West Health Institute's Joseph Smith: 'Patients are waiting' for interoperability

Interoperability was the word of the day at last week's Health Care Innovation Day in Washington, D.C. FierceHealthIT caught up with West Health Institute Chief Medical and Science Officer Joseph Smith to get his thoughts on why West Health is focused on solutions and his vision for getting the ball rolling on interoperability.

FierceHealthIT: What's your ideal timeline for everyone in the industry to get the ball rolling for interoperability?

Smith: Today would not be too soon. "Patients are waiting," [is a common quote] and that's very much the case here. People are being harmed every day, maybe thousands, so we can't do this fast enough.

How fast will it actually happen? With new leadership at the ONC ... I think Jeff Shuren of the FDA has been speaking about it and feels passionate about it, and Karen DeSalvo speaks very passionately about it. I think people get it that we're in a crisis setting, with both the cost and quality of U.S. healthcare. This is one of those opportunities, that when you act on it, it saves time, money and lives. It is like a new triple aim; better healthcare, better health and lower costs. This is saving time, lives and money.

FierceHealthIT: What would you say to the solo practitioner who can't afford new technology, or had to lay off staff because they spent so much money implementing a new EMR system?

Smith: I would say neither one of them is getting the value of the technology they purchased simply because it doesn't effectively, smoothly connect. Everyone will buy an iPhone or Galaxy because they see the value proposition. We've not revealed or uncovered the value preposition of the technology they're encouraged to buy because it doesn't connect properly.

Failure is an orphan--no one will claim responsibility--but when you incentivize people to buy equipment, without urging them to be interoperable, we create more of the problem, not less. A law would facilitate adoption more than many things, but we can still work with the buying power of hospitals and providers to say they should demand this. Up until now, it hasn't been in the vendor's interest. But now we're revealing that, we're growing the buying power, and I think the whole system can move in a free market fashion. If it becomes a consistent market failure, there's a role for heavy-handed market regulation.

FierceHealthIT: So ideally [interoperability] wouldn't require a law...

Smith: You would like to incentivize it--like you heard Jeff Shuren say--if you use a set of standards we recognize, then the path the regulation can be smoother. If that doesn't work, you can expect heavier-handed intervention because it's a safety imperative and we've got government agencies set up to protect patients. When you hear the ONC saying, "We would like to see people do it, we're not ready to make people do it ..." that's partly an inducement. They would be remiss in not using the full weight of their authority to help save patients.

FierceHealthIT: Who does it start with? Who needs to act first?

Smith: A market-based solution will have the buyers asking and the vendors responding to new user requirements. In a world that is buyer-beware, the providers ought to be asking for this. We'll either watch market dynamics work, or if they're stubborn or slow, we can ask the regulators to intervene on behalf of the patient.

FierceHealthIT: If you had to sum up the message of the day in a sentence or two, what would it be?

Smith: I think we saw the entire ecosystem come together, to, by their presence, recognize the importance of the problem, and I think at the end of the day we're going to charge everyone with what they can do to make it better. We're not just about advertising the problem or carrying a flag, we want to find a solution. You see a lot of people willing to help. It's always tough to call the tipping point, but you are seeing it's part of the conversation at every regulatory agency.

When you put the patient in the center, no one can argue against that. People are feeling it--that our system is bloated, disconnected and wrong and we're going to have to solve it in order for people to succeed.

Joseph Smith (@Unaffordable_Rx), a former practicing cardiologist, is chief medical and science officer of the West Health Institute (@WestHealth), an independent, non-profit medical research organization focused on lowering the cost of health care. Check out his piece from FierceEMR last week, Shutting down the 'sneakernet' with interoperability.

Editors' note: This interview has been edited and condensed for clarity.

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