- Healthcare organizations have long suffered from interoperability challenges since adopting digitized IT infrastructure. Tackling interoperability across an organization’s entire infrastructure can prove overwhelming to executives and IT staff at first glance.
There is no silver bullet that will solve interoperability among health IT system, but understanding how to begin to adopt the right tools and develop a long term strategy will put these organizations on course to achieve a highly interoperable health IT system.
Digital interoperability has plagued health IT infrastructure since the early 2000s. Organizations wanted to move to the web to reduce IT enterprise costs which was a massive incentive. Now organizations are faced with an entangled infrastructure of legacy systems and no clear solution to make them work together.
“The hardest thing is understanding what interoperability really is,” Health2047 Managing Director of Technology Charles Aunger told HITInfrastrucutre.com. “If you relate interoperability to diabetes, diabetes is generally labeled, but there’s actually many different issues with blood sugar levels and other factors that can cause diabetes. It takes a long time to find out what the core root and the core diagnosis of the problems are.”
A similar generalization has been used to categorize interoperability. Once organizations went through an initial digital transformation in 2000, enterprise interoperability wasn’t a pressing issue. The lack of incentive to continue improving interoperability is one of the major reasons why interoperability plagues health IT infrastructure today.
Health IT is reactive by nature. The attitude of “if it ain’t broke, don’t fix it” runs rampant and has many unintended negative consequences down the line. Aging health IT systems fit for replacement are only fixed once a catastrophe befalls them. The first step to solving interoperability is taking a proactive approach to recognizing when legacy systems can cause trouble down the road and taking steps to replace them.
“We’ve had EHR incentives,” said Aunger. “Vendors built these monolithic EHR platforms on technologies that are old. Nobody has ever really sat down and said, ‘we should collapse these platforms and change the way that we're writing them.’"
Health IT vendors and provider organizations have tended to ignore the root of the problem and instead directed their efforts at addressing more digestible scenarios.
“If you break it down into those individual pieces, it becomes individual problems that can't simply be labeled as interoperability as a problem statement,” said Aunger. “We have a lack of real understanding of what is needed.”
Organizations also have trouble prioritizing interoperability alongside other tasks and projects that are urgent. Many organizations develop applications in house and the cost of producing new versions of these apps can be too expensive. Spreading staff thin can also impact progress on improving interoperability. IT staff consumed with maintaining legacy solutions likley have their work cut out for them simply trying to keep the lights on, making large-scale projects unrealistic.
These networks are complex and make the task of interfacing with different healthcare apps difficult. Simplifying how apps interface will improve interoperability, but it’s not prioritized.
“It's difficult to sit in front of someone and show the complexity of their connectivity within their healthcare systems and applications,” Aunger explained. “It’s difficult to get people to sit there, go through the whole platform from end to end and say, ‘How do we fix it?’ It's a lot of money and a lot of time and effort.”
The technology exists, but it all comes back to incentives. Aunger compares the financial industry that has had more success with interoperability than healthcare. Banks use mobile payment apps. Their incentive is that they lose customers if they can’t produce a usable app that also interfaces with application programming interfaces (APIs) and gives customers access to their financial information.
Healthcare lacks the same business incentives present in other industries. Patients just want to be treated, they don’t necessarily care about apps and how to access medical information. There hasn’t been a general movement of patients from one practice to another because of interoperability-related issues. Nor is there an urgency to improve interoperability for the sake of the business in healthcare yet, according to Aunger.
Organizations are increasingly relying on digital tools and that has brought interoperability back to the forefront in health IT. Healthcare organizations of all sizes are now tasked with developing a plan for tackling interoperability before it impacts their business.
“Ninety-nine percent of the time interoperability has to be a strategic objective for healthcare organizations to lay down that they are going to start consolidating and connecting technologies together,” said Aunger. “They need to evaluate their technology and set a strategic objective to reduce the complexity of buying new technology.”
Including all IT staff involved from the lowest to highest level and taking all opinions keeps organizations on a consistent and transparent path when planning a strategy. Teams that are not communicating can delay the process if there are too many opinions and not a straightforward baseline that allows everyone to work toward the same goal.
Examining the network and untangling legacy systems that have been together for years is a good place to start. Network complexity begins to dissolve when organizations evaluate applications that work together.
Testing applications is also a vital step that many organizations overlook.
“Organizations forget about doing testing and how they work with multiple vendors,” Aunger stated. “If organizations don't get testing nailed down at the beginning they end up running into problems across the whole environment.”
“You can’t stick band-aids over interoperability problems because it drives up complexity in the long run,” he continued. “Complexity drives the lack of interoperability because people create workarounds. Workarounds change the original mission and changes the value away from creating connectivity and intertwine applications.”
Intertwining applications is critical to creating a seamless user experience for end users and better network visibility and control for administrators. Something as simple as interfacing systems so patients entering a healthcare organization only check in once increases infrastructure functionality. The system then knows what that patient is doing, why they’re there, and where they are going.
“When I was at Stanford Health Care we tackled this problem by rationalizing,” Aunger explained. “We set the priorities, put everything together, and tested it. A patient checks in once. The system knows that patient now exists in the building and it tells all the other systems. This system worked because we did it from day one. These weren't new apps, these were applications that we already had in the building, but we set the principle.”
“Once you start a project with interoperability in mind, all the new implementations or application changes you implement are interoperable and they work,” he continued. “Every time we moved forward with a new project, we knew we were going to do it in that way,”
Aunger suggests that organizations keep four key points in mind when approaching how to solve interoperability issues.
“Set your mission correctly and understand your goals,” he advised. “Testing needs to be absolutely defined, and you need to examine look at how you interact with the system. Lastly, don't go after the big apple approaching the environment as a whole will never work.”
Interoperability is an issue that spans the entirety of health IT infrastructure, but breaking down the approach of how to fix it is key to success. Separating the larger issue into smaller parts makes the individual activities more achievable and realistic for IT teams to accomplish. At the same time, this approach allows organizations to be more budget conscious with smaller projects.