Thursday, May 29, 2014

We Are Still A Long Way From Effective Health IT Interoperability. Here and In The USA.

This appeared a little while ago.

Interoperability Needs More Than Fired-Up Buyers

Scott Mace, for HealthLeaders Media , March 25, 2014

Health information technology buyers have been 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.

On his first comedy album, Bill Cosby did a timeless bit called The Pep Talk where a football coach gets his team all fired up in the locker room before game time and then sends them forth… only to be stopped by a locked door.
This bit came to mind as I read a new report from the Gary and Mary West Health Institute, which along with the Office of the National Coordinator for Health Information Technology, held a one-day conference on healthcare IT interoperability last month.
In the report, the authors urge all buyers of healthcare IT, that's healthcare systems, hospitals, practices and patients, to insist that technology vendors make their products work well with each other, share data, and support open standards.
But when I talked to the report's author, Joseph Smith MD, chief science and medical officer at the West Health Institute, I was somewhat taken aback when he told me that healthcare IT buyers have yet to make it clear they want interoperability.
"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."
Lots more here:
It seems the possible savings are significant.

More Medical Interoperability Could Lead to Big Savings

March 25, 2014
Medical interoperability could be a source of more than $30 billion a year in savings and improve patient care and safety, according to a new white paper released by the La Jolla, Calif.-based Gary and Mary West Health Institute and the Office of the National Coordinator for Health Information Technology (ONC).
The white paper, summarizing the HCI-DC 2014: Igniting an Interoperable Healthcare System conference, features lessons learned and synthesizing findings into a call for action to achieve an interoperable healthcare system. The West Health Institute’s HCI-DC 2014, which took place Feb. 6, 2014 in Washington D.C., and was co-hosted by ONC, brought together experts from across the healthcare community to consider how interoperability can cut costs, improve efficiency, reduce errors, and improve health .
More here:
So clearly there is an issue in the US.
In Australia I believe it is fair to say we are also struggling with the same issues. The amount of effort to get even a basic Health Summary and results into the PCEHR shows the difficulty that can be faced.
To me that we see most vendors and countries struggle to arrive at comprehensive interoperability suggests it is not easy and that the problem has yet to be solved at a strategic level let alone a practical level. 
In this situation I think that starting simple and working for incremental improvement is the right approach. I hope we can see real progress over the next few years with this sort of approach.
David.

7 comments:

Grahame Grieve said...

"purposeful strategies to maintain market share and increase switching costs" - it's the same principle that means Microsoft won't release Office the iPad, and Apple won't license OSX for clones.

When it works, it works really really well. When it doesn't... oh, that's right, Microsoft are selling Office for the iPad now.

So it is market failure (well, maybe), but as long as the market rewards vendors for an action, who can call blame the vendor. You do what works for you, right?

Dr Ian Colclough said...

I agree David - "the problem has yet to be solved at a strategic level let alone a practical level".

The technical solution(s) will follow after the right strategies have been thoroughly thought through and implemented. Defining the right strategies has proven to be exceedingly elusive.

Anonymous said...

A big chunk of the problem is the procurers.
A tender process may say a specific level of interoperability, however either simply accept a lower level, or accept the lower level with the promise of the higher level being achieved in the near future. This is not usually delivered, however if it is after the pain of the initial implementation there is no appetite and/or no budget to implement it.

Anonymous said...

A tender process is not a strategy. It is prescriptive specifying an outcome in the absence of a strategy. And the end result will be .......

Bernard Robertson-Dunn said...

re: A tender process is not a strategy. It is prescriptive specifying an outcome in the absence of a strategy."

My view of a tender process is that the tender specifies the requirements for a solution. It assumes the solution is for some problem that has been well understood and the solution well defined. In the context of government IT systems, this is very rarely the case.

Usually, someone has a Good Idea (tm) for a solution, the business case is a flimsy argument describing unjustifiable benefits but not the problem to be solved.

With the PCEHR, I understand nobody has seen a business case. Maybe there isn't one (which goes against the Department of Finance's procurement rules) or they are ashamed of it.

Anonymous said...

So therefore if the problem is not well understood and not well defined, and if there is no business case (or if there is one it fails to define the problem to be solved) and if the strategy is not precisely defined then no tender should be called. No wonder PCEHR is going no where.

Bernard Robertson-Dunn said...

My experience with senior managers and project managers is that they unconsciously subscribe to the "and then a miracle happens" theory of management.

Either that or the Jeremy Clarkson approach "how hard can it be?"