The U.S. healthcare industry has gone through waves of groupthink around questions about how the leaders of patient care organizations should think about software vendors as a collective. At one point, the consensus was that best-of-breed vendor selection strategies were best. Then, as patient care organizations moved forward to buy and implement electronic health record (EHR) systems and related clinical information systems, a massive shift in sentiment took place, with large numbers of CIOs, CTOs, and others endorsing the idea that the so-called “big box” EHR vendors could give them nearly everything they needed; single-source had suddenly become all the rage.
Fast-forward to the past few years: thinking has once again shifted. And in the present environment, more and more provider leaders are realizing how rudimentary are the offerings of their core vendors in specialized areas like analytics, population health and care management, and revenue cycle management. So providers are in many cases turning away from their core EHR vendors as they plunge into accountable care and population health.
Fran Turisco, associate principal at The Chartis Group, a Chicago-based consulting firm, says that it is precisely as patient care organizations shift towards value-based care delivery and payment or expand through acquisition and consolidation, that the demand for interoperability becomes so much more urgent. “I think that what we’ve seen on the care delivery side has moved to consolidation for EHR applications when it’s in alignment with the organization’s business model,” the Boston-based Turisco says. “But when organizations move beyond their walls to get to predictive analytics and take in data from other sources (e.g., merger-and-acquisition situations and other affiliations, clinically integrated networks, collaborations for population health programs like DSRIP, communities and research), that’s when there are interoperability challenges. Even on the care delivery side, the CCDA is the data exchange vehicle that many vendors use, but the exchange still requires some configuring.”
Fran Turisco
None of this is exactly new, though, notes Bill Reed, a partner in the Moosic, Pa.-based Huntzinger Group. “I agree with the premise of the need for interoperability, and the need to achieve it more quickly. On the other hand, this is a problem we’ve been facing for more than 15 years, and we’ve never adequately addressed it.” Still, Reed says, “Whether we’re talking about providers or consumers/patients, there is a growing expectation for it, and growing awareness of how it should be.” Consumer expectations of data agility and availability in areas including financial services and retailing are now coming true in healthcare, he notes. “And quite honestly,” he adds, “as we take a look at more and more patient-generated data, whether that’s coming from the FitBits of the world or whether it’s patient-generated data in the PHR [patient health record]—the fact is that we can’t yet even combine data from within the four walls of organizations themselves.”
How Real?
For all the immediate challenges facing healthcare providers, the Chartis Group’s Turisco believes that “The future of interoperability will move beyond the basics of data exchange. The next phase of interoperability is about relationships, collaborations and new ways to work together in order to achieve the strategic imperatives for the industry, organizations and patients.” That will be particularly true when it comes to the shift towards population health, accountable care, and value-based delivery and payment, she says.
So how is all this playing out on the ground? The landscape is decidedly mixed, says Mark Rauschuber, CIO at UT-Southwestern Medical Center in Dallas. “I think the vendors are moving forward cautiously right now, trying to figure each other out, doing baby steps. Some of the bigger vendors, they want to know whether they should be getting into specialized markets, so they’re leery about sharing with a potential competitor, lest that cooperation hurt them in the future. But we need interoperability now for our operations,” says Rauschuber, whose organization is a participant in the Medicare Shared Savings Program for ACOs. “I’d like to think it would be done altruistically, but really, it’s going to be baby steps working with the vendors together for now,” particularly given that data interoperability standards have yet to be adopted at deeper programming levels.
Mark Rauschuber
So are vendors beginning to work together successfully? “They are trying, but they need to have specs that they all agree to use,” Turisco says. “Certification is a good example” of how success can be pursued. “A third-party group develops the standard and then the vendors design their systems to meet the standards.”
In the meantime, how should CIOs and other healthcare IT leaders pursue a forward path in this area? “When selecting a solution,” advises UT-Southwestern’s Rauschuber, “try to see how open the bigger vendors are to working with others. How open is their architecture? How open are they to different APIs, and to sharing their data more efficiently and more easily?”
On an industry-wide level, some things are indeed happening now. For example, in January, the leaders of the Sequoia Project announced that five major EHR vendors had agreed to adopt the interoperability- and health information exchange-focused group’s Carequality Interoperability Framework, which, according to a Jan. 21 press release, “will be easier and less costly because each vendor will work with one set of legal agreements that apply to all other participants, rather than seeking individual legal terms with other vendors.” Meanwhile, on Feb. 24, the CommonWell Health Alliance announced in a press release the availability of its cross-vendor interoperability services to the post-acute care market.
The extent to which these and other initiatives achieve some level of success will only become apparent over time, of course. But what is clear is that providers will increasingly find themselves putting more pressure on their vendor partners to, well… partner. After all, the success of so many initiatives will depend on their vendors working together to achieve practical interoperability—no matter how rocky the road to actual interoperability might turn out to be.
