Cutting through the hype to find practical approaches to interoperability

June 20, 2019 4:21 pm

The healthcare industry has a hype problem. We tend to fixate on rising technology — the hot new silver bullet — and idealize its potential to solve longstanding challenges. Today we’re focused on the promise of artificial intelligence and blockchain. Tomorrow the bandwagon might revolve around something entirely different.

Interoperability is an excellent example of healthcare’s hype-machine mentality. The industry is constantly preoccupied with new initiatives and technology that will “solve the interoperability problem.”

Consider FHIR, or Fast Healthcare Interoperability Resources. This new standard from HL7 already has been breaking barriers to real-time data connectivity. FHIR offers speed, efficiency and security and will be applicable under a wide range of circumstances relating to data and information sharing. However, the notion that one standard can address interoperability challenges for an entire industry is unrealistic.

This is not to say we should not adopt new and emergent technologies. But it takes time to see real results and benefits. In the meantime, we should continue to address present challenges with the tools at our disposal. For many use cases, for example, old-school standards like HL7 V2 or DICOM would be optimal choices.

Two issues with the ‘silver bullet’ approach

As it relates to interoperability within healthcare, there are two major problems with the silver-bullet mentality. First, we are focusing on hype rather than substance. In the case of FHIR, the industry has positioned this solution as an extensible application programming interface and web-friendly standard that will handle high-bandwidth and high-availability use cases effectively.

Realistically, however, FHIR is not yet the best solution for integrating HIPAA transactions from multiple billing systems for transmission to a clearinghouse. We need to get beyond the hype to understand the true nature of the standard and its capabilities if we are going to use it effectively. Transitioning from one standard to another is more of a multiyear process than an instant transformation.

The second big problem with the silver-bullet mentality is that it belies the true nature of the interoperability challenge. Issues with data integration and connectivity cannot be solved by transitioning the entire industry over to a single technology or standard. Incompatibility in terms of organizational behavior is far more pervasive and introduces more subtle obstacles to interoperability.

Existing tools can reduce the task of mapping analogous fields among electronic health records to just a few minutes. However, if Organization A puts the diagnosis in an ICD-9 field and Organization B puts it in the notes field, all of the field mapping and natural-language processing in the world is not going to solve the problem. The same goes if one oncologist puts the cancer stage in a discrete field but another believes that capturing tumor size and growth rate is the best way to characterize a specific cancer diagnosis.

The way forward: Making the most of the tools we have

Hospitals and healthcare organizations should focus less on shiny new toys and technology and instead give greater consideration to individual behavior and the divergent ways in which administrators and physicians in different organizations — and sometimes even different departments within an organization — make use of these tools.

Implementation of universal training standards across systems, states, medical societies and other leadership entities throughout the industry can resolve these challenges and allow new technologies and tools, like FHIR, to do their jobs. As much as technology, the industry needs integration profiles that describe specific data elements, permissions and workflows, tailored to the specific needs of each role across the continuum of care.

The fixation on new technology is only slowing down the process of addressing interoperability once and for all. Interoperability is here. The industry should stop with the distractions and 1) focus on utilizing the technology that is readily available; and 2) implement universal integration profiles so that organizations can more effectively leverage the available technologies and standards.


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