Everyone who provides healthcare is a partner to health information exchange and interoperability.  [What are] ‘Critical’ changes with each implementation, and is dependent on the use case.  Some HIEs have focused on the hospitals in a geographic area and have not included the ambulatory and/or long term care services.  This approach can be successful, and, hospitals are critical, but the value increases with more partners.  And, further value is achieved if users can be confident that all their partners are included.

There is no question that interoperability will continue to grow and expand, and to become an integral layer of healthcare operations.  Several use cases, including alerts on hospital and ED admissions, have established themselves and clinicians would not want to see them go away.  The challenge in getting there is to allocate the costs.  Providers want the convenience and improved communication but don’t feel they have the margins to pay for it.  Centralized HIE hubs require substantial financial commitment.  It is not clear to me who is going to bear that cost over the long run.  States like NY have provided considerable start-up money and are now challenging their HIEs to find other means to establish sustainability.  While the “coop” model that funds the HIE with fees from each of the participating organizations is appealing, it is difficult to sustain.  Payers and patients are the major beneficiaries.  It is my hope that a tax on payers will provide ongoing funding.”

Doug Hill, COO of Rosetta Health:

“Interoperability needs to continue to grow and expand to improve patient care and drive healthcare costs down. Part of the near term road map is in place as CMS shifts payments from fee for service to value based payments. This shift will result in payers seeking acquiring clinical data and sharing it back to the community to improve care across populations. This will push the current standards to adapt to the needs of payers as well bring new standards/protocols into the current fabric of clinical interoperability.  Additionally, as Nance Shatzkin points out, HIEs are likely to evolve to encompass more of their community.

The exciting aspect for RosettaHealth is this is exactly what we focus on. Specifically,

  • Building a highly scalable and reliable platform that easily adds bandwidth capacity to handle this growth
  • Rapidly make client connections (hours –vs- weeks/months), enabling them to adapt to additions to their community
  • Track and deploy new standards/protocols in advance of client needs

We are very much looking forward to being part of the future of HIE/Interoperability. We think we have a lot to offer and our customers are continually validating this."

Jared Blake, Partner at SocialClime

“I think the most significant issues [to interoperability] really are the widespread adoption of so many systems. While there are standards, there are so many different systems and processes that there isn't ever just one way to get something done. That is good and bad, but definitely always adds a layer of complexity.”

Phil Beckett, CTO of HASA

“I struggle slightly with this because, I don't think technology is the limiting factor today in information exchange. I look at other industries like finance, energy, and retail and you can see what interoperability technology we have today can do. Telecom is seamless - you can dial any number anywhere in the world, all on different technologies, different vendors, invisible to the user.

Top of mind for me is security. Breaches are daily events in our world and certainly a barrier to open an exchange between appropriate partners. Medical records are worth a lot of money on the dark web. Blockchain is a fascinating opportunity to help in this arena and I hope we see it, or equivalent, layered on top of interoperability to ensure it is iron clad and to the best of all our capabilities, un-hackable.

If it made good business sense we'd all be connected today, just like the banks are. The value use cases for interoperability in healthcare are much more nuanced, complex, delicate, and ephemeral. If it is at all difficult to use then a busy clinician will not use it, even if it has the potential to be helpful, sometimes. The CFO will look at the cost, ask the physicians how much they [will] use it, if they say "little", it faces an uphill struggle. We have to use smart workflows and make it super easy for the health care provider to get the information they need without hunting and rabbit trails. I believe if we can reduce the friction to accessing the right information, and I mean that in multiple ways based on clinical and business need, then the value will overwhelm the costs and this will seem so natural we will wonder how and why we ever did without interoperability."