Interoperability: Uncovering Simple Solutions for a Complex Problem

Alan Swenson
My wife recently needed some lab work. Our PCP’s office has a lab attached, so the specialist ordered it to be completed there. The specialist and our PCP are unaffiliated and do not share an EHR system. The lab order needed some way to get between the specialist’s office and the lab. They faxed it. No interoperable exchange, just fax, the cockroach of American medicine that won’t die.
When my wife arrived at the lab, they asked why she was there. There was no order in their EHR system, and no record of an order ever having been received. The specialist’s office told us the order had been confirmed. I have no idea where it went, or why it wasn’t in the lab’s EHR system. Luckily, we were able to work with our awesome PCP to quickly get the test re-ordered locally.
My wife was able to get the needed prescription based on the lab result, and the lack of interoperability in this case was merely an inconvenience (though it required duplicate orders to be placed and wasted time from multiple office staff as we tried to get the lab completed). And as I’m writing this, I also realize that the specialist likely still does not have those lab results. Her order has still gone uncompleted, wherever the fax took it. Lack of interoperability is going to require some more out-of-band work from the patient on this one, and likely more faxing to make sure the information gets where it needs to go.
I work in interoperability every day, so I also get to see the tremendous success that is happening nationwide with interoperability efforts. Unfortunately, stories of interoperability not being there are the ones that often get the most news and make it to Congress – leading to interoperability being written into laws.
There are plenty of stories like mine with a lost fax page, and others with more serious consequence (time, duplication of test/procedures, unknown allergies leading to medication reaction, etc.) However, we are also seeing huge leaps forward in the interoperable exchange that is happening. 
  • Carequality sees more than 36 Million patient records exchanged between providers on a monthly basis, and that number continues to increase every month, which includes are a growing number of patient-initiated queries, and queries for payment, coverage, or operational use of data.
  • CommonWell Health Alliance® brought its Carequality connectivity to General Availability late last year and continues to roll out to its participants who are anxious to use the extended connectivity provided.
  • In a joint effort, Carequality and CommonWell has published a Document Content white paper seeking to address long-time issues from difference of interpretation of C-CDA document standards to provide better recommendations for exchanged information.
  • Reporting record growth the past two quarters, DirectTrust™ recently celebrated its 1 Billionth (yes, with a ‘B’) Direct Secure Message sent and received over the DirectTrust network.
  • Carequality is expanding beyond query-based document exchange into FHIR and Subscription-based Notifications, and will even be adding image exchange to its portfolio in the not too distant future.
  • Argonaut, Da Vinci, and others who make up dozens of ongoing FHIR workgroups, the Data Element Library (DEL) from CMS, the Electronic Medical Documentation Interoperability Implementation Guide, the 360X initiative, and the list goes on and on…
I believe we are at the point today where providers are beginning to see interoperability as an expectation rather than an exception, but they need to rely on Health IT vendors and partners to help lead them through the change. About seven years ago I fell into interoperability, not necessarily because I was passionate about healthcare, but rather passionate about doing what it right. I truly believe that enabling the secure flow of health information will help our country enhance the patient experience, improve population health, lower the cost of care and reduce the overall burden on our providers.
I thrive on finding simple solutions to complex problems. Let me be clear, simple may not always be obvious, but I am fortunate to work among other thought leaders in Health IT who share this common interest… where our collective minds can dissect a problem, create a plan and tackle each part until we achieve the whole. In the case of interoperability, we obviously are not there yet, but by applying a simple formula to solve the problems the industry faces with health information exchange, in time I am confident we will get there.  Having health information readily available will become as common as using any banking ATM regardless of your account membership.