3 Conditions that Must be Met to Make Interoperability a Reality

interoperability, rope, braid

The term “interoperability” holds different meanings for different people. While we all would agree that the primary goal of interoperability is to make sharing data easier in order to improve outcomes and lower costs, there are varying perceptions about what that looks like. FHIR has been great at giving us a common set of protocols and standards to work from, but how we connect and how data actually gets shared are still open challenges.

In a truly interoperable healthcare ecosystem, I strongly believe data wouldn’t need to be requested, aggregated, and validated each time it’s needed. And it wouldn’t be limited to specific exchanges, systems, or enterprises. Instead, it would be continuously refreshed, always current, and always accessible in real time to those who have the permission to access it. Much like your available balance in a bank account or credit card is accessible almost anywhere in the world in real time. Or how your seat assignment automatically updates on the electronic boarding pass on your cell phone with most major airlines today.  It is THIS type of data access and interoperability that will completely revolutionize the way healthcare is transacted.

How close are we?

There is no question that we have a long way to go to achieve this level of interoperability, but I do think we’re getting much closer. The technology available today, if fully utilized in a secure trusted way, can help the industry take a giant step forward.  The way I see it, three conditions must be met before we can say we have meaningfully progressed towards this vision.

1. The patient experience must become a tangible, measurable strategic goal. It’s about more than patient portals, shorter wait times, and improved safety, although those are all important to the patient experience – it must encompass the administrative processes that run behind the experience. The focus on patient experience requires seamless real-time information sharing between payers and providers. Especially when it comes to eligibility, coverage, prior authorization, and claim processing activities.

2. We must think beyond the tools we have. You know the saying about doing the same thing over and over again but expecting different results. Most healthcare organizations—payers, providers, and vendors alike—have invested millions in disparate systems and bolt-on solutions with project goals to get closer to real interoperability, but the systems remain mostly disconnected and encumbered by more and more technical debt to yield small incremental improvements. While this “incrementalist” approach can and often does yield positive results, in most cases this actually takes us further from true interoperability as technical and process debt is accumulated making these processes ever more complex. There are manual processes and teams of people to keep them running. There are so many layers of middleware, point solutions, connections, and vendors to keep the legacy systems and processes running, organizations find themselves with a growing share of their available IT and staffing dollars consumed with “running the business” rather than available to improve or “change the business.” It’s time to think differently about how we interconnect and the tools we’re using to achieve the data fluidity we need.

Healthcare lags far behind other industries when it comes to interoperability. Banking is a prime example. Anyone can send or request money from anyone else using an app like Venmo, regardless of where either party banks. The transaction is conducted seamlessly, and users are alerted when the transfer is complete and the money arrives in their account. Just think if coverage determinations or prior authorizations were redesigned to be this simple! We have to think beyond our existing sets of tools and systems and courageously embrace “possibility thinking.”

3. We need to reimagine interoperability. As an industry, we can achieve greater interoperability by looking beyond APIs, data exchanges, messaging tools, and closed-network solutions. I’m not saying we need to abandon these, in fact they are key to how transactions process today and should be leveraged differently, but we need to start building a new picture of interoperability, one not limited by our current reality. For example, what if we could create a single, decentralized network – a healthcare data fabric – for all clinical and administrative transactions? Payers and providers could continue to control their own data, but they could commit to making that data discoverable by those allowed to securely access it, including patients. What if that data was always current and available without faxes, emails, and phone calls? What could you do with the resources currently assigned to tracking down data?

 We need to start painting a picture of a completely reimagined healthcare experience without applying our current limitations, technologies, and organizational and departmental priorities and incentives. We need to completely reimagine what healthcare should be and begin to work toward making it happen.

It’s time to get real

The U.S. spends more than twice as much on healthcare administration than other wealthy nations, at least half of which is administrative waste. Some estimate this results in over $1 trillion in administrative spend in the U.S. annually.  We can all agree that our current system doesn’t work as well as we all would like. So why are we trying to tweak what we already have in hopes that it will get better? What we really need to do is reinvent the system. How the data flows.  I’m not talking about starting over or throwing out existing systems—at least not yet. I am suggesting we invest our efforts to think beyond our current solutions and reimagine what true interoperability could look like in an ideal healthcare ecosystem. Can we make progress in reimagining how healthcare works in 2023? I believe we can. We must. We will.