by Harry Greenspun, MD, Senior Advisor for Health Care Transformation & Technology, Deloitte Center for Health Solutions, Deloitte LLP
My wife, Kerry, and I were having dinner with her sister, Patricia, now 25 weeks pregnant. Looking radiant, she’s doing everything she can to stay healthy. Knowing that Kerry and I are deeply involved in health care and information technology (IT), she asked a seemingly simple question: “What’s the best way for me to track health information for me and my baby?”
Based on the look in my wife’s eyes, I could see we had both immediately grasped the frustrating complexity of her situation: during her pregnancy, she had switched obstetric (OB) practices. While she has received care in the OB offices, she will deliver in a hospital. Her baby will be examined there initially, and then subsequently seen in a different pediatrician’s office. Just to add another twist, she and her husband are both very health conscious and monitor their exercise and diet with a variety of gadgets and mobile tools.
In short, Patricia was asking about how to achieve interoperability among a personal health record, four different electronic health records (EHR)—assuming all providers had implemented them, an independent ultrasound clinic, several external laboratories, mobile health apps, online registries and personal tracking devices.
The need for interoperability extends far beyond people like Patricia. Health care organizations are struggling to connect their myriad of information systems and medical devices together, allow data to flow and provide comprehensive information to those who need it. It’s popular to suggest that this data is trapped in a silo. However, if you drive along many country roads, it’s quickly apparent that silos are huge and hold a tremendous volume of grain. Rather than siloes of data, in health care we have created vast collections of cereal bowls, each holding just a small serving of data. This fragmentation and isolation serves as major barrier to transforming and improving health care.
Health IT advocates routinely invoke successes of other industries to help solve their interoperability challenges. Few conference speeches are complete without a comparison to banking, retail or travel. The outrage of, “I can go anywhere in the world and use my ATM card to access my financial information, yet I can’t get my medication list at my local pharmacy!” has become so commonplace, it could be the basis for an exhibitor giveaway competition at HIMSS. Thus, I was excited to moderate a panel for Health Care Innovation Day in Washington, D.C co-sponsored by the Office of the National Coordinator for Health IT and the West Health Institute. The panelists contemplated what we can learn from other industries, bringing together actual health care “outsiders” to learn how they had dealt with interoperability challenges.
We heard Dr. Bill Check, Senior Vice President, Science & Technology and Chief Technology Officer of the National Cable & Telecommunications Association (NCTA), describe how the cable industry pooled resources across the entire sector to create a common standard, now known as Data Over Cable Service Interface Specification (DOCSIS), rather than creating company-specific programs. Steve Katz, Founder and Owner of Security Risk Solutions LLC, brought a wealth of experience from the financial services industry, where interoperability challenges had to be addressed in the 1850s to serve customer needs. Back in the days where checks were just handwritten pieces of paper, banks came to realize they needed to know which bank to send checks to—an important step to help prevent fraud. As a result, in the 19th century, The Clearing House was formed to “clear checks.” In the early 1900s, the Federal Reserve created the routing codes we all have at the bottom of our checks. As he stated, “interoperability was a result of organizational drive to access and take care of…customers regardless of where they are.”
Finally, Sid Fuchs, President and Chief Executive Officer, MacAulay-Brown, Inc., brought a fascinating perspective from his experiences across the intelligence community (including his work as a CIA officer). For him, the key issues revolved around people: “It’s not technology that keeps us from sharing information. Technology is the easy part. What is hard is the culture and governance.”
A common thread for achieving interoperability was overcoming the false sense of security that the more you own and the less you share, the more powerful you are. This required making interoperability a priority, creating an enabling leadership environment and fostering organizational cultural change.
- Hear the voice of the customer: the interoperability discussion is often dominated by vendors. While well-intentioned, the focus often falls on how their individual products can serve as a central aggregator of information, rather than facilitating free flow. Hospitals, providers, patients and other stakeholders need to make their needs clear and then make them explicit in their RFPs and purchasing. Until these groups get their advocacy organized and set the interoperability agenda, we will likely continue to face challenges in sharing data.
- Create a culture of data-sharing: stakeholders across the industry need to understand that they each play a critical role in getting the right information to the right person at the right moment. Anything that inhibits this sharing creates a bottleneck and even a detriment to patient safety. It will take strong leadership to help the industry understand that holding on to information does not give them a competitive advantage—instead it makes them part of the problem, and others will take notice.
- Get priorities straight: Sid said it best when he talked about leading teams to overcome challenges: “The first thing I ask them is ‘What’s broken?’” We face a number of issues impeding interoperability: slow end-user adoption of IT, inadequate or conflicting standards, misaligned incentives and weak governance among others. Each manifests differently in the various sectors of health care. We need to identify what the key barrier is in each and fix that first.
- Remember concerns about privacy and security: as we move closer to achieving the free flow of data across devices, systems, facilities, and beyond, let’s not forget we are moving very personal information. This is a network ultimately held together by trust. Without proper governance, protection and controls, it could fall apart.
How quickly health care can create sufficient urgency and act remains to be seen. In the interim, the needs of society move on unmet, and Patricia’s due date is fast approaching. Her child isn’t going to wait for this issue to be resolved.
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Harry Greenspun iis the senior advisor for health care technology and transformation at the Deloitte Center for Health Solutions. He has held a diverse range of clinical and executive roles across the health care industry, giving him a unique perspective on current and future challenges.