HIT interoperability will happen when the cost of isolation becomes too high

Following the June release of ONC’s Ten Year Vision to Achieve an Interoperable Health IT Infrastructure, National Coordinator for Health IT Dr. Karen DeSalvo posted, “We have heard loudly and clearly that interoperability is a national priority.” While there can be no doubt that interoperability in the health IT infrastructure is desirable, it is not […]

Following the June release of ONC’s Ten Year Vision to Achieve an Interoperable Health IT Infrastructure, National Coordinator for Health IT Dr. Karen DeSalvo posted, “We have heard loudly and clearly that interoperability is a national priority.”
While there can be no doubt that interoperability in the health IT infrastructure is desirable, it is not enough to open the floodgates of innovation in healthcare and usher in the long overdue era of data-enabled care.
In 2004, Dr. David Brailer, the first National Coordinator for Health IT, outlined the vision for implementing the federal mandate that “every American have an electronic record of the healthcare by 2014 and link all the records into one giant medical internet called the National Health Information Network.”

Ten years elapsed and now we’ve allocated another ten years. Can we risk another decade to achieve what is commonplace across all industries – the flow of data?
Interoperability enables the flow of data from one point to another. It does not drive connectivity and behavior change. The standards of the internet enabled commerce; eBay, Amazon and a multitude of others revolutionized the retail experience and in doing so, restructured entire industries.
Another ten years of cajoling diverse entities to embrace and use standards will not change the foundation of healthcare.
Interoperability will allow the flow of data between any two points based on standards. But it does not connect those two points or the millions of other points necessary to enable the new generation of healthcare.

The flow of health data can be likened to a credit card network. Standards enable the flow of information from any consumer through their card issuer to connect to any merchant through their member bank. Thus the consumer can travel the world and present their card to any merchant – randomly without the need for the merchant or the consumer to know they have a need to connect. Every cardholder is indirectly connected to every merchant in the network at all times. Visa, MasterCard, American Express, et al – all exist to enable these transactions. Interoperability, (standards) enable the networks, but the networks enable markets.

And markets change behaviors. How did Borders and Barnes and Noble respond to the availability of the internet, the World Wide Web? How did they respond to Amazon.com? (Of course, a rhetorical question – they didn’t respond to the internet; with the rise of Amazon, Borders filed for bankruptcy and Barnes and Noble stands as the last remaining national book chain.)

Healthcare, representing nearly a fifth of the U.S. economy will only change when the cost to any organization in the industry of being a data island exceeds the cost of being “connected.” When the cost to a world-renown academic medical center that leverages the vast data within their archives is unable to compete against a research institution that has access to a world-wide data store; when the proprietary information system/EHR platform becomes a liability to its owner because it does not seamlessly connect to the world-wide health eco-system; when consumers choose health providers based on their level of connectivity that enables ease of access, portability of information, automated input of data from any health device or application they may use, or disparate location they may interact with, when these dynamics are enabled, healthcare will enter a new era.

The winners, above all else, consumers; they will enjoy best care, best outcomes, easy access and affordable care. Beyond consumers, the organizations that innovate and find new ways to integrate data into their product, service or application. The connected organization will thrive; the data island will struggle for relevance.

This industry transformation cannot be mandated or ordered into existence. It will evolve of necessity and like the many industries that have been revolutionized as a result of “global connectivity”, in hindsight it will happen faster than anyone can anticipate.

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