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Interoperability Needs More Than Fired-Up Buyers

Scott Mace, for HealthLeaders Media, March 25, 2014

"Part of the mission we have in front of us is to make the buyers aware that there's something you can ask for, and that the vendors can innovate and provide it," Smith told me. "I don't think there's been an adequate focus from the buying side of the equation to understand that if they do specify that [products] talk using open standards, the vendors, because they're trying to sell their wares… will follow that requirement."

I would argue that buyers have been like that pumped-up football team in Cosby's comedy bit. They've been fired up and loudly demanding interoperability for some time, yet too many IT vendors have too often kept the door to interoperability locked tight, denying the industry $30 billion in potential savings, according to West Health's estimate.

During the February event, organizers asked the audience what was preventing functional interoperability in medical devices and information systems. "Their dominant answer was, [it was] purposeful strategies to maintain market share and increase switching costs," Smith said.

"The assembled audience was dominantly of the opinion that this was kind of a market failure, as opposed to not having the technology available, not having sufficient standards. They were saying that this was kind of a vendor-driven reality."

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2 comments on "Interoperability Needs More Than Fired-Up Buyers"

Joseph M. Smith, MD, PhD (3/25/2014 at 7:32 PM)
Scott [INVALID] Thanks for the interview. Would agree with much of what you said, particularly that energized and aligned buyers are necessary but likely insufficient, hence the call out for specific actions by clinicians, patients, vendors, regulators and payers as well. And to clarify one point, the meeting and resultant paper were directed at the broader issue of interoperability, including medical device interoperability, where the voice of the buyer has not yet been raised.

Frank Poggio (3/25/2014 at 5:24 PM)
Well there ya go again! Got a problem - blame the vendors. We all know they are the real Satan of systems interoperability. Hey, wait a minute. Wasn't it the vendors that started HL7 almost thirty years ago? Promoted CCOW and other tools? Well it must be the vendors because if banks can work together so I can get money out of any ATM around the world and the debit makes it to my account instantly – why can't health care vendors do that? After forty years in healthcare IT I'll give you five reasons: 1)First of all, if health care and medicine were as simple as banking we'd all go to our loan officers when we cut our fingers off. True financial transactions can be complex but no- where as complex as trying to figure out why Johnny keeps vomiting. 2)Every time we think we have ironed out a 'EBM standard' somebody comes up with a new medical protocol or research study that upends it and requires more and different data, to support (or challenge) it. See PCA test, mammography, sepsis diagnosis, Pap tests, etc. 3)Computer technology keeps changing, not only the hardware but the software and data tools as well, not to mention the telecommunications improvements over the last thirty years. To be sure they have helped, but see item 5. 4)When a provider buys a new specialty system (say an anesthesiology system) he/she wants the latest tools running on the latest op systems. But they do not want to change out all the underlying mission critical systems like CPOE, meds management, etc. This makes for real fun interop project. 5)To maintain software stability and keep glitches down a basic rule of IT is to NOT change anything unless you absolutely have to. Change causes pain and interoperability is usually the first to suffer. Yet the providers want new enhancements, the feds want MU tools added, and medicine keeps finding new deceases and procedures to address them. Stop the changes and see interop work! Lastly if you think commercial industry is a heaven of smooth interoperability, next time you are at the airport take a long look at the screen that comes up for the ticket agent. Believe it or not they still use 'character filled green screens' running under state of the art operating systems like Windows XP and then type in cryptic codes to get you a seat change. Then if you need to change flights to another carrier they actually have to PRINT out a ticket that you take to your new carrier. Now that's what I call interoperability! Why can't healthcare be more like that? Frank Poggio The Kelzon Group