Last week, Dr. Doug Fridsma, chief science officer at the ONC, published an excellent article on health IT interoperability titled Health IT as an Ultra Large-Scale System . In the article he very knowledgeably and effectively counters the argument I hear so often from those who work outside of health IT, especially strong advocates for the Affordable Care Act, whose demands sound a little something like this, give or take a word or two: "HEALTHCARE INTEROPERABILITY IS TAKING TOO LONG! At this rate, we'll never see change in our lifetimes."
They'll get no arguments from me – health data exchange and interoperability does indeed take a lot of work. However, it is happening at a much faster pace than most people realize. I mentioned in my last post  on health information exchange organizations that there were 322 in operation in the U.S. in 2012. Alone, that's a phenomenal advancement (27% more than 2011); however, only 88 of these HIEs are actively exchanging health data. What does that mean? That demand for health data exchange is much greater than what systems currently have the ability to support.
Queue, Dr. Fridsma:
"Ultra-large scale systems are not about a single software application, or a couple of applications working together, but rather an 'ecosystem' of interacting software systems. In health care, small practices may have:
- a billing system
- a clinical system
- web portals, and
- other IT systems.
Most medical centers have 20 or 30 different computer programs that work together to take care of patients. Take 20 or 30 different programs, multiply that by the number of medium to large medical centers in the country, add in the small practices, and we are talking about thousands of programs that need to work together.
Building that from the top down isn’t going to work. The report argues that we need to think differently about how we create ecosystems in the health IT industry."
The report he is referring to is the Software Engineering Institute's “Ultra-Large-Scale Systems: The Software Challenge of the Future .”
Dr. Fridsma goes on to describe health IT interoperability as "the difference between constructing a building and designing a city." It simply isn't feasible to design an entire city's plumbing and electrical blueprint prior to construction. Buildings that are grouped together and are connected together, in one way or another, make up a city, which in turn adapts and responds to provide supporting utilities.
Another great health IT thinker, Dr. John Halamka, CIO of Beth Israel Deaconess Medical Center, I thought summed up the pace of interoperability perfectly:
"…the country is on a great healthcare IT trajectory. We need to walk before we can run. …Stage 2 is a natural evolutionary step that requires data sharing, patient/family engagement, and decision support. These changes are occurring at a fast pace but an appropriate pace. The technology, policy, and education/training needed to safely implement them is straining all healthcare stakeholders, so I do not believe Meaningful Use can or should be done faster than the current timelines.
"To those who say that the industry should have solved all these issues years ago, I respond that 9 women cannot grow a baby in a month. It takes the focused energy of 1 woman for 9 months."
I apologize for the quote-heavy blog, but I always like it when I can piece together a growing health IT body of knowledge, especially in a field that is evolving at such a tremendous pace. Thankfully there are many smart people out there who are so open and willing to sharing their thoughts and expertise as we all work toward a common goal of health data interoperability – whatever that will look like when we get there.
If you will be in New Orleans next week for HIMSS13, please take a few minutes to stop by booth 6641 to meet our team. You can also pick up a copy of our handy 2013 Interoperability refers to the ability of two or more systems or components to exchange information and to use the information that has been exchanged. Guide, which has info on Meaningful Use, HIEs/ACOs, Web Services, Consolidated CDA and Direct Project . Additionally, I will be at the conference Tuesday to host the live #HITsm TweetChat in the HIMSS Social Media Center. The event begins at 11 a.m., and should be a lot of fun and a good way to make "in real life" connections.