The acute perils of non-interoperability

Feb. 9, 2022 / By Steve Cantwell

When I came to 3M Health Information Systems 20 years ago, the vital importance of interoperability—to efficiently exchange health care data—captured my attention right away. At the time I was new to health care IT and I worked closely with a 3M linguist from the medical terminology team who taught me that no level of interoperability could occur in health care without a common language. We needed semantic interoperability. The data systems had to talk to each other before clinical data could be shared between physicians, health care sites and insurance companies.

To make his point, he told me the harrowing story of a nine-year old girl getting three spinal taps during a short course of treatment. This child endured this dangerous and painful procedure repeatedly when once was more than enough. Unfortunately, due to variance in medical terminology and the many technical barriers to sharing the test results between data systems and physicians, this child suffered unnecessarily. What I’ll call “non-interoperability” also delayed diagnosis, treatment and reimbursement—and increased costs.

With the need being so acute and obvious, back then I naively imagined a leap forward in overall interoperability must surely be near at hand. Yet here we are decades later still at it.

So, what’s taking so long? Interoperability is unavoidably complex. Fluid data exchange must be balanced with rigorous information security and privacy policies. Personal health information must be protected. Robust identity infrastructure is crucial to help health care organizations balance IT security with urgent interoperability needs and compliance regulations. And the same is true for financial data and many other types of protected information.

Still, many unnecessary barriers to interoperability persist. We all encounter these barriers with educational systems, government institutions, web sites, legal and accounting firms, even online retail stores, and of course with pharmacies, clinics and hospitals. We answer the same questions and fill out the same forms again and again. This repetitive effort is costly and burdensome to both individuals and organizations. The key is finding the right balance. To provide quality health care, crucial clinical data needs to be quickly accessible at the right time and place. 

This summer I encountered acute non-interoperability in a personal way that helped me better understand the scope of the challenge the health care industry faces. Our family home was flooded due to a construction accident. Contractors at a nearby high school construction site crushed a sewer main. The contractors did not repair it and when a severe rainstorm hit, sewage flooded 10 homes.

We suffered more than $60,000 in damages and found ourselves in a pitched battle with construction companies, subcontractors, attorneys and insurance companies. For each of these we had to provide the very same photos, videos, receipts, damage assessments, repair estimates and testimonials. Even our own homeowner’s insurance company required us to submit the same documentation to multiple departments. You can imagine the countless emails and phone calls. It took more than four months to resolve the claim. The only possible benefit of this experience was to earn the equivalent of a graduate degree in the craft of persuasive communication.

The point is we all experience the perils of non-interoperability. It surrounds us. So much of it is unnecessary and we must find ways to improve. In health care, the stakes have never been higher.

The urgency of containing COVID-19 infections, protecting health care workers and vulnerable populations, and tracking testing and vaccinations, is forcing us to speed up progress for interoperability and finally begin to overcome persistent barriers.

For example, the eHealth Exchange collaborates closely with the Association for Public Health Laboratories (APHL) to send millions of COVID-19 testing and diagnoses reports to the Centers for Disease Control and Prevention (CDC) and other national and state agencies (in all 50 states).

In a recent interview in Healthcare IT News, Jay Nakashima, executive director of eHealth Exchange, said the pandemic has pushed transaction volume dramatically—to well over 12 billion transactions annually—and counting. Because accurate health care data is the lifeblood of care delivery, the eHealth Exchange focuses on data quality and ensuring the right terminology is used. For example, it’s essential to use a LOINC code for lab results (such as COVID-19 tests) rather than a homegrown code unique to a state agency. What is the “right” terminology? Nakashima clarifies it is RxNorm codes for medications, LOINC codes for lab results and SNOMED codes for everything else.

In 2021 the U.S. Office of the National Coordinator for Health IT conducted an intriguing survey that offers a glimpse of what interoperability will look like in the future. Here are a few notable highlights of what’s coming (Click here for more highlights and to dig deeper into survey results).

• Individuals will no longer fill out paper forms for any health care encounter or process
• All referral and transition of care data will be electronic
• Patients will be able to seek care without having to provide information themselves, while still controlling how their data is shared
• Public health response and preparedness “will be driven by real time data to quickly identify when and where infectious disease outbreaks occur”
• Access to representative data sets will enhance medical research and discovery by allowing comparison to real world performance of treatments, procedures, devices and drugs

In December 2021, the Center for Medicare & Medicaid Services (CMS) administrator Chiquita Brooks-LaSure updated the health care industry on progress and next steps toward better interoperability in U.S. health care. She clarified why CMS is committed and how they will help “improve data exchange across the health care ecosystem, including public health systems, for better communication of care, clinical decision making, and a high quality of care for patients.”

This week I experienced improved interoperability for myself when my family of four was tested for COVID-19. Yes, we had to wait in a three-hour queue of cars to get the test, but I was impressed by how efficiently we received results (our tests were negative) and especially by how the front line health care workers—the ones in the protective gear wielding the swabs at the testing site—quickly adapted to patients who struggled with the registration technology on their smart phones or needed to update identifying information or simply showed up for testing without a reservation. Clearly, these health care workers were connected to the right systems to exchange data quickly, identify patients and complete the vital tests. 

These recent breakthroughs and glimpses of the future are encouraging signs we’re getting closer to the right balance between security, privacy and interoperability.

Steve Cantwell is a senior marketing communications specialist at 3M Health Information Systems.