Healthcare Interoperability Musings: Incentives, Barriers, Blocking

Healthcare Interoperability Musings: Incentives, Barriers, Blocking


Continuing our series on healthcare interoperability, where we last presented the “Top 10 Recent Quotes on Interoperability”, this post further examines what it will take to truly solve healthcare interoperability, or at least  get us on the right path.

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We discussed this  topic during our annual GPAC conference last week, with the seemingly hotly contested issue as to whether the government (ONC) or the market should serve to solve interoperability being at the heart of the discussion. Perhaps it is not as cut and dry as one or the other, but what was abundantly clear is that the HCO community is tired of solving the same interoperability challenges over and over again – seemingly re-inventing the wheel each time. This was supported by a HIT Consultant article on 3 key barriers to interoperability, which presented eHealth Initiative poll results on health data exchange:

“It is like we are starting from scratch every time,” said Kevin Stambaugh, director of Physician e-Services of Intermountain Healthcare in Utah expressing his frustration with interfaces during the webinar panel  of HIE executives responding to the survey (Hall/Fierce HIT, 10/9/14).

In addition, Paul Black, CEO of Allscripts, recently testified before the Senate Committee on Health Education Labor and Pensions, to share his thoughts about how to advance health data exchange. As part of a three-part blog series, Paul addressed  1) overcoming barriers 2) financial motivation and standards, and 3) information blocking. Of the many salient points in his articles, the most important (and perhaps most obvious) was as follows:

The current payment system simply does not offer appropriate financial motivation for providers to create an interoperable healthcare environment; this is especially true given that the burden of cost falls to them almost exclusively. Healthcare providers are genuinely committed to providing the best care they can to patients, but the common reality of running on only a few days’ cash flow sometimes trumps loftier goals.

That said, the right incentives are not the only impediment to achieving not just exchange, but true interoperability, and Paul’s post on overcoming barriers elaborated on these obstacles and solutions:

  1. Expand standards development process
  2. Require organizations to follow available standards
  3. Harmonize state laws and regulations
  4. Address legal and liability concerns
  5. Agree on what and how we store data
  6. Create activation strategies
  7. Develop a national patient matching strategy
  8. Achieve greater transparency around interoperability 

Paul’s last article on information blocking presents the problem that his own company is a part of. Vendors, not providers, lack the proper incentives to provide data liquidity. Further, it can be argued that all EHR vendors are guilty of data blocking in some shape or form. Data blocking is not a new topic for Galen – in fact, it was one of the key motivations and inspirations for our investment and innovation in architecting our GalenETL platform, which serves to provide true data liquidity for groups pursuing data conversions and system migrations.

We recognize that as an industry, we’ve collectively solved one tough part of the HIT equation – capture of the data. Now it’s of paramount importance to transform that data into information, providing true insights to improve care delivery. This is only achieved through interoperability.

As touched on during our interoperability presentation at GPAC,  the future seemingly resides with open platforms, Platform-as-a-Aervice (PaaS) and APIs built on those platforms to expose the data. Our GPAC keynote speaker, John Moore, supported this notion in both his presentation, “Healthcare Transformed: Where We’re Headed” and Chilmark Research’s recent release of their report: “2015 Platforms in Healthcare: EHR Vendors’ Capabilities for Interoperability” 

Look for the next post in our series, where we’ll address open platforms & APIs.

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