Where’s the plan for interoperability?

Healthcare IT News September 22, 2014

It is a simple question: “Why doesn’t electronic health information flow after the nation spent $26 billion on electronic health records?” Suggesting a 10-year timeframe or arguing that there is progress if you look hard enough just doesn’t answer it.

Congress does not think so either. Despite the HITECH funds’ accomplishing a significant degree of EHR adoption there is still a large amount to do to achieve modest interoperability. And the question posed above is going to politically fester until something significant is done.

Part of the interoperability problem is that only a limited amount of the HITECH meaningful use leverage has been used to encourage data exchange. Interoperability took a back seat to adoption of EHRs and other things in meaningful use plans.

But another part of the problem is that there is no real technical plan. From a health IT perspective, the kind of “plan” that is needed would describe high-level functional needs, identify important technical elements, and show how they all fit together. It would be an architectural blueprint to guide technology in the very complex, loosely coupled system that is the health sector. And it would strategically articulate critical, but limited, pieces of the national health IT infrastructure. It would also show how what exists needs to be supplemented and changed to achieve the future state. It would be, in short, more of a high-level technical architecture than a roadmap.

A roadmap can help too but the nation needs to know where it wants to go in order to use a map for how to get there. Some, who not infrequently would rather go their own way, attack the word “architecture” as meaning “top down control.” So call it a “technical plan” or a “framework,” call it a “design pattern,” a “schematic” or whatever you want; interoperability will suffer until we have a picture that helps articulate and guide where we are going.