True Interoperability: Public API’s Provide the Open Platform Health IT Requires

Edmund Billings, MDDo we finally have the spark? Interoperability is the current health IT buzzword because it’s the essential ingredient in creating a system that benefits patients, doctors and hospitals. Almost everyone in healthcare is pressing for it and is frustrated, though probably not surprised, that Meaningful Use did not get us there.

The ONC says within three years we’ll have a roadmap for providing interoperability “across vendor platforms,” which should probably elicit a collective groan. Look, a map is a fine tool but of limited use if I don’t speak the language. Change in this industry requires market drivers instituted now, if not sooner. We must move from MU to a health care payment model driving True Interoperability, not the garden-variety stuff.

What should True Interoperability be in health care? From the following definitions we can pick the best of the lot.

 1.   The ability of two or more systems or components to exchange information and to use the information that has been exchanged.
The Institute of Electrical and Electronics Engineers (IEEE) posting on Wikipedia (http://en.wikipedia.org/wiki/Interoperability)

Too narrowly tailored, this definition covers “interface-ability” or basic data exchange. It lacks context and collaboration, which is required for care across systems. There is no mention of the technical challenge and costs that can make even this narrow goal a difficult one.

Compare that with another interoperability definition, also found on Wikipedia:

2.   Interoperability is a property of a product or system, whose interfaces are completely understood, to work with other products or systems, present or future, without any restricted access or implementation.
Wikipedia (http://en.wikipedia.org/wiki/Interoperability)

With this definition, we’ve moved a step beyond simple data exchange, which is helpful. But health care has arguably unique challenges with interface variance and restrictions on access and implementation created by complexity, huge costs, and closed platforms and business models. Established data exchange standards within a restrictive business model yields closed records.

So, can we get closer to a definition that really has traction?

3. Interoperability is the ability of making systems and organizations work together (inter-operate). While the term was initially defined for information technology or systems engineering services to allow for information exchange, a more broad definition takes into account social, political, and organizational factors that impact system-to-system performance. The task of building coherent services for users when the individual components are technically different and manage by different organizations.
Wikipedia (http://en.wikipedia.org/wiki/Interoperability)

This definition nails the requirements for continuity, coordination and collaboration to help transform our health care “system.” In particular, I think we should pay close attention to the message in that last sentence; coherent services focused on different components and from different organizations =True Interoperability.

We must shift from basic interfaces to open and public access that allows systems to interoperate. We need Application Programming Interfaces (APIs), which some think is pure fantasy.

Indeed, health care and health IT are plagued by delusion, but not among those who have watched the automation of every other industry. As Micky Tripathi, president and CEO of the Massachusetts eHealth Collaborative and co-chair of the independent scientific task force JASON, said, "Kendall Square [home of MIT] and Silicon Valley are laughing at us."

In April, JASON released a report on the "robust health data infrastructure" required for health care. The report calls for publishing as many API’s as possible and proposes a strategy “modeled after the principles that have allowed the Internet to scale—a core set of tightly specified services that enable multiple heterogeneous ecosystems to emerge.”

Tripathi says Washington should align all programs around an API strategy and use the government’s tremendous purchasing power to move the market. "I'd like to see a world where you get paid because you have good informaticians," Doug Fridsma, MD, former chief scientist at ONC and now CEO of AMIA, recently told Healthcare IT News,

Hmmm. Require public API’s and let the market drive True Interoperability? Sounds like we have a winning definition. Now, if only we had some public API’s lying around … It turns out HL-7 is testing a product called Fast Healthcare Interoperability Resources or FHIR (pronounced fire).

According to Charles Jaffe, CEO of HL7:

FHIR represents a departure from the notion of messaging and document-centric ideas. It uses technology that everyone is familiar with and it's very, very easy to implement. That's the real key to this, the fact that it's not only an effective solution, but it's a very cost-effective solution. That's what makes it unique.

So, are we finally lining up all the ingredients necessary for True Interoperability? A set of public API’s can open up interoperability to all developers who know web technology. Government purchasing power can dramatically alter the existing market. A small spark and gusting winds enable the fire to spread.

The question is still which vendors will seize this opportunity and serve the market and which will protect their locked-in client bases. Insisting that the wind isn’t changing direction to put you right in the fire’s path is not always a sound strategy. Can’t wait to see whether or not the wind starts to blow.  

Edmund Billings, MD, is chief medical officer of Medsphere Systems Corporation, the solution provider for the OpenVista electronic health record.