National health IT coordinators at HIMSS14: Interoperability a multilayered challenge

National health IT coordinators past and present agreed interoperability is a multilayered issue that encompasses more than just the exchange of data.

At a panel discussion Wednesday at HIMSS14 in Orlando, Fla., current National Coordinator Karen DeSalvo, M.D., said she's been thinking about interoperability--which she also talked about in detail earlier this month at Health Care Innovation Day in Washington, D.C.--as an elephant.

"Not so much that it's the elephant in the room, but because it's the blind man and the elephant," DeSalvo said. "Everybody sees a little different piece of it, and they're all relevant pieces."

DeSalvo added that the task at hand is putting all of those disparate pieces together, but at the same time not rushing the process.

"The last part of the elephant is [that] we have to eat it one bite at a time," she said. "We have to have a very focused, step-wise approach for building block on block on block so we get to a place where everybody gets the pieces they want. It's not just about technology or the privacy issues or the governance issues or the network--it's all of those things. We have to get all of those things work in concert together."

Farzad Mostashari, M.D., who led ONC from 2011 to 2013, agreed, expressing annoyance with phrases like "true interoperability."

"Can we give people some help here without trying to solve all problems for all people all the time, and have that be the standard against which our success of interoperability is measured?" Mostahari asked. "When people say 'true interoperability,' that sends a shiver down my spine because what that means is, we're never going to make progress until it's perfect."

David Brailer, M.D., who served as the first national coordinator from 2004 to 2006, called interoperability "a bunch of very small hills" with "the same vertical mass as a mountain," adding that it's a space that's going to need lots of shots on goal.

"I think in the end, we've got to remember that having the standards is necessary but it's not sufficient," Brailer said. "There are so many steps that have to be made, and the ultimate test will be 'is data flowing behind the patients?' We don't see that very often today. It's going to be very difficult to create business, technical, financial and regulatory conditions where that can happen, and I'd hate to put all my eggs in one basket."

Still, both Mostashari and Robert Kolodner, M.D., who served as national coordinator from 2007 to 2009, seemed optimistic about the outlook for interoperability efforts and their impact on the healthcare industry. "The trajectory is really there," Kolodner said.

Added Mostashari: "Twelve months from now, my prediction is we will look back and say, 'Wow things have really started to pick up now and the change is really now visible. What we're banking here is really starting to pay off.'" 

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