A recent report issued by the Institute of Medicine – titled “Best Care at Lower Cost” – calls for a dramatic transformation in health care delivery, saying “America’s health care system has become far too complex and costly to continue business as usual.” Its first recommendation (“The Digital Infrastructure”) focuses on the importance of health information systems and highlights a crucial aspect of their development that is too often overlooked – the issue of interoperability. Will the individual systems that are created be able to work together efficiently?
It’s an enormously important issue for health care broadly, and it will determine how effective those systems can be on a national level. At present, health care providers across the country are creating or enhancing their health information systems. In some cases, like ours at Intermountain Healthcare, those systems have a long history; we began instituting electronic medical records 40 years ago. Others are early in the journey. But all are being developed essentially for their own internal needs. Interoperability is low on the priority list.
Five health care providers who have been in the forefront of using electronic medical records have been collaborating on the creation of a Care Connectivity Consortium to pioneer the effective connectivity of electronic patient information across their systems. Those five are Intermountain Healthcare (based in Utah), Geisinger Health System (Pennsylvania), Group Health Cooperative (Washington), Kaiser Permanente (California), and Mayo Clinic (Minnesota). But even that ground-breaking effort, in which I’m heavily involved, will result in a multi-provider network, not a national one.
While we are already learning a great deal from the collaboration, and that learning can be broadly shared, it’s a national network that we ultimately need. Only a truly national network will allow the efficient transmission of secure patient information to best serve patients in multiple ways. It will serve them when they move (changing doctors or providers, traveling temporarily or relocating permanently); it will enable best practices to be shared across the country, and it will allow the broadest research and learning to advance health care delivery.
The IOM report recommends, in part, the following: “The National Coordinator for Health Information Technology, digital technology developers, and standards organizations should ensure that the digital infrastructure captures and delivers the core data elements and interoperability needed to support better care, system improvement, and the generation of new knowledge.” Here standard-setting is the key, and a good analogy for the problem can be seen in the evolution of the railroad in Australia.
There railroads developed one by one: some for moving natural resources like coal; others for carrying more freight, and still others for transporting people. While trains and tracks did get built, the railroad system was not constructed with adequate standards. Many different scales of railroad evolved, preventing railroad cars on one track from running on others.
To overcome this obvious challenge, the railroads built new stations and invented new contraptions to move cargo from one set of train cars to another. They were clever indeed; excellent engineering, for sure. But each contraption and transfer station slowed the transportation system down, added risk of product loss and increased the cost of shipping by rail. After many years of subpar train service and increasing costs, Australia defined a standard gauge for its train system. It was likely a huge expense to make this change, but the efficiencies gained continue to be realized today.
The parallel is obvious for America. We need national standards to ensure, as the IOM recommends, “that the digital infrastructure captures and delivers the core data elements and interoperability needed”. The federal government has rightly made a major investment in electronic medical records, having committed $35 billion from the stimulus bill to it. We must now ensure that, as the capacities of many individual providers grow, they evolve into an efficient and effective national network.
Information and information systems in healthcare have tremendous capabilities. Moving from paper-based to digital systems is a crucial step in facilitating the sharing of knowledge, but adequate standards are needed to allow for the ubiquitous sharing of data and, ultimately, enhanced knowledge. The potential is enormous, if we set the standards that will provide common tracks on which this railroad of information will run.
Marc Probst is Chief Information Officer for Intermountain Healthcare, headquartered in Salt Lake City.