Lowering the Cost of Interoperability

June 1, 2015 |
Carequality Blog

We all agree that solving our nationwide health information exchange challenges would have a positive effect on both the outcomes and the efficiency of the healthcare system. So why is it such a seemingly slow process? To me, the most important challenge is the lack of economic incentive to invest in health information exchange. There certainly are other challenges to overcome, but if the fundamental business drivers for healthcare were aligned with information sharing, we would find ways to address the other challenges pretty quickly.

Healthcare is often compared – unfavorably – with the financial sector when it comes to electronic information sharing. But consider the incentives. Financial markets depend on linking compatible buyers and sellers. Without information sharing that allows the two parties to be identified, the market doesn’t even exist. Fortunes turn on the ability to move information quickly and efficiently. It should come as no surprise that financial information systems are highly advanced and highly interconnected.

The business of healthcare is quite different. Physicians have historically treated patients as they present themselves, with a goal of resolving a particular concern and restoring the patient to full health. Having additional data about that patient’s health history may be helpful, or even critical, but in many cases the patient or a family member can fill in enough of the picture to guide the physician’s own observations and analysis. There certainly are times when every second counts, but in those cases the immediate focus for both the clinical team and the IT systems supporting them is on the urgent protocol steps needed to save the patient’s life.

None of this is to say that interoperable IT systems in healthcare aren’t important. Much of my professional life has been dedicated to making health IT systems work better together, and I fully understand the value of interoperable systems in enabling the health system we all want to see. We need to be realistic about the economic dynamics, however. When interoperability comes at a cost, it’s always going to be subject to prioritization, from both the technology developers and the providers they serve.

We can work to gradually change the economic incentives, and the move toward value-based payment models is a huge step in the right direction. Such a fundamental shift, however, will take considerable time to complete, and we rush it at our peril. What can be done in the meantime?

The most important step is to lower the costs that currently can be a barrier to investment in data sharing. Technology vendors play a role in this area, but are by no means the only source of costs, and in any case vendors face costs, themselves, in developing support for data sharing. Carequality can help lower costs to both vendors and providers. Here’s how we do that:

  • We create one legal agreement that works for all participants, removing the cost to healthcare organizations of establishing one-off agreements with many business partners.
  • We provide for data sharing between and among data sharing networks, reducing the need for healthcare organizations, particularly large organizations that span a wide geographic area, to join multiple data sharing networks.
  • We identify technical standards while clarifying ambiguous points and removing optionality, simplifying the development task for technology vendors and providing for a reasonable expectation of connectivity across diverse players.
  • We provide access to a large number of data sharing partners in one step, increasing the likelihood that records will be available if a search is performed, which in turn increases the likelihood of user adoption and the return on investment in the connection.

We encourage you to join us in reaching our common nationwide health information exchange goals:


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