What’s in a Word?

April 1, 2007

Well, we’re just back from HIMSS and it was a great show. Enthusiasm was high and the technology sparkled. By our measure, the show also was noticeably larger than previous years. At least our aching feet told us so. As is our habit, we asked those with whom we met what trends they’d spotted that differentiated this show from the last. The answers surprised us. Interoperability, they said, almost to the last, was the growing trend. Now, if you’ve been reading this magazine for the past two years you know that interoperability has been covered in HMT’s pages for at least that long. So to us, the topic isn’t new. However, it did gain momentum in the past year, what with EHR CCHIT certification, which apparently put it on the radars of many in attendance.

Well, we’re just back from HIMSS and it was a great show. Enthusiasm was high and the technology sparkled. By our measure, the show also was noticeably larger than previous years. At least our aching feet told us so. As is our habit, we asked those with whom we met what trends they’d spotted that differentiated this show from the last. The answers surprised us. Interoperability, they said, almost to the last, was the growing trend. Now, if you’ve been reading this magazine for the past two years you know that interoperability has been covered in HMT’s pages for at least that long. So to us, the topic isn’t new. However, it did gain momentum in the past year, what with EHR CCHIT certification, which apparently put it on the radars of many in attendance.

It’s in an editor’s nature to be inquisitive. We were curious as to what interoperability truly meant to all those folks bandying the term about, apparently for the first time. So we asked, “What does interoperability really mean?” To their credit, few people balked and though no one appreciates a pop quiz, everyone happily answered the question. What troubled us was the answers were entirely subjective. They ranged from “It means my EMR can talk to another EMR,” to “I’ll have my people get back to you on that.” We quickly realized that, while most of those polled knew how to use the term in a sentence, many didn’t have a clear understanding of what it meant, and what it would ultimately mean to the industry as a whole. It had entered their marketing lingo. They just couldn’t define its actual purpose.

Webster’s New World dictionary defines “Interoperability” as “The ability of a system or component to function effectively with other systems or components,”—sort of like playing nice with the other kids in the schoolyard.

However, government mandates aside, what incentives exist that drive disparate companies in competition with each other to build systems that share information? Altruism? Please. This is business. Were it not for the mandates, would the free market be heading in this direction? It seems unlikely. Imagine the government mandated tomorrow that all U.S. automobile manufactures build cars that could interchange parts with each other. Would that affect the automobile market as a whole? Would such a mandate stifle competition? You betcha. How would Ford set itself apart from Chevrolet? What would happen among third-party component manufactures? The true reason for interoperability is bigger than business.

To further convolute matters, many of the systems in question aren’t hardware-based at all—they’re software. Not to mention the Internet-based companies and Application Service Providers. Think of the challenges involved getting Macs and PCs to link up and share files. Now envision that times hundreds of companies and thousands of applications across a region or nationwide. There’s much more to the whole affair than simply sharing health data in the name of patient safety, or improved remittance. A working RHIO or NHIN means pandemics can be spotted and hopefully stopped before they breakout. It means cardiac arrest patients have a much better chance of finding a donor heart. It means rare blood can be found while there’s still time to save the patient. It means the health of our nation, belongs to its people. That’s the nut interoperability promises to crack. Can it be done? I hope so. Much is riding on the attempt.

What does interoperability really mean? It was a trick question.

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