Glimmers of hope on the interoperability horizon

Andy Slavitt sounded every bit the part of a an administrator looking to fundamentally change the way healthcare is delivered during his shared keynote address with National Coordinator for Health IT Karen DeSalvo at least week's Healthcare Information and Management Systems Society's annual conference in Chicago.

He was authoritative and direct; the forceful yin to DeSalvo's optimistic yang.

Slavitt called for a "more modern infrastructure;" one that's less flashy ("I think we could do with a little less innovation on shareable and wearables") and more focused on ensuring care coordination between providers. And he expressed disappointment in the current lack of interoperability between the electronic health records systems of disparate care facilities, sharing his opinion about a recent visit to a federally qualified health center unable to track patient care beyond its own four walls.

"To be clear: this won't be acceptable to patients," Slavitt said. "It will not be acceptable to care providers. It's not acceptable to tax payers. It's not acceptable to us."

Slavitt's tone was one of a stakeholder fed up with inefficiencies in the mechanics of a healthcare system trying to sprint to keep up with new demands to provide more accountable care to its consumers. After all, how can providers be expected to keep up with such demands if the tools they're using won't cooperate with one another?

"I'm asking a great deal more of the innovation engine of our system," he said. "It's time to get down to business and really advance the gains that have begun under health reform these last five years."

However, some glimmers of hope have started to appear on the horizon. Four examples include:

  • The Argonaut Project--unveiled in December by Health Level Seven International in coordination with several electronic health records vendors, including Epic and Cerner--continues to plug away to advance Fast Health Interoperability Resources (FHIR) to enable expanded information sharing for EHRs. Just prior to HIMSS, Accenture and Surescripts became the latest organizations to join the effort.
  • Surescripts also recently announced efforts to implement its national record locator service with Epic, eClinicalWorks and Greenway Health to locate patients electronic records stored in any healthcare location.
  • Healtheway announced at HIMSS that 11 health data sharing networks will participate in its rollout of a new framework--Carequality--aimed at "inter-network" information exchange. The networks include more than 2,000 hospitals and 200,000 physicians.
  • The CommonWell Health Alliance announced prior to HIMSS that five of its vendor members--Cerner, athenahealth, CPSI, Greenway Health and McKesson--will take its network national later this year.

What's more, several vendors--including Epic, athenahealth and Cerner--said they would not charge providers for exchanging information with other providers.

In a conversation with Medicity Director of Standards and Government Affairs Brian Ahier at HIMSS earlier in the week, he called the transition of healthcare from a fee-for-service system to one that is value-based and focuses on population health a work in progress.

"We're working on an airplane while it's flying," Ahier said. "That's a challenge."

One major aspect of the Office of the National Coordinator's Interoperability Roadmap unveiled in January was constant cooperation with the private sector to ensure the future goal of a robust learning health system. DeSalvo, time and again, has stressed that the federal government cannot make such a leap alone by regulating from an ivory tower.

Slavitt's concerns about interoperability, no doubt, are legitimate. But it appears that the system and its stakeholders are finally heading in the right direction. - Dan (@Dan_Bowman and @FierceHealthIT)

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