Interoperability – Why is it Taking So Long? 6


AEGIS invests a lot of resources in support of advancing interoperability of electronic health information. The AEGIS DIL provides an unparalleled platform for helping EHR vendors, exchanges, standards organizations, and certification bodies test for interoperability and conformance.

But there is one critical aspect of interoperability that no technology can fix – that is, the inertia of organizations who do not want to make their systems and data interoperable.

I was unpleasantly surprised recently when an extended family member was admitted to the ICU of a regional hospital for treatment of the same problem that had already happened earlier this year. After three days in the hospital, speaking to my relative’s doctor, I asked if he had received the records from the relative’s earlier hospital stay in a neighboring town served by a very large competing hospital system. He said he had not, but they would request the information. When I spoke to the ICU nurse about the same topic the next day, he said they were waiting in the fax to come through.

So I asked, “Does this mean you do not exchange health records electronically with the other health system?” He laughed and said, “No – they use Epic, we use Cerner – and the two systems can’t talk to each other. So we call over there and then wait for faxes to come through, or they call us when they need our records.” As you can imagine, knowing what I know about electronic health information exchange and all that AEGIS is doing to support it, this was extremely frustrating news to hear.

As the industry prepares for Health IT Week next week, a question I have for our industry and government peers is, what’s taking so long?

I read a lot of articles and hear a lot of talks about why interoperability is hard – sometimes even claims that it’s virtually impossible. But the reality is, as AEGIS, some EHR vendors, health information exchanges like the eHealth Exchange, standards bodies like HL7, and HHS ONC are demonstrating, interoperability is possible today.

We have the way – do we have the will? Yes? Then why is it taking so long?


About Michael Callihan

Mr. Callihan has more than two decades of experience in software engineering and business consulting. His expertise is in application architecture and helping customers develop best practices in enterprise software development. Mr. Callihan has worked with large government organizations including more than 10 years with the US Army, and many large corporations – HP, Time Warner, and various health care systems. His experience includes object-oriented analysis, design and programming, team mentorship, technical training, and project management. Mr. Callihan is a Project Management Institute (PMI) certified Project Management Professional (PMP) and a certified Lean Six Sigma Sensei (LSSS). He is a graduate of Carnegie Mellon University with degrees in Information and Decision Systems and Industrial Management.


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6 thoughts on “Interoperability – Why is it Taking So Long?

  • Bob Coli, MD

    Useful insights into understanding why achieving full healthcare interoperability is taking so long are provided by the slides from the most recent meeting of the HIT Policy Committee’s JASON Report Task Force (1) and an article from the Clayton Christensen Institute for Disruptive Innovation. (2)

    (1) http://www.healthit.gov/FACAS/sites/faca/files/JTF_Slides_2014-09-02_v4_0.pptx and
    http://www.ihealthbeat.org/articles/2014/9/4/jason-task-force-co-chairs-criticize-health-it-interoperability-report

    (2)http://www.christenseninstitute.org/why-ehrs-are-not-yet-disruptive

  • Dean Hudson, President EngageHi2

    I agree with the comment on the one mitigating factor of inertia. However, I think more has to do with the vendor landscape and the readiness of solutions. As with the large Vendors, they want to not only control market share but also how their respective clients look at interoperability. They evangelize to their respective clients that they have a complete solution for all needs. This is not only untrue but it impacts greatly the openness required to look at true interoperability solutions in the marketplace. True orchestration and interoperability solutions exists in the marketplace. The issue is most are new to the market and present such a shift in thinking that it makes the big guys and the policy heads nervous. At EngageHi2 we feel we have those solutions and the answers.

  • Dr. Nash Aragam

    Having worked in the IT (3D Graphics, Networking Protocols, File Transport Protocols) standardization efforts back in the 80’s and 90’s the main problem in Interoperability is the sheer reluctance of those vendors who (for whatever historical reasons) get stuck with their definitions, semantics, and syntax and hate to conform to a more generalized solution (which, in most cases, tend to be the least common denominator solution, and hence, might not be highly efficient for any particular vendor’s platform!) that is often proposed as a standard. What’s more, any interoperable solution tend to be inefficient, slow, and ends up costing niche markets that most vendors use to distinguish themselves. Nevertheless, standards and interoperability in software does happen and any bemoaning of inefficiency and speed factors are trumped by cheaper and faster hardware solutions. So it’s a question of time in EHR’s before one standard would prevail and interoperability between the current disparate solutions will disappear in due course. My experience tells me that any standard will take at least 10-15 years to mature and enjoy wide implementations.

    Just my $0.02 worth…

    Thanks, Nash

  • Richard Floyd

    I agree with Dr. Coli and the Clayton Christensen Institute. It is apparent that the ideal of ehr inter-operability is, and will remain a myth. I believe we should shift our attention and support to a new design which would leverage secure cloud storage (without imbedded patient identifiers) and smart personal devices which include fingerprint and voice recognition. Technology is at hand to seamlessly integrate ehr records flow. We just need to re-think how it should be done.

  • Michael Callihan Post author

    I’m glad to see the discussion that this post generated because it’s an important topic. But I have to disagree with the assertion that fixing the problem requires a new toolbox. I think the problem lies with the carpenters (and perhaps their unions and/or employers to carry the metaphor further), not their tools. The facts are:
    1) Standards exist today to support effective health info exchange (and they continue to evolve as Dr. Aragam points out)
    2) Exchanges that operate according to those standards are up and running at the national and state levels
    3) Yet organizations are not sharing the information
    Moving the tool set from, for example, a document sharing model to a cloud-based model doesn’t alter the fundamental problem which is lack of sharing. In fact some of the alternate tool set ideas make no sense to me. My elderly relatives and their peers don’t carry smart devices around for storing their PHRs. To the extent that we have an aging population especially in certain areas of the country, moving the solution down to personal technology levels might not make sense in real life. And of course the older a person is, generally speaking, the more likely they are to be interacting with the health care system and to be in need of effective interoperability.

    There’s a Part II to the story in the blog post. My relative had to be transferred to the flagship hospital of the system she was admitted to in this latest encounter. That flagship hospital did not have electronic access to the records accumulated at the smaller hospital in its own system! That’s unforgivable in my opinion and points right back to the problem I mentioned earlier – current technology is not the barrier to making interoperability happen. The problem is the people who ‘own’ (I use that word loosely) and manage the data and the decisions they are making or not making to cooperate with interoperability. I think vendors have culpability as Mr. Hudson notes. My understanding is that some of the big players “don’t agree with the standards.” Isn’t like like GM saying they don’t agree with seat belts? And some providers share in the culpability – they consider the data “theirs” and are loath to share it because, I suppose, it represents a certain kind of intellectual capital? It leads me to wonder, sadly and somewhat frighteningly, that if there isn’t a clear business benefit to sharing information, is it not a priority? Is this about money and stock value instead of patient safety and quality of care?