The Promise of Healthcare Interoperability

What if there really is a solution that can deliver on the interoperability promise?

Mark Dunnagan

Mark Dunnagan Follow

April 24, 2019


Interoperability – the ability(ies) of different systems or software applications to meaningfully exchange information between EHRs, practice management, billing, radiology, and other systems – has become the eight-syllable answer to everything. But let’s face it … the process of migrating an entire industry of people and systems that have worked as independent entities into cross coordinated care teams is one of if not the greatest challenge healthcare will ever face. Why? Because if you’ve seen one physician practice, Emergency Room, hospital, laboratory, medical device company, urgent care center, Contract Resource Organization (CRO), Skilled Nursing Home (SNF), rehab center, behavioral health clinic, and on and on … you’ve seen one. Every workflow is different. Every core operational system is different. And even if two physician practices have the same EHR brand, it’s likely the EHR version is different.

Care coordination, accountable care, the transition from fee-for-service to value-based care, seamless data exchange, workflow efficiency, connecting healthcare ecosystems, and all the other industry buzz words that we speak and write about all sound great in theory. They electrify the Exhibit Hall at HIMSS to the point that we walk out believing that traditional EHR database interoperability methods are easy peasy and the vendors that can work this magic, a dime a dozen. Demos occur, contracts are signed, the project kick-off happens, and then reality sets in. The deployment that was supposed to take a month or two ends up taking nine months to a year and the budget is blown by thousands due to unexpected change requests. All this … for one interface. No wonder there are more skeptics than hopefuls when it comes to trusting healthIT vendors and the promise of interoperability.

Beyond Meaningful Use

As much as the lack of interoperability drives us crazy, our healthcare technology systems are actually working as designed. They were built to be highly secure, laser-focused, efficient and to “do their job”. And only their job, for the most part. Unfortunately, their design doesn’t fit well in the new ‘we’ll pay you if you join with a group of competing providers and aggregate quality data from each of your EHRs to prove you’ve met specific cost and quality scores’ generation of healthcare.

The good news is we’ve made some great strides towards enabling aspects of the digital healthcare conversation with the help of Meaningful Use and now APIs and the use of FHIR. The not so good news is we’re still an extremely fragmented industry. Even as capturing data in an EHR becomes more of a commodity, there are arguably between 500 and 600 EHRs in the marketplace. Add to that the issue of information blocking plus all of the other systems that are critical to the care continuum that simply cannot integrate in a meaningful way like practice management, revenue cycle management, lab information, document management, and others. Continuing down the path of traditional database integrations will not make a dent in the 18% of GDP costs we’re now experiencing in healthcare. Nor will it improve – by any stretch – the quality of care we ALL receive as patients. We have to think outside of the database box and take a look at how other industries have solved this same issue.

Thinking Outside of the Database Box

It makes sense that folks living in the healthcare technology trenches are tired of hearing the same old same old about interoperability. But what if there really is a solution that can deliver on the interoperability promise? When challenges are intensely complex, it’s easy to get stuck in entrenched ideologies and overlook solutions that are simplistic in nature. Ask yourself: What interface has been there all along? It’s not a database interface, it’s not a web service’s interface. For as long as there have been computers and people interacting with machines, there’s been a user-interface; and through time, user interfaces have become quite sophisticated.

The user interface approach (often referred to as front end integration) doesn’t involve the database or the system vendor. It’s been widely adopted by other industries and proven to significantly decrease both integration time and total cost of ownership. Leveraged alongside more traditional messaging and even API-driven interfaces like FHIR, front end integration can get to standard and non-standard data that Meaningful Use left behind. When it comes to making fast strides in healthcare interoperability, innovation, moving beyond entrenched ideologies, and trust are what will win the day.

Find out how Goshen Medical Center, North Carolina’s largest Federally Qualified Health Center, leveraged Smartlink’s front end integration solution to solve three integration challenges with no EHR or practice management vendor involvement and minimal clinic disruption. Download Now.

Learn more about the origins of front end integration here.

Mark Dunnagan

As the VP of Health Informatics, Mark is an experienced and pragmatic technology executive focused on the delivery of services and the continual improvement of Smartlink Health's connection methodologies. He also loves 'farm living' with his wife, kids, dogs, and horses.