National Health IT Week (#NHITweek) Rant: Point-of-care Interoperability – #FAIL!

Becoming Technology Geeks: Check!

Let me start out by thanking all the clinicians, public servants, technologists, industry leaders and patient advocates who have fought tirelessly (in some case for decades) to advance health IT as far as it has come. At the macro level, the state of health IT is worlds ahead of where it was just a few years ago, and your efforts have made that happen. Congratulations to you (us), and happy National Health IT Week!

At the provider level, I have seen how my doctors have embraced health IT tools over the past few decades–especially in the past 5 years. I have also noticed this make me more interested in my own family’s care, and it has brought us closer to our medical providers. This is fantastic progress–an essential, but not sufficient, step toward interoperability.

Point-of-Care Interoperability: #FAIL!

That heading saddens me greatly. I became involved in health IT specifically to help solve this problem, and I have been honored to work along side of (or basking in the shadow of) legendary talent on this mission. We have made great progress connecting networks of providers to each other, overcoming technical and political challenges that seemed insurmountable.

However, for basic, where it really counts, coordination of individual patient care, we are still stuck at the starting line far too often, as Michael Callihan’s recent post highlights. That this is EVER heard nowadays makes me ashamed–for all of us:

They use EHR A; we use EHR B. They don’t talk to each other. We’re waiting for the fax to get your medical records.

Really?!? In 2014? Really?

Cart Before the Horse

I am blessed with an exceptionally healthy family–for which I am grateful every day. In retrospect, I see that my resulting lack of exposure to care coordination logistics may have blinded me to where we should have all been focusing our interoperability efforts. Don’t get me wrong: I was at ONC when KP and VA made history as the first participants in the nascent NwHIN; it was a fantastic moment, and no group deserves this advance more than our veterans.

However, that ANY patient, veteran or not, still experiences lack of interoperability as expressed by the quote above is a disgrace to everyone involved in the interoperability mission, and it makes me think that we put the cart (connecting healthcare systems and networks) before the horse (basic sharing of medical information for individual patients).

We put the cart (connecting healthcare systems and networks) before the horse (basic sharing of medical information for individual patients).

Is it REALLY this hard? (Hint: Ever used budgeting software?)

Let’s take a rapid acronym tour of just some of the standards and initiatives we have spent so many person-decades contemplating:

C32, CDA, CCD, C-CDA, FHIR, Direct, Blue Button …

Let me purposely simplify and generalize by saying that these are all flavors of XML (i.e., a standard way of expressing data) designed to package up medical records. ANY ONE of these is infinitely better than nothing, and they are all better than burning hours (or days, or weeks) of labor to manually copy medical records, deal with fax machines, and wait for overworked humans on each side to pull it all together.

How many medical errors have been made–how many people have died–while waiting for medical records to be faxed from another provider?

I still do love you all, but I have to say that I am disgusted with us as I write this. And yes, I know the argument that the CCD/C-CDA (or FHIR, or Blue Button, or Direct) is evolving rapidly, so we need to wait until it stabilizes (or becomes a pink unicorn) before settling on that format for medical record export/import.

I get the arguments for waiting to pick a format–to which I humbly call bullshit.

What have we been doing? Contemplating our navel to perfect standards doesn’t help patients who need interoperability NOW.

Ever heard of OFX? It stands for Open Financial Exchange, an XML format the financial industry settled on for exchanging consumer financial transactions (checking, brokerage, credit cards, etc.).

The financial industry is fiercely competitive, and they have a great deal of difficulty working together. Nevertheless, they settled on a simple XML standard for exchanging financial data between systems and software products. If you use Quicken or any other budgeting software products, you are using OFX when you import your banking transactions into your budgeting software.

No faxes. No waiting. It’s seamless. It’s simple. And it’s been around for seventeen years!

OFX, a simple XML format for exchanging financial records, has been around since 1997. What are WE waiting for?

Share Our Data. NOW!

So, EHR vendors, pick a format for exporting and importing medical records. Now.

There is no need for additional contemplation. People are dying while you drag your feet. If you need help deciding as a peer group, I will be happy to facilitate conference calls, organize a decision-making summit, help with board meeting pitches, find you implementation help, help you test this functionality–whatever it takes.

EHR Vendors: Tell me what is blocking you. I will do whatever it takes to help your product export and import medical records. But do it NOW.

What I won’t do is be passive about this issue–and at least one of your major competitors won’t either. If patient safety won’t motivate you, competition will provide the clarity you need.

I look forward to your responses. Patients look forward to better coordination of care. And the market will speak.




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