The Manufactured Interoperability Crisis is Failing Docs

Sometimes the most important scientific experiments are the ones that yield the most unexpected results.

The discovery of penicillin is a famous example. In September 1928, bacteriologist Sir Alexander Fleming returned to his laboratory after a holiday to discover mold growing in one of his bacterial cultures.  The culture was obviously ruined, nonetheless he took another look and noticed that the mold growth had a zone around it in which no bacteria were growing. Although it must have been tempting to simply throw the ruined culture away, he designed a new series of experiments around this bacteria-killing mold. The rest, as they say, is history. Millions of lives have been saved by antibiotics and the practice of medicine was forever changed.

Want a more recent example?  Eighteen years ago sufenadil, a drug meant to treat high-blood pressure and chest pain, was in clinical trials.  Although the drug turned out to be ineffective against those two conditions, the test subjects didn't want to give the drug back...it seems a certain beneficial side effect arose (sorry couldn't help myself).  Today we call that drug Viagra.

The key to the success of both of these events was that the researchers were open-minded and unbiased enough to change their narrative based on unexpected data.  Had Sir Fleming just thrown his ruined culture away or if the folks testing sufenadil had not listened to the unstructured comments of their test subjects, major discoveries would have been missed.

Today the health IT community faces similar "unexpected results" that conflict the narrative.  A couple of months ago, I attended a health IT meeting entitled, "Connecting Healthcare."  Like dozens of similar HIT meetings, the entire event was dedicated to interoperability.  The moderator for the first panel asked for a show of hands from the audience on two questions.  The first was, "Do you believe there is a crisis in HIT over lack of interoperability?"  Out of about 1000 attendees, about four people raised their hands.  Second question: "Do you believe the connectivity crisis can be solved with government policy?"  A couple of extra hands were raised, but no more than 10, or about 1 percent of the audience.  The four panelists, all representing major HIT / EMR vendors, were asked the same two questions.  None answered yes to either question.

Later in that meeting, a panel of four physicians convened to discuss, "Improving physician engagement through interoperability" for one hour.  The conversation stayed on the subject of interoperability for about five minutes.  Then the conversation drifted towards the things doctors really talk about:  EHR notes are impossible to read; meaningful use is confusing, impossible to comply with, and adds nothing to patient care, EHRs add dozens of hours per week to a physician's workload, leaving less time and energy for the patients themselves.  And the list went on...

So here is the unexpected result - the "mold in the culture dish." The interoperability narrative pushed by EHR vendor CEOs, government and HIMSS is accepted neither by those of us who touch patients for a living nor by many who work in health IT.  The concept of interoperability has been hijacked by those at the top of the HIT food chain to serve their needs, not the needs of patients and those who give them care. 

The Grand Narrative defines interoperability in terms of moving large volumes of medical records between major silos in the healthcare system.  While that definition does indeed have some relevance, almost all doctors will tell you that the interoperability we care about the most comes not a top-down paradigm of healthcare but a bottom-up model that regards every patient as unique.  We need interoperability that supports individual patient workflow.  Doctors need a system that can - with a single button click, or a couple at the most - do anything from schedule a chest X-ray to order labs to schedule surgery to refer to a specialist.  That capability requires back end connectivity - interoperability, if you will.  It's hard for docs to think about the "larger view" when our basic IT needs are still unmet.  We need interoperability that gets our work done so that we can pay more attention to our patients, not less.  We need connectivity to labs, imaging facilities, physical therapists, surgery centers and any place else we send patients to get care.  That kind of connectivity does not exist beyond large "closed shop" institutions.

The HIT community is currently obsessed with interoperability, but their definition is misguided. So what will the top of the HIT food chain do with its "moldy culture dish?"  Will they follow Sir Fleming's lead and make the proper adjustments to the narrative?  Will they listen to doctors and their own colleagues in the HIT community?  Will they redefine interoperability in a more relevant, useful manner?

Let's talk about it.