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Competitive Pressures Kill Interoperability…and Not Just in Healthcare

Posted on December 8, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

The past few weeks I’ve been working to get a new cell phone unlocked and transferred from one network provider to another. There’s no need to name names of which networks since they’re all a pain from what I’ve read online. Needless to say, it shouldn’t take me weeks to get a cell phone unlocked and transferred to a new network provider, but it was a total pain.

Think about how much simpler the world of cell phones is compared to healthcare. There are really only 2 standards: GSM and CDMA. In the US that translates to 4 main providers: T-Mobile/AT&T and Verizon/Sprint. Sure, there are a number of smaller providers as well, but there are really only 4 major carriers in the US. You’d think it would be simple to transfer between them since people are doing it all the time. Not to mention there are laws that are passed that require you to be able to switch between providers.

While it seems to have gotten a lot better with these new laws, there are still a lot of competitive pressures for why one network doesn’t want to have someone transfer to another network. It’s in their best interest for it to be difficult for you to switch. That includes your phone not working on the new network even if your phone has all the chips and tech needed to work on it. It’s fair to say that if it was economically good to have that capability, we could seamlessly move between any cell phone provider and be just fine. This is absolutely not a technical issue, but it’s still a challenge to actually do it.

As I was thinking about my experience playing musical cell phones, I couldn’t help but think that the comparison to health care interoperability is really strong. There are competitive pressures for why health care organizations haven’t wanted to share data. New laws are starting to change that, but it’s happening slowly. Far too often I talk to people aghast that healthcare wouldn’t be sharing data with each other. This is far from a healthcare only problem as I saw first hand in the cell phone industry.

Plus, let’s be honest. Healthcare data exchange is at least an order of magnitude more complex (possibly two order of magnitude) than cell phone data. I’m sure the cell phone providers spent plenty of time talking about the technical challenges associated with transferring cell phones from one network to another even though it’s much simpler than healthcare. We all know we’ve had those same arguments in health care for years. I imagine cell networks have even pulled the privacy card that we hear so often in healthcare when you talk about data sharing.

I’m not sure it’s much of a consolation, but I feel it’s good to realize that interoperability is a problem in many industries and not just healthcare. No doubt healthcare has a unique culture and a number of idiosyncrasies. However, I think we have more in common with other industries than most of us realize.

It’s taken the right laws and incentives in place for my cell phone transfer to be possible at all even if it’s still not as easy as it should be. We’re seeing the same thing play out in healthcare. Competitive pressures made it impossible in the past, but that’s really changing. There’s still more work to be done, but we’re getting there.

EHR Data Hostage Wouldn’t Exist if EHR Were Truly Interoperable

Posted on October 20, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently talking with Mario Hyland, Founder and Senior Vice President of AEGIS (or better known on social media as @interopguy), about various healthcare IT certifications and really a follow up discussion to our previous look at achieving continuous healthcare interoperability. Next month I’ll be launching the Healthcare Scene podcast and I’ve invited Mario to join me as a guest. So, more to come on EHR testing in the future.

However, as we were discussing my vision for what would be a “meaningful EHR certification” I suggested that it would be meaningful to doctors if an EHR vendor was certified as able to export all of the EHR data. It would be meaningful to doctors if an EHR vendor’s contract was certified to not hold EHR data hostage if a doctor chooses to go to another EHR. I think many EHR vendors would do it as a way to instill trust in the doctors who choose their EHR (Translation: We’re so certain you’ll love our EHR that we’ve made it possible for you to leave our EHR if you want to leave).

As I recounted this idea and others, Mario Hyland made a great observation: If EHR software were truly interoperable, an EHR vendor couldn’t hold a practice’s EHR data hostage.

Think about the concept. If there was true EHR interoperability, you could just buy a new EHR, connect it to your old EHR, and all the data would be available in the new EHR. We’re not even close to getting there yet, but the concept is right.

One challenge is that in practice, we’re only sharing a small subset of the data in the EHR. Even if we got the entire medical chart interoperable, there’s still a bunch of other data in an EHR that would be beneficial to retain. For example, things like audit logs from the old EHR might come in valuable if an old record comes under scrutiny in some legal case.

I still love the concept. I also think it’s one extra reason why we don’t see EHR vendors running towards interoperability. I only know a few EHR vendors that have enough trust in the EHR software they’ve built that they’d be ok building the functionality for their doctors to leave.