Electronic Health Reporter

By John Kelly, chief technology officer, PatientKeeper, Inc.

If there’s a topic in healthcare IT that has absorbed more ink over the past decade than “interoperability,” I can’t imagine what it would be. (Well, going back to 2009, “meaningful use” may rank a close second.)

The federal government has taken a significant interest in advancing health IT interoperability. For instance, Title IV of the 21^st Century Cures Act is all about it, and in 2020 ONC promulgated rules designed to push the industry along to make interoperability a practical reality. One specific way is through an application programming interface (API) approach that “supports health care providers’ independence to choose the ‘provider-facing’ third-party services they want to use to interact with the certified API technology they have acquired.”

But, generally speaking, government mandates have paved a slow and bumpy road to any health IT goal.  They focus on rules and regulations rather than incentives (admittedly, meaningful use was a different case).  And thus far, that has been the fate of interoperability.

The metaphor our parent company, Commure, uses to describe healthcare today is a city without roads. We built the “city” of healthcare, populated with over 3,000 healthcare IT companies, without considering the pathways that would connect them. Healthcare lacks the proper infrastructure and connectivity to collect and serve up data in ways that will meaningfully transform the way care is accessed, coordinated, delivered, and experienced.

I believe healthcare IT is, at long last, on the cusp of finally realizing the much-hyped, yet elusive promise of true interoperability. Why now? Because of the cloud, and cloud vendors’ embrace of open standards in their APIs, notably FHIR.

The cloud is the best path to interoperability because it removes barriers to entry. Historically payers and providers didn’t want to leverage the cloud; they believed “I have to build everything.” But now they’re realizing they don’t have to build everything – the cloud enables them to use what someone else has developed to accelerate their own progress and innovation. Payer organizations moved first, and many have made the transition to the cloud, which has prompted provider organizations to begin doing the same.

I liken what the cloud and FHIR can do for healthcare to what happened 15 years ago in the mobile market. Apple built iOS and Google built Android as open platforms for third-party developers to build on. Without those, you wouldn’t have Twitter or TikTok or tens of thousands of commercial apps. The same concept applies to healthcare: the big push has been the FHIR standard. Now we need a platform, akin to iOS and Android in the mobile market, upon which development and innovation can occur to benefit both providers and patients.

That excites me from where I sit as CTO of PatientKeeper, with our focus on streamlining provider workflow. With a FHIR-based platform as the foundation, we can sit on top and enable more providers to improve their processes. And oh by the way, mobility is a critical value-add in a variety of clinical use cases, too.

The fragmentation that exists in healthcare today is untenable. It can cause real harm to patients and clinicians and hamper the ability of our health system to deliver the best care. It puts heavy administrative burdens on patients and care professionals alike, and acts as a stumbling block to innovation.

There is growing demand among hospitals for a common architecture that lets them more nimbly deploy new solutions and pair them with other innovations in care. Thanks to the cloud, I am fully confident it is coming – perhaps not tomorrow, or next week, but a lot sooner than it otherwise would have.

The cloud also offers other potential benefits to healthcare IT – for instance, wider use of AI and robust analytics – but the real game-changer will be widespread system interoperability. The migration of health IT to the cloud will make the vast trove of patient data that has been digitized over the past decade more broadly accessible and clinically useful.

As a technologist, I can’t wait. But more importantly, providers and patients can’t wait.