What is the Problem with Interoperability?

In a recent article by Dave Levin, MD, the astute and experienced physician points out the "reasonable, but incorrect assumption that two installations of the same EMR can easily share data...The hard truth is that every implementation of an EMR is different and even same-brand EMRs do not seamlessly connect." Why not? It seems almost shameless in an industry that has had a directive to achieve interoperability, at least since George W. Bush's executive order 13335 in April of 2004: "Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator".

That order was made over 13 years ago, the same period in which Facebook became the foremost social network in the world (with extreme interoperability), and about the same time that Amazon expanded into jewelry, shoes, and electronics, rapidly becoming the largest retailer in the world and making its founder, Jeff Bezos, nearly the richest man in the world. Why are EHRs not able to obtain the same level of interoperability?

The missing piece is an absence of standardization. Even within a single vendor, achieving interoperable standards is apparently harder than climbing Everest, and less survivable too. A number of organizations have attempted to create EHR standards, notably HL7. Their valiant efforts have been largely ignored. Again one must ask: why? For the most part, one must point a finger at the government's inability to establish and mandate simple interoperability standards. The efforts that have been made have been an abysmal failure.  Meaningful use? Seriously! Many of us say: meaningless use. It is not a standard, it is a hand-tying imposition on progress. There would be no Facebook, no Amazon, if such impediments were operative in the general internet commerce and social media space.

Think of it this way. GE, Samsung, Amana, Westinghouse, all make refrigerators and other appliances. They all seem to work fine on 120v current. Why? because that is the standard, and the companies know that is how they have to be built. What if (as with EHRs), companies were allowed to construct their innards any which way? We would not have cold food, or ice, dishwashers or air conditioning. None of the devices would be able to talk to the electrical grid. But now, EHR vendors can build what they want, can tell potential client hospitals (as well as the VA and the DOD) that they alone have it together and you better stick with them exclusively. Would we not rather choose an EHR based on how easy it worked? Knowing that it spoke the needed language as a baseline. The culprit in this is VA's and DOD's boss. In 2004, George Bush saw it, but the ability to stand up to the big companies that deliver health care tools is absent.

Until the government gets out of the business of trying to tell doctors how to practice and instead tells vendors they have to make EHRs that meet an interoperable standard, chaos will continue to reign.