by Chuck Parker
June 2013 – We constantly hear that healthcare needs interoperability like the ATM or cell phone networks, but what does that really mean? Interoperability is becoming more important as we begin to implement systems in all of healthcare. The goal of the HITECH and ACA legislation was to increase the use of HIT throughout the modes of care. Once implemented, especially at scale, these systems need to easily talk or communicate with each other.
The definition of interoperability is broad – even HIMSS recently had three different levels defined. However, the common idea is that it is plug-and-play, meaning “I don’t have to think about how to connect these devices, systems, or services or go through an elaborate pairing process that may require custom settings.”
Why do we want this? The more difficult an item is to use, the less likely it is to be used. Let’s take the cell phone example. For many years, if you wanted to go from one country to another or use a phone on a different network, you had to buy another phone. When the industry standardized on the GSM chipset, it became easy to allow crossover in network operators by simply changing a small chip, not the whole phone. And, you could go nearly anywhere with the device. This made cell phones easy to use and the market took off.
We stand at this same opportunity in devices and systems, but with several economic drivers now pushing us into a new paradigm of healthcare. With the advent of new payment models and rewards for quality care, we need to monitor individuals beyond the office and hospital. This is Personal Connected Health, or how we keep the individual connected in the healthcare system. Today, healthcare is provided either by governmental bodies or through large private insurers. All of these are under economic pressure to reign in mounting care costs. This primarily means moving away from expensive fee-for-service payment into models that pay for the best outcomes and least expensive care models.
In order to understand outcomes, we need to tie together patient data, population data, and treatment plans. Ultimately, this means, “how do I prevent patients from experiencing events that may require them to go into inpatient stays or have ER visits?” We should treat individuals appropriately, but if we can monitor them effectively, we can lessen the need to go to acute care facilities. This lowers stress on the individual as well as the overall healthcare system – ultimately preserving resources.
Lack of physician and clinical resources, both in the US and internationally, will require that we establish new ways of providing care. (In the US we have a baby boomer aging into retirement at the rate of one every 8 seconds and will have this rate for the next 20 years.) We are also living longer (80+) and thus will require care longer. By establishing a system of interoperable care devices, services, and systems, we can create a system of care that is easy to implement and connect. This interoperability allows us choice in services – physicians, specialties, hospitals – while making it easy to add or integrate new monitoring or services.
Internationally, China, India, and Brazil won’t be able to build facilities at the rate of Western cultures; it is not economically feasible to provide that level of hospital rooms. Therefore, care must migrate the individual to either smaller clinics or multi-user personal systems. Care must be at the home or community and made easy to deliver. We have seen some of this already in disaster areas where solutions provide a one-to-many ability for equipment to be deployed quickly to monitor a population. With interoperability, these systems can be set up in days and can monitor multiple conditions of survivors or displaced populations.
Additionally, scale can only be achieved through standards. Systems that can’t easily talk to each other become difficult to upgrade and integrate with newer technologies. Each iteration requires custom development or custom programming. Most vendors’ current business models scale to tens of thousands of units. However, we need tens of millions of units globally (either devices, systems. or services). Without standards, we won’t have enough resources to manage changes, much less costs, as the number of integrated systems grows exponentially. Even in a small community, the number can get staggering quite quickly. For example, 16 providers, 1 hospital, 1 lab, and 5 specialties would potentially result in over 270 direct interfaces. Add devices to this and it becomes clear why standard interoperability becomes necessary as we deploy millions of devices, systems, and services globally.
As we begin to deploy many new systems and services, it becomes less expensive for the vendor to move towards the interoperable approach. Why?
• Less technical time is needed integrating devices and systems. You do it once and the interoperable interfaces allow standard communication;
• Less technical time is spent upgrading devices and systems to remain connected. This also results in less time required for maintaining upgrades and changes at both ends of the communication channel;
• Interoperability drives lower cost parts acquisition. Efficiency of scale comes with standard implementations and parts builds. We saw this in computing platforms, with standard motherboards and chip sockets and interoperable plug-in cards and accessories;
• Interoperability drives larger market movements. Buying in bulk with knowledge and price efficiencies allows systems to be deployed less expensively and with reduced labor;
• And, standards allow selling across international boundaries. You can buy a Bluetooth headset anywhere in the world today and expect it to work. Yet, there are more headset manufacturers than ever before.
Ultimately, interoperability provides better scalability of deployments, which leads to better deployments of technology, which eventually lead to improved use of the tools and services. This creates a great opportunity for us to manage our health better as individuals and systems, and also to find new ways to care for individuals, with personalized care and in new care settings – at home, work, or play.
About the Author
Charles (Chuck) Parker is the Executive Director of the Continua Health Alliance, an international non-profit organization convening global technology industry standards to develop end-to-end, plug-and-play connectivity for personal connected health. Chuck leads the many workgroups and day-to-day operations of the Alliance.
Mr. Parker has over 20 years of experience in healthcare technology, policy, and the strategic design of evaluation and measurement strategies. He has led national programs for practice transformation and has served on national committees for assessing adoption requirements.