Interoperability – the express lane to nowhere

Posted on  December 15, 2017


There are several government mandates dating back to the Obama administration as well as certain initiatives by the Trump administration that seem to place interoperability between medical providers as a priority issue with respect to healthcare reform. Not surprisingly, it has and still remains something of an abstract idea. We can all admit that theoretically if a patient came to a doctor or a hospital and the provider had instantaneous access to the patient’s medical history, it would be beneficial to the patient. It is rather elementary to postulate that knowing a patient’s history and having baselines off of which to work are beneficial to the patient.

However, if we try to move this abstract and laudable goal to a more concrete framework, there are a number of issues that come to mind. I will address two of them.

The first issue is that to the extent the government has placed significant emphasis on patient privacy, HIPAA and HITECH (which are important), the harsh reality is that opening closed portals to other medical providers definitionally affects the security of a network. It is entirely possible that secure networks on the one hand and easily accessible networks on the other cannot coexist. However, rather than stumble around trying to develop a framework and implementation that may very well be impossible or incongruent with the current regulatory landscape, why can’t we ask patients to back up their medical history on thumb drives, and ask doctors to have a standalone laptop that is not part of their network so that when a patient comes in they can hand over their memory stick or thumb drive through which (a) the doctor will have access to past medical history, and (b) the doctor will be able to load the patient’s new or updated records onto the thumb drive, or after the visit by secure email send a copy to the patient and the patient can then load her or his records onto their own thumb drive. The reason I suggest a separate off network laptop is so that the thumb drives cannot corrupt the network with viruses. If you are concerned that even off network a thumb drive can wreak havoc, how can we consider having doctors and other medical providers open up their systems to interoperability.

The second issue is that the EMR and EHR companies that have invested significant resources in developing, updating and fine-tuning their systems in fact prefer that information not be easily transferable outside of their software, because they want to maintain sticky relationships with their customers. Is it realistic or even appropriate for the government to have initiatives where the business/proprietary interests of software developers should be undercut? At a certain point, because on the one hand medicine deals with people’s lives, and on the other hand it is big business, there is a general feeling that the business of medicine must make specific allowances because people’s lives are at stake. For example, when big Pharma wants to take a totally business-like approach to pricing the drugs that they have spent billions of dollars to bring to market (and as we all know they are priced at levels that will make you take pause), the general argument is how can they play with people’s lives. However, if a company outside the medical field sold an advanced product at a certain price we would allow market forces to create equilibrium. It is beyond the scope of this post to get into the pros or cons of this argument, but I raise it merely to point out that it exists and that it is not only with big Pharma, but to some extent even with the EMR and EHR software providers, who may be asked to subject themselves to a paradigm that departs from market equilibrium when there may be a simpler solution that can be achieved by moving in the direction of patient involvement, participation and responsibility.

What do you think?

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