How’s interop going? Take this survey!

  | July 18, 2016

Do you remember the Department of the Treasury survey that asked if your financial information was available through your Mint.com account? How about the Federal Aviation Association questionnaire that asked if Kayak, Expedia, and Google Flights gave you useful information — about flight time, average delay, leg room, and on-demand video — that factored into your flight selection?
You don't? Me neither. Had I gotten one of these, I'd have plenty to praise about the richness, accuracy, and usability of the data in the financial and travel industries.
Unfortunately, the same can rarely be said about information exchanged between electronic health records.
So it's easy to predict the results of the surveys that, it seems, will be a key way the government measures healthcare interoperability.
Earlier this month, the Office of the National Coordinator (ONC) announced that it will be using data from existing surveys, conducted by the Centers for Disease Control and the American Hospital Association, to determine how well the industry is doing. The agency will focus on two interoperability measures, which it says will suggest how well-positioned healthcare organizations are to coordinate care and improve patient outcomes:
  1. Proportion of healthcare providers who are sending, receiving, querying, and integrating information from outside sources
  2. Proportion of healthcare providers who actually use that information

OK. Analyzing exchange and usage sounds reasonable, particularly when no better interoperability metric has been proposed. But, sometimes context is everything.

More than $35 billion of government funding was spent on the HITECH Act, the 2009 law aimed at creating a nationwide information sharing network. And yet the government's survey data will focus on the most basic of questions: “Are you sending and receiving information, and are you using that information?"

Is this really how we should define success to classify a healthcare provider as a high achiever or a straggler?

Yes, healthcare stakeholders can uniformly agree on the shared goal of widespread interoperability. But the survey data will only tell us there is work to be done.

And there's a danger that, because the ONC's measures are so general and vague, the results might give the industry a sense of accomplishment that it doesn't deserve. It would be like getting a medal at mile 15 of a marathon. You've done a lot, but you're a long way from the goal of true, meaningful digital integration — the kind that exists, as a matter of course, in other industries.

Though health IT lags behind where we'd like to be, that doesn't mean the future isn't bright. The industry is full of relatively young companies that have yet to reach their full potential. There are plenty of high aspirations, and there's plenty of room to improve the patient and provider experience.

Now, we need to shift from identifying the exceptions — those rare cases where seamless exchange of relevant clinical information occurs — to creating the expectation that the right information will be available all the time.

However maddening and complicated MACRA is, the transition to value-based care may provide the refocusing and gut check the industry desperately needs. But ONC needs to allow stakeholders to play to their strengths, without being bogged down by surveys or compliance-driven metrics.

Let the caregivers drive the ship by focusing on delivering quality care. Empower the health IT developers to design and build the powerful engines to respond to their client needs.

And from the people entrusted with making sure all of this works, don't settle on a few survey questions to determine the success of a $35 billion investment.

Greg Carey is the Technology Standards & Policy Manager at athenahealth.

How’s interop going? Take this survey!