The Funniest Satire on Interoperability You’ve Ever Seen (Trust Me)

By  |  May 29, 2008 | 

There is nothing better than a good satire to capture certain (uncomfortable) truths – just ask any of the presidential candidates after an episode of Saturday Night Live. So check out this hilarious spoof on information technology interoperability.

As Captain Kirk said to Bones, “have you lost your mind?” Hilarious? Interoperability?

But really, check it out. It is very funny.

Now for those deep truths. When my friend David Brailer became the first federal IT czar, I think most people expected him to focus his attention and bully pulpit on promoting CPOE and EMR implementation – a “chicken in every pot, a computer in every office” strategy using incentives, regulations, and more.

Yet David, who is one of the smartest and savviest people I know, focused much of his energy on the seemingly arcane and stultifyingly boring topic of interoperability – creating a common language so that the computers of different vendors can speak to each other. You know interoperability – it’s when you go to the Bank of America ATM and it spits out twenties from your Citibank account.

David succeeded in getting interoperability on the radar screen, and now there is an alphabet soup of organizations (CCHIT, AHIMA, HIMSS, HITSP) trying to implement another alphabet soup’s-worth of standards (SNOMED, HL7, COCLE). Most people view interoperability through the prism of the banking analogy – it is the scaffolding that will eventually allow the docs in an local Emergency Department to view my computerized record, even though it lives on a different computer platform. And clearly, this kind of information sharing is part of interoperability’s promise.

But there is another rationale for interoperability that might well be more compelling. When my hospital or yours decides to fork over $100M to GE (or Epic, or Cerner, or Eclipsys, or Joe’s IT) to buy an electronic health record and/or CPOE, we worry about what happens if we don’t like the system. In a non-interoperable world, the transactional costs of a bad marriage are huge – if my system calls a potassium a “K+” and yours calls it “potassium,” moving my data to your system is hugely complex and expensive, since somebody has to map out this and a buzillion other connections. In an interoperable world, a K is a K, and moving K’s from one system to another is relatively easy. It still wouldn’t be trivial to change systems, but it wouldn’t be a deal breaker.

Given this, my understanding of human nature leads me to guess that the IT vendors might say all the right things about interoperability (who could be against that?) but might just drag their heels a bit when it came to the hard work of making it happen. Here’s how the webmasters of SEEDIE put it:

SEEDIE [the Society for Exorbitantly Expensive and Difficult to Implement EHR’s] recognizes that data exchange should only occur after a lengthy and expensive custom integration process. Further, that integration should require ongoing technical support from multiple vendors.

Far fetched? Another looney conspiracy theory? Most of my IT friends found the SEEDIE site spot on. My colleague Russ Cucina did a little IT snopping (something having to do with “source codes,” or maybe he said “Morse codes”) to try to uncover the provenance of SEEDIE site. No surprise – he found that it was the work of pros, and completely untraceable. An inside job? Your guess is as good as mine.

Whoever the perpetrator, SEEDIE does highlight a key drag on interoperability – the sluggish response and manufactured enthusiasm of some of the players in the field, who have vested interests in defending their silos. It is the job of the rest of us – and the feds – to demand the kind of interoperability that not only allows critical patient data to flow freely to the right people at the right time, but that lubricates a truly competitive EHR/CPOE market – one in which hospitals and doctor’s offices know that the choice to switch vendors for a better product, service, or price is not tantamount to a decision to ruin the next 3 years.

Thank you to the good folks at SEEDIE for helping to make these crucial points.

And for making interoperability funny.

About the Author:

Robert M. Wachter, MD is Professor and Interim Chairman of the Department of Medicine at the University of California, San Francisco, where he holds the Lynne and Marc Benioff Endowed Chair in Hospital Medicine. He is also Chief of the Division of Hospital Medicine. He has published 250 articles and 6 books in the fields of quality, safety, and health policy. He coined the term hospitalist” in a 1996 New England Journal of Medicine article and is past-president of the Society of Hospital Medicine. He is generally considered the academic leader of the hospitalist movement, the fastest growing specialty in the history of modern medicine. He is also a national leader in the fields of patient safety and healthcare quality. He is editor of AHRQ WebM&M, a case-based patient safety journal on the Web, and AHRQ Patient Safety Network, the leading federal patient safety portal. Together, the sites receive nearly one million unique visits each year. He received one of the 2004 John M. Eisenberg Awards, the nation’s top honor in patient safety and quality. He has been selected as one of the 50 most influential physician-executives in the U.S. by Modern Healthcare magazine for the past eight years, the only academic physician to achieve this distinction; in 2015 he was #1 on the list. He is a former chair of the American Board of Internal Medicine, and has served on the healthcare advisory boards of several companies, including Google. His 2015 book, The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, was a New York Times science bestseller.

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2 Comments

  1. WRS May 29, 2008 at 4:42 pm - Reply

    Check out the Extormity website. The mission statement screams honesty.

    http://www.extormity.com/index.html

  2. menoalittle May 30, 2008 at 2:38 am - Reply

    Bob,

    Another poignant post…keep up the good work

    In the excerpt of Dr. Brailer’s bio (see below), President Bush made a fallacious assumption in his Executive Order. It is fact that there is not proof that “widespread deployment of health information technology…to help realize substantial improvements in safety and efficacy” is anything but ideology.

    “Dr. Brailer was appointed the first National Health Information Technology Coordinator on May 6, 2004. Dr. Brailer’s duties as National Coordinator are to execute the actions ordered by President George W. Bush in the Executive Order that he issued on April 27, 2004, which called for widespread deployment of health information technology within 10 years to help realize substantial improvements in safety and efficiency.”

    Dr. Brailer was indeed clever to focus on interoperability since safety and efficacy of CPOE instruments has never been assessed and can not be until interoperability is achieved. In 2008, there are interoperability problems within each hospital, let alone between hospitals.

    In 2008, all CPOE devices will fail assessment as being safe and efficacious without interoperability, and some may fail even with adequate interoperability. It is perplexing how these have been allowed to be deployed without undergoing such tests. Is it because President Bush said that CPOE and health information technology are safe and efficacious? I wonder what scientific literature our lawmakers have read that I have not..

    BTW, your readers in the states should take a gander at E-HEALTH INSIDER for news on one of the companies mentioned in your post and its exploits in the UK. It may be a case of truth is stranger than satire.

    Best regards,

    Menoalittle

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