Health IT vendors are at a critical point when it comes to their role in interoperability. While the government has criticized vendors for "information blocking" and vendors face accusations that business principles trump their mission to sharing information, vendors themselves are overcoming barriers to information-sharing that are embedded in the healthcare industry's processes and procedures.
Here, Mark Janiszewski, executive vice president of product management for EHR vendor Greenway Health, offers some thoughts on interoperability, issues to achieving interoperability and how health IT vendors can work together to effectively share healthcare data.
Note: Interview has been lightly edited for length and clarity.
Question: Different folks offer slightly different definitions of interoperability. How do you define it?
Mark Janiszewski: We've recently gone through a very rapid period of EHR adoption so that we now have patients' medical records in electronic form. When I think of interoperability, I think of how we can share that information electronically between all the people that need to have access to it — whether it's providers sharing amongst themselves, insurers who are interested in clinical data they wouldn't necessarily get within the claims, or providers sharing information with their patients.
Q: Is there an element of real-time access and being able to modify data?
MJ: Real-time [access] is important for certain cases. I think of a patient who wants to look up information or [who] has a new provider and wants to see if that chart exists and where they can get their hands on it. I also think information needs to be machine-readable or codified. We're consistently trying to make sure we talk about the same diagnoses, procedures and problems in the same way. By having health [data] codified, we can make sure we're talking about the same thing even though there are many different ways to describe it.
Q: Can you paint a quick picture of the current state of interoperability?
MJ: Maybe because not many people had EHRs in the past or because it was relatively new, but nobody was really asking to share their data electronically until recently. We all were very comfortable with the fax machine. It seemed like on a Tuesday last October, everyone felt like they needed to be connected electronically. Our demand to be connected to providers, state health exchanges and payers went up exponentially. We're in a natural evolution of first taking the data and content you have, and second trying to connect it to your network. That's what we're working through right now. With multiplying factors like value-based reimbursement and reporting on quality, it has really accelerated the demand for discrete data to be exchanged and aggregated. We're catching up from a tech perspective, but we're still a little behind. The demand for interoperability is outpacing our ability to deliver it — especially in a cost-effective and efficient manner.
Q: Do you view interoperability as a tech problem or a political/economic problem?
MJ: I consider the interoperability standards to be a technology issue, but I don't ascribe that to the word "political." The organizations that set these standards are typically independent and not driven out of a political system — or even a government system. It's also an economic problem. We have what I would call a "loosely-defined" standard that's subject to interpretation. At the end of the day, for two systems to figure out how to convert and communicate, there's some level of manpower, hours and efforts that are required. If you're a for-profit organization, this results in having to charge somebody for their time. There's a cost for interoperability, and that's where we get a lot of talk.
Q: What is the key barrier right now to reaching interoperability?
MJ: We have loose interoperability standards in a lot of cases that allow different systems, vendors and end-users to implement [IT] in different ways. It's not a given that if I offered to send you patient demographics from my system that you're going to be able to receive them in your system, and vice versa. Especially in the area of population health, the need for codified data has quickly outstripped the current standards for packaging, digesting and consuming this data. People are going way above and beyond looking for ways to do that [in a] nonstandard [way] while waiting for the definition to be included.
Q: How do you work with other vendors to open access to data, share it and allow it to move?
MJ: We work directly with our customers’ vendors and their affiliated hospitals where they want to connect. We also participate in collaborations and forums with other health IT vendors where we get together and talk about how to advance the cause and grow the interoperability standards. We have been participating in and are founding members of consortia, like CommonWell Health Alliance and Carequality. It's hard to say which one of the consortia will be the one to prevail or whether they all [will] be necessary and have their own use cases, so it's important to be participating and connecting with all of them.
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