To achieve interoperability, simply reduce the cost of interfaces. The economic value will follow.
Vendors, hospitals, patients and the states are all the wrong places to look for interoperability. Vendors prefer to lock-in their customers, differentiate their product and derive revenue from interfaces. Hospitals prefer to lock in their patients, differentiate their service and derive revenue from pricing power in the marketplace that results from consolidation. Patients confused by the technical nature of interoperability are easily misled into erecting privacy barriers that obscure quality and cost transparency. Finally, the states spend federal money designed to seed interoperability following established bureaucratic and political paths dominated by unchallenged input from vendors, hospitals and misinformed patients.
The cost of interfaces is the sum of Identity, Consent, Transport, Software and Opportunity. Reducing the cost of all five to near zero is possible and relatively easy. The Web and DICOM interfaces to radiology systems demonstrate many of the details at a large scale and for over a decade.
Identity can be free and easy if it’s voluntary to the person or system being identified. On the Web, identity is an email address. Email is free and available to all, even if they have to go to the library to use it. Email IDs are voluntary, you can use one or another as you choose without prejudice or permission. For a system example, DICOM interface IDs are IP (Internet Protocol) Addresses. They too are free and voluntary. The Direct Project is healthcare’s version of a free and voluntary ID for people and for systems. For both patient and clinicians, Direct Project identity is based on email addresses. Patients can already get a free Direct email ID from Microsoft HealthVault. Doctors can get one from Surescripts/AAFP for $15/month and free options are sure to follow. Free, voluntary identity eliminates one of the major costs of health information exchange: the Master Patient Index (MPI). MPI is one of those technologies that costs more the larger it gets. It’s time we abandon MPI as a path to interoperability.
Once a persons record has gone electronic, it really should never go back.
A paper printout of an Electronic Health Record is often huge and unwieldy. If it is printed out or faxed it creates something so huge that it is pretty impossible to be useful in a paper record.
This is the reason why need electronic interoperability solutions like the Direct Project. Without it, when a patient leaves one doctor, they have to print out an electronic record, take it to the next doctor, and then have that doctor scan the record in.
That doesn’t sound too bad until you realize that a patients printed EHR record often looks like this:
This image was provided to me by Jodi Sperber and Dr. Eliza Shulman, who generously agreed to share the photo under a Creative Commons license. Here is the full description from Flickr, which provides greater context.
An example of why interoperability is as important as the electronic health record itself.
The story behind this photo: This is a printout of a patient’s medical record, sent from one office to another as the patient was changing primary care providers. An EHR was in place in both offices. Additionally, the EHR in both offices was created by the same vendor (a major vendor); each health organization had a customized version. Without base standards the systems are incompatible. Instead, the printouts had to be scanned into the new record, making them less searchable and less useful.
Note that this was not the entirety of the patient’s medical record… Just the first batch received.
Fred Trotter is a recognized expert in Free and Open Source medical software and security systems. He has spoken on those subjects at the SCALE DOHCS conference, LinuxWorld, DefCon and is the MC for the Open Source Health Conference. He has been quoted in multiple articles on Health Information Technology in several print and online journals, including WIRED, zdnet, Government Health IT, Modern Healthcare, Linux Journal, Free Software Magazine, NPR and LinuxMedNews.
A simple technology for linking EHRs will have a major impact on health care.
We’ve all heard the one about what does the barking dog do when it catches the car.
The dogs of health IT seem to have caught their car when the Interim Final Rule for standards for meaningful use accepted certification of “EHR Modules” and left it up to the marketplace to decide how the modules would communicate with each other. I think ONC deserves much praise for a very fair and innovation-friendly approach.Continue reading…
I have been blogging and twittering
from the World Health Innovation and Technology conference this week
while waiting to present today. The keynote speaker before me was Scott
McNealy, the Chairman and founder of Sun Microsystems. He has a long
and storied history with Sun, and a well earned reputation as the “human quote machine.”
His talk started with several examples of his health care experience
(long time user as a hockey player and father of four boys) and
business experience had so many corollaries. The fight for standards.
The fight for common interfaces. The fight for privacy and security.
The find for high quality, low cost, and transparency.