The healthcare industry and policymakers have seized on the importance of "interoperability" in information technology, a force that could pave the way for better, cheaper and more efficient care for our workforces and families. This meeting of minds could foster a breakthrough for simple, accessible communication of healthcare data and the quality improvement that comes with it. But like a tactical explosive charge, the concept's application could either blast a path through barriers or blow up in our faces, depending on how we handle it.
Those who aim to achieve interoperability must agree on what they mean by it. To create a clear reference point, the National Alliance for Health Information Technology has developed this definition: Interoperability: the ability of different information technology systems, software applications and networks to communicate, to exchange data accurately, effectively and consistently, and to use the information that has been exchanged.
As the next step in gaining industrywide consensus on a definition for interoperability, the alliance is holding a March 23 teleconference to provide a brief synopsis of how it reached its definition, then open the call to discussion and feedback. (To participate, send an e-mail to [email protected])
Without a common understanding of interoperability, IT systems will not interrelate, making it impossible to piece together a solid health history and ongoing electronic record on individual patients who see different caregivers. At the very least, healthcare providers will be forced to continue footing the costly bill for work-around projects called interfaces.
Modern Healthcare reported nearly two years ago that universal adoption of a standard method for expressing clinical terms in computer language could remove millions of dollars in upfront interface expense and annual IT maintenance costs (July 28, 2003, p. 30). The federal government's $32.4 million purchase of a national license for the healthcare industry to use a common standard, called the Systematized Nomenclature of Medicine, was a stake in the ground for interoperability. That was just the beginning. Dozens of such standards for many types of crucial data have to be adopted in a comprehensive strategy if we are to achieve the goal of interoperability in U.S. healthcare.
Without consensus, working definitions of interoperability may vary just enough to complicate the industry's adoption of future requirements-from Congress, federal regulators, the Office of National Coordinator for Health Information Technology, the congressionally chartered Commission on Systemic Interoperability, IT product-certification efforts and other groups springing up to tackle the objective. Failure to align their efforts could litter the industry with conflicting instructions on how to comply with a concept that is valueless unless uniformly applied. Healthcare executives would do well to insist on an industry consensus to avoid the higher costs and administrative and technological headaches that are bound to accompany any fracturing of industry cohesion in the pursuit of interoperability.
Consider the issue of holding IT vendors to their commitments, for example. The proposed definition avoids the trap of fixating on technical benchmarks and instead looks to the essential outcomes of interoperability for healthcare organizations and consumers. Experience in the field has shown that technical standards can be incorporated in computer products and still fail to yield effective and consistent exchange of information from one computer system to another. From a legal perspective, the proposed definition can help guide discussions about whether a product meets appropriate legal and contractual definitions of interoperability.
This definition also provides the focus on the end result that allows for changes in the business environment and healthcare technology. Nearly a decade ago, a campaign to bring interoperability to healthcare cast the solution according to technical standards at the time instead of remaining flexible with a definition focused on achieving simpler means of sending and receiving insurance-related transactions. The Health Insurance Portability and Accountability Act of 1996 stands as an example of how not to go about making interoperability simpler and cheaper. Its prescription for data interchange was written before the rapid growth of the Internet, before alternate forms of electronic communication and before the healthcare industry understood the downside of calcifying IT standards in federal regulations.
A better example of standardization is the evolution of healthcare performance measurement under the National Committee for Quality Assurance. As employers began to evaluate HMOs in the early 1990s to determine what they were getting for the healthcare dollar, health plans were peppered with differing and inconsistent requests for data from payer to payer, increasing the cost and trouble of gathering the information by which they were judged. Through the NCQA's efforts, payers and health plans settled on a specific set of measures-the Health Plan Employer Data and Information Set-and agreed to revise the measures according to changing or newly emerging priorities.
The solution has had its problems: The reporting requirements called for gathering evidence that was fragmented, scattered and not in a form that could be easily compiled, aggre-gated and shared. That's still a problem today. The industry can learn from the past: In the pursuit of data standardization and interoperability that will measurably improve quality, safety and operating efficiencies, the healthcare industry must do even better this time around.
Scott Wallace is president and chief executive officer of the National Alliance for Health Information Technology, Chicago.