Land Before Interoperability
Politics and party lines aside, it’s tough to debate the need for improvement in the current state of US healthcare. After all, the World Health Report 2000, Health Systems: Improving Performance, did rank the US health care system as 37th. In the world. Trending downward.
According to “Ranking 37th — Measuring the Performance of the U.S. Health Care System,” published in The New England Journal of Medicine, “the conceptual framework underlying the rankings proposed that health systems should be assessed by comparing the extent to which investments in public health and medical care were contributing to critical social objectives: improving health, reducing health disparities, protecting households from impoverishment due to medical expenses, and providing responsive services that respect the dignity of patients.”
In an effort to keep everything copasetic, I’ll avoid a deep discussion here about the recent Supreme Court decision on the Obama Administration’s Affordable Care Act. Instead, I’ll state something we can all agree on—the importance of creating electronic versions of all patient information and medical records, i.e., an electronic medical record (EMR). In fact, this was one of the few issues that both Republicans and Democrats agreed upon. In this case, health data = gold.
Dr. Jody Ranck, a global health policy and health technology researcher and strategist, wrote an article for Forbes entitled, “How Connected Health, Public-Private Cooperation, and Big Data Can Revolutionize Health Care.” In addition to discussing some of the deeper issues arising from the NFIB v. Sebelius decision, Ranck discusses the specific challenge of EMR interoperability, and, because all challenges are ultimately opportunities, he posits that this is a significant one for the public and private technology sectors.
“Having the ability to choose different devices and technologies to collect and store our [health] data and to be able to move that data from one health plan to another or across healthcare providers is no easy feat,” Ranck says. “Most large healthcare IT programs in the 1990s–early 2000s were very capital intensive, lengthy technology implementations that are expensive to replace.”
In other words, they’re server-based and require significant investments in both time and money. And, because many of these systems are unable to communicate with one another, the industry is left with behemoth, dinosaur-like programs that don’t play nice with others (think Sarah the Triceratops on steroids).
According to “Epic Challenge: What The Emergence of an EMR Giant Means For the Future of Healthcare Innovation,” contributed by David Shaywitz in Forbes, “Any one company’s EMR system isn’t particularly compatible with the EMR system from another company, resulting in—or, more fairly, perpetuating—the Tower of Babel that effectively exists as medical practices often lack the ability to share basic information easily with one another.”
So what’s the next step in EMR interoperability? According to Shaywitz, it’s a software-as-a-service-based (SaaS) open data approach that will win out because this architecture provides flexibility, nimbleness, and cost effectiveness. But has the dawn of the lightweight, agile, and cloud-based niche electronic medical record systems truly begun? (Think WebPT for physical therapists.) Or can the dinosaurs evolve? Only time will tell, and these next few years will certainly be pivotal in the digital health landscape.