Electronic Health Reporter

In a drive for standardization, the proposed U.S. Core Data for Interoperability¹, mandated by the 2015 21^st Century Cure Act², calls for the identification and refinement of a basic set of clinical data to be required for all electronic health records. The American Medical Informatics Association, however, recommends that healthcare researchers and providers concentrate on sharing data as quickly as possible, deferring the creation of standards until sometime in the future.³ “This is a false choice and a distraction,” said James D’Arezzo, CEO of Condusiv Technologies.

D’Arezzo, whose company is the world leader in I/O reduction and SQL database performance, adds, “What the healthcare industry really needs to focus on is enabling its heavily overburdened IT infrastructure to do the job it’s being asked to do.”

The industry’s preoccupation with interoperability and standardization, notes D’Arezzo, is perfectly understandable. Turf wars over proprietary interfaces and protocols are having a major impact on healthcare IT budgets.⁴ Non-compatible electronic health records contribute significantly to the fact that computerized record keeping consumes more than 50 percent of the average physician’s workday, which now stretches to more than 11 hours.⁶ Healthcare organizations struggling to process this tsunami of data are frustrated by the number and variety of analytics tools they are forced to use.⁶

Supporting all this activity, however—unnoticed and, says D’Arezzo, dangerously neglected—is the basic computational machinery itself. Data analytics requires a computer system to access multiple and often far-flung databases, pulling information together through millions of individual input-output (I/O) operations. The system’s analytic capability is dependent on the efficiency of those operations, which in turn is dependent on the efficiency of the computer’s operating environment.

According to experts, the most widely used operating system, Microsoft Windows, is in many ways the least efficient. In any storage environment, from multi-cloud to a PC hard drive, Windows penalizes optimum performance because of server inefficiencies in the handoff of data to storage. This is a problem that, untreated, worsens with time. The average Windows-based system pays a 30 percent to 40 percent penalty in overall throughput capability because of I/O degradation.⁷

The good news, said D’Arezzo, is that I/O degradation is a software problem, one for which relatively inexpensive software solutions exist. Dealing with it does not require (and is not helped by) major investments in new computational and storage hardware. Condusiv Technologies provides solutions that—without the need for additional investment in hardware—can, in the Windows environment, improve overall system throughput by 30 percent to 50 percent or more.

“Over the long term,” said D’Arezzo, “given the realities of the healthcare industry—and the lifesaving potential of current healthcare data collection and analytics—the current level of system inefficiency is insupportable. It’s as though you were being asked to double the volume of traffic flowing through New York City while keeping a third of the tollbooths and highway interchanges closed. In that context, the share-versus-standardize debate is like arguing about who has the right-of-way on 42^nd Street. That will work itself out in time; right now, we need to get the roads unclogged.”

1. “Draft U.S. Core Data for Interoperability (UCDI) and Proposed Expansion Process,” Office of the Coordinator for Health Information Technology, January 5, 2018.
2. “21^st Century Cures Act,” U.S. Food and Drug Administration, January 2017.
3. Miliard, Mike, “Interoperability: Do we have the value proposition upside down?”, Healthcare IT News, Apri 10, 2019.
4. “Interoperability: Sharing patient information to coordinate care,” Elation Health.
5. Finnegan, Joanne, “Primary care doctors spend more than 50% of workday on EHR tasks, American Medical Association study finds,” Fierce Healthcare, September 13, 2017.
6. Donovan, Fred, “Healthcare Organizations Stymied by Health Data Analytics Tools,” HIT Infrastructure, March 14, 2019.
7. Morin, Brian, “Windows is still Windows Whether in the Cloud, on Hyperconverged or All-flash,” Condusiv blog post, June 5, 2018.