An new report from the National Academy of Medicine charges that barriers to progress in healthcare interoperability are not technical, but "in the failure of organizational demand and purchasing requirements."
Players on all rungs of the industry must commit to interoperability as a primary priority, identify goals, collaborate with stakeholders to align contracting specifications, specify clear functional interoperability stipulations in current and future proposals and purchases and assess the progress of measures and improvement of health outcomes.
The 191-page document, collated by NAM in partnership with the Gordon and Betty Moore Foundation, notes challenges like a lack of consensus across systems, the tenuous path to implementation and the lack of consistency across tech suppliers and organizations, along with rampant data blocking and hoarding limiting the free flow of information across the healthcare datasphere.
The report comes amid frustrations at the poor state of interoperability and that the government is dragging its feet and not offering much help. "Connected care is the goal; disconnected care is the reality," the authors write in a pretty accurate summation of interoperability in American healthcare today.
Despite the exponential growth of EHRs over the roughly two decades, (in 2016 the digital records could be found in more than 95% of hospitals) unfettered interoperability remains out of reach for most healthcare organizations. That lack trickles down to patients as well. Bad interoperability results in wasted time and money, inefficiency and doctor burnout, all of which harms quality of care.
The report's authors argue that players on all levels of the healthcare ecosystem have a role to play in fostering a "person-centric, high-value, and continuously learning" health system. Progress is particularly needed, though, at the point-of-care level "where the lack of plug-and-play interoperability" remains a fundamental barrier to quality of patient care.
The report also notes fixing data siloing and oiling the free flow of information will require a fundamental shift in how systems approach interoperability. It needs to be thought of as a core requirement, not a lofty goal.
"Part of the reason we are having problems with interoperability is that we have defined it too narrowly — in a very provider-centric way for a long time," Don Rucker, head of the Office of National Coordinator for Health IT, said at a stakeholder panel convened by NAM. "We need to think about interoperability in a much broader way … on a population level."
The report recommends businesses create an interoperability steering group to organize the long-term implementation of open health IT systems and outline and track their specific needs. It also calls for the creation of a vendor-neutral interoperability platform architecture that is "modular, scalable, services based, and secure."