Car Crashes, Auto Bumpers, and HealthIT Interoperability

When meeting someone new at a party, or some other social networking event, we are often asked about what we do professionally. “Where do you work?” or “What do you do?” This is a common and quick way to find a common understanding of the person and their background and to ultimately begin a meaningful conversation with the person you’ve just met.

Recently in this situation, I’ve been telling people that I am a “Cognitive Ergonomist” working in HealthIT. Depending upon the situation and their level of understanding of that phrase, the person that asked me the question either knows, or doesn’t know what I do for a living.

If they don’t understand, I tell them to think about sitting on the seat in their car. If they have a modern vehicle it probably has an adjustable steering wheel, the height of the seat can be adjusted to match their height. Some times the bottom of the chair has special contours to better match the shape of their bum, of maybe offers special Lumbar support. This is user-centered-design for automotive hardware (aka “Ergonomics”). The developers of the seat knew that humans would be sitting in the chair and they made special design considerations to make the chair better match their users.

Those that know me know that I’ve made numerous mentions of the analogies between the automotive industry and the (healthcare) software industry (see for example “Crash test dummies and the usability of HealthIT” or “What is Usability and User-centered Design? ”).

Ralph Nader's book Unsafe At Any Speed raised public awareness of some of the safety problems associated with the Chevrolet Corvair. Nader’s book, however, was also an indictment of the auto industry as a whole and served as a lightning rod for legislation establishing what would eventually become the National Highway Transportation Safety Administration (NHTSA).

These two industries, HealthIT and automobiles have quite a lot in common including that they are both highly regulated. These regulations exist because in both industries poor design can lead to safety issues and the possible death of their user’s. See The Joint Commission Sentinel Alert 54 on the Safe use of health information technology, and From Benz To Bumpers: A Brief History Of Auto Safety.

At this year’s HIMSS conference, interoperability was again one of the hottest topics of discussion. Interoperability was even a featured showcase at the HIMSS Interoperability Showcase. Yet the lack of interoperability in HealthIT remains.

HealthIT is not unique in its interoperability woes and other industries, including the automotive industry, are still struggling with associated safety issues.

Passenger vehicle bumpers

To meet federal rules, car bumpers must be 16 to 20 inches off the ground and limit the amount of damage that can be sustained in a low-speed crash. The idea is to ensure that the bumpers on colliding cars engage, absorbing most of the energy of the impact and keeping damage away from expensive-to-repair parts like fenders, grilles, headlights, and taillights.

"When cars collide with other cars, their bumpers usually line up pretty well," says IIHS president Adrian Lund. "But in SUV-to-car crashes, the bumpers often don't match up at all, and the result is thousands of dollars of unnecessary damage in low-speed crashes."

Blue Button and EHR Interoperability

The U.S. Department of Veterans Affairs (VA) first used the Blue Button logo on its patient portal in 2010. By clicking on the button, individuals could download their medical records in digital form. Since then, millions of Veterans have logged onto the tool to download their personal health information. Recognizing the success and potential of the Blue Button, in 2012, the Office of the National Coordinator for Health IT (ONC) within the US Department of Health and Human Services (HHS) took on the responsibility for taking it nationwide, in collaboration with the VA, the White House, and a host of other public and private sector leaders. For more on Blue button see here.

As part of the ONC’s Meaningful Use stage 2-certification program for health information technologies, EHRs were required to be able to import medical records in C-CDA file format for a patient’s medication, allergies and diagnoses. For more on CDA files and Meaningful Use stage 2 see here.

Although this is not interoperability and despite obvious security issues associated with sharing data this way, it was the first step in patients being able to obtain and share their medical information using a thumb drive.

By the year 2024, HHS wants interoperability between disparate electronic health records systems (EHRs) to be a common capability. Late last year, ONC released their Interoperability roadmap, a 10 year plan that lays out a clear path to catalyze the collaboration of stakeholders who are going to build and use the national health IT infrastructure. See A Shared Nationwide Interoperability Roadmap version 1.0 for more in the roadmap. There are still many unsolved challenges in HealthIT interoperability, see the article Are Patients Ready for EHR Interoperability?

Federal law mandates that car bumpers must be between 16 and 20 inches off the ground, but all the other vehicles on the road, including semi-tractors, trailers, buses, trucks, vans, and SUVs, have no obligation to have bumper heights to protect passenger cars in collisions. The Federal bumper standard does not apply to vehicles other than passenger cars (i.e., sport utility vehicles (SUVs), minivans, or pickups trucks).

Both the healthcare and auto industries seem to be struggling with various consortiums of different vendors each with different concerns. Some are pushing for, and actively sharing safety innovations, like the three point safety belts were pioneered and shared by Volvo. Others are blocking data sharing, and hording their data because of a huge financial incentive to do so. When safety is so important to all of us, I’m not sure why everyone can’t just get along?