By Inga Shugalo
Today’s digital technology is making substantial inroads into the advancement of patient care in the United States. Solutions such as augmented reality, computer vision, and machine learning are rightly held up as vital tools for clinical decision support (CDS). They reduce diagnosis time and accuracy, ease the burden on overworked physicians, and contribute to increasingly successful, and often life-saving, outcomes.
At the current time, though, interoperability challenges frustrate capitalization on these crucial advances. Institutions are struggling to build online networks enabling a secure, free flow of data to provide universally applicable CDS.
In an industry that society depends on for the maintenance of health, happiness, and life expectancy, surely technology vendors and healthcare institutions can find a way to surmount conflicting priorities. They must work more closely to achieve the only goal that should matter—fast, successful diagnosis and effective patient treatment.
The Interoperability Gap and Why It Matters
Clinical decision-making is a complicated affair, not least because a person’s health records comprise data captured at different times and places, and in various contexts. The picture is a composite one, like a jigsaw puzzle with parts scattered everywhere.
The government’s implementation of HITECH in 2009, incentivizing meaningful use of electronic health records (EHR), should have been the answer everyone was looking for to bring the puzzle parts together. To date, though, progress has been slow and erratic, limiting the potential CDS value of MedTech advances enabled by the internet of medical things.
It’s not so much that MedTech solutions themselves are hampered, but rather that reuse of the invaluable data they generate is limited. That’s because interoperability between the hundreds of disparate systems in use is not sufficient to enable streamlined data exchange and interpretation.
Here’s Why It Matters
To illustrate the CDS problems arising from interoperability challenges, take the hypothetical example of a patient visiting the emergency room while on an out-of-state vacation. The patient’s condition and symptoms are not important for this example, but suffice to say that a fast diagnosis and treatment decision would be a lifesaver.
In the current U.S. hospital environment, the likelihood is slim that the attending physician can access, in a moment or two, an entire record of the patient’s previous medical history. That history might include test results, X-rays, scans, treatments, and diagnoses from several different healthcare systems.
If such a complete patient record was available, the physician could arrive at a diagnosis in a fraction of the time currently possible. That, in turn, could make a massive difference to the outcome for the patient.
In the current absence of adequate interoperability, however, the physician must make her decision with whatever limited data is immediately available, or delay treatment while conducting investigations. She will perhaps need to contact a range of other providers to learn about the patient’s history or spend time researching for clues to aid diagnosis.
The example is simplified, of course. However, it should serve to highlight the importance of the interoperability gap, and why bridging it is an imperative bigger than the commercial aspirations of technology vendors and medical institutions.
The Nature of the Gap
If interoperability is so critical, what is standing in the way of its realization? After all, a range of standards has been developed and accepted. The Office of the National Coordinator for Health IT (ONC) even released an advisory this year, recommending adoption of the HL7 set of standards for clinical decision-making.
The most significant challenge relates to EHR vendors’ adoption of the standards. It’s not that the vendors are reluctant to adopt them, but as yet, there is no single stable version of a standard such as FHIR. Neither is there any governmental mandate in place to finalize one, so vendors have different ideas about which version to adopt, and why.
The Persistence of Closed Systems
The progress of interoperability is hindered further by inherent financial disincentives to simplify or even enable information sharing across vendor solutions and healthcare organizations.
For example, organizations are free to choose an EHR solution from any vendor, and the lack of universal-standard adoption is hardly a handicap from a commercial perspective. The disparities make it difficult for patients to seek healthcare from providers outside of a given organization, so the organizations benefit from assured retention of their patient populations.
Together, these factors promote the existence of data siloes, proprietary systems, and exploitation of patients’ health records as assets, rather than the adoption of common standards and investments in seamless interoperability.
Positive Steps Toward Interoperability for CDC
Efforts to change the current situation are apparent, at least among a handful of EHR vendors bucking the closed-system trend. For example, Cerner and Epic are just two pioneering software companies developing their platforms to facilitate a secure free flow of information across health systems.
At the same time, the ONC is finalizing new rules to curtail information-blocking by healthcare organizations and health IT vendors. As a result, one Florida hospital incurred a fine of $85,000, following an information-blocking complaint from a patient.
It is not before time that these developments are arising, at least in the area of clinical decision support. Until all parties can come together and collaborate to move interoperability forward, the only losers are the patients.
The sooner the barriers come down, the more completely can the capabilities of today’s incredible digital technologies be unleashed. Secure and free-flowing medical data should be the right of every patient wherever, whenever, and under whatever circumstances they need to receive treatment.
Where There’s a Will, There’s a Technology to Match
The path to solving the CDS interoperability conundrum is not about navigating technological challenges but overcoming business issues. The technology to securely and effectively share medical data already exists in the form of cloud computing, open APIs, and blockchains.
Unblocking progress requires the will of healthcare institutions and software vendors to look past the commercial concerns and become more mindful of the reason those exist. While legislation looks likely to force the issue sooner or later, let’s hope the actors don’t wait for that to happen.
Patients deserve better healthcare, so the time for open systems and true interoperability to commence is now.
Inga Shugalo is a Healthcare Industry Analyst at Itransition, a custom software development company headquartered in Denver, Colorado. She focuses on Healthcare IT, highlighting the industry challenges and technology solutions that tackle them. Inga’s articles explore diagnostic potential of healthcare IoT, opportunities of precision medicine, robotics and VR in healthcare and more.