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Towards Healthcare Interoperability: What Must Be Done?
November 09, 2015

Towards Healthcare Interoperability: What Must Be Done?

Howard Chen is a radiology chief resident at University of Pennsylvania in the Healthcare Quality and Leadership pathway. Howard graduated from Harvard Medical School and Harvard Business School and was the recipient of the 2014 Imaging Informatics Open-Source Leadership Award from the Society of Imaging Informatics in Medicine. His peer-reviewed papers investigate the role of data science in patient care, radiology education, and computational genomics. Howard writes about creating value for patient care through informatics and innovation. He tweets under @howardpchen.
Not All Electronic Health Records Are Made Equal

Walgreens' choice of Epic is not without good reasons. Epic is well on its way to become an industry standard. In The Digital Doctor by Robert Wachter, MD, the author describes Epic as a safe bet for EHR, like the healthcare equivalent of the famous IBM marketing phrase from the 1980s: Nobody Ever Got Fired for Buying IBM.

Last month, KLAS Enterprise released a new report ranking various EHR offerings based on its “Average Interoperability Rating” as graded by each product's customers. HIT Consultants summarizes the findings, describing athenahealth, Cerner, and Epic as the 3 highest-rated solutions, with Epic rated 3.7 to 3.8 on a 5-point scale. Based on a SK&A analysis, Epic Systems Corporation owns 42% of the market in large practices (26 to 40 physicians) and 54% of the market among very large practices (more than 41 physicians).

Epic achieves interoperability through what it calls Care Everywhere, which reportedly supports both its own and non-Epic EHR, but “a richer data set is exchanged and additional connectivity options” are available when both sides of the communication use the same vendor.

Interoperability through the use of the same proprietary solutions is one method of achieving this goal, much like the way Microsoft achieved “interoperability” in the 1990s—Microsoft Word.doc format became the de facto standard format for document exchange simply because everyone used Microsoft Office. It was a practical application of demand-side economy of scale (also known as network effect).

Proprietary vs Open Standards

However, the road to interoperability does not necessarily require ubiquity of proprietary support. To the contrary, the European Committee for Interoperable Systems (ECIS) argues that so long as a system remains proprietary, its effect on interoperability will always be limited:

“In the closed proprietary world, there are restrictions on which vendors can implement the standard, which in turn impacts consumer choice and market competition. These restrictions can be a lack of access to a democratic standardization process, onerous licensing terms, or proprietary technical hooks.”

The ECIS advocates open standards, in which vendors and developers agree upon a specific way of implementing services so that their data are compatible.

The best open standards are invisible—they work so seamlessly that we hardly realize that monumental efforts had been invested to create this experience. Examples include the aforementioned IEEE 802.11 wireless standard, and the HTTP and HTML5 standards. Imagine if some websites required that you use Internet Explorer, while others only supported Safari, some Firefox, and half of them required you to download an extra software plugin to watch videos that came in as many versions as there were browsers.

This was the way the Internet worked in the early 2000s. The technology industry fixed it in a hurry after realizing that open standards for the Internet benefits all players as much as the end-users.

And so it should be for healthcare.

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