Health Interoperability Exposed

Confusing Theuth for the Truth? Don’t Feel Badly…It’s Been Going on For Centuries!

Imagine being at a meeting, where 100 participant each speaks a different language.  How could they have a meaningful conversation?

Ideally, everyone could learn a common language.  This, unfortunately, is a naïve and somewhat arrogant construct.  I remember traveling to Italy many years ago and observing an angry tourist yelling at the proprietor of a charming trattoria, “The world would be a whole lot better if you people would all just speak English!”

Another approach would be to have an unlimited number of translators in the room—enough to translate each language into any other.  In addition to needing a huge room, the logistics would be staggering.  Think of how many single points of failure would exist.  Finally, even if such a system was operational, it is likely that subtle, but often critical, nuances in meaning would be “lost in translation.”

All of this should serve as an obvious and painful metaphor for the current state of healthcare information exchange.

Now to truly have an intelligent discourse, it is essential that each participant be capable of truly understanding the opinions of others, in the language which he or she is most fluent. This begins to touch on what is referred to as semantic interoperability. In healthcare, all members of the care delivery team must be able to comprehend information in a format that they are most comfortable with, while—and this is the important part—the data retains its original and intended meaning.

A bigger challenge is to convince caregivers that access to data does not equate with having knowledge. In Plato’s Phaedrus, Socrates tells the story of Theuth, the inventor of the written word.  After learning of this new technology, the Egyptian king became upset. For he quickly understood that a collection of facts in a single source would not necessarily make his subjects smarter.  By confusing aggregation of facts with the attainment of actual knowledge, they might in fact lose wisdom.

Similarly, interoperability by itself cannot improve healthcare by merely presenting more system specific data points.  Instead it must present information in a meaningful and efficient way in order for caregivers to fully comprehend and process it as knowledge.

As information continues to increase at a rate much faster than the availability of new medical devices, the imperative to accomplish this goal could not be greater.

My “Geeky” Obsession Confession

I have been a Family Practitioner for almost 20 years.  When I decided to implement an EMR in my 4 office, 5 doc practice 8 years ago, the term “interoperability” was not one that I frequently used.  None-the-less, I was increasingly frustrated when patients saw me in more than one office, and I did not have their medical records.  Instead, I had to fax a portion of it.  The sheer coolness of an EMR was surprisingly matched by a first year ROI of $60,000 and a huge increase in productivity.  But “interoperability” between offices was the biggest benefit.
 
Because of my evangelical-like advocacy, I was tapped to be the physician champion and later CMIO for a CPOE project at my community hospital.  We immediately had 100% adoption, resulting in nearly 80% reduction in pharmacy errors within the first 6 months alone.  Don’t let me imply that this was easy, I still have the scars on my back to prove it.  Asking dedicated physicians, who are at the top of their game, to change the way that they practice always requires a leap of faith.  Decision support remains an  unmet mandate.  Alert fatigue and lack of true enterprise-wide intelligent rules continues to frustrate.  Still, it gives me great pleasure to know that 4 years later, almost everyone agrees that they could not go back to paper.

Needless to say, continuing to practice primary care medicine, while having the experience of EMR adoption in both the ambulatory and acute care settings, has given me a rather unique perspective on the needs, benefits, and frustrations of data sharing.
 
In my current role overseeing semantic interoperability projects, I have come to understand the further complexities of incomplete ontologies, imperfectly controlled medical vocabularies and the insanity of multiple standards.   What I used to think was a rather esoteric area of medical informatics, has now become almost an obsession (OK, I admit I’m a geek).  The truth is, many of the problems facing healthcare today, will only be solved when we can easily start exchanging knowledge—not just data—while maintaining a reasonable work-flow.

The purpose of this blog is to shed some real-life perspective on these issues. Hopefully, I can educate a little, while learning a lot.