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.