Interoperability in Health IT – Is it really so bad?

Posted Posted by Martin Peacock in IHE     Comments No comments

Short version:
Health IT is often compared unfavourably to IT in Financial Services, with, perhaps, a grass-is-always-greener perspective, but maybe HIT isn’t as badly placed as many think?  The challenges are greater, the investment lower, and still, the quality of solutions actually compares equitably.  In fact, HIT is probably better placed than FS-IT to step up to the next level. Perhaps we shouldn’t beat ourselves up *quite* so much.



Longer Version:

I came across a post in MedCityNews this morning (well, maybe more of an advertorial than a post but interesting nonetheless).  The story – in a nutshell – is about one particular vendor potentially using ‘Big Data’ to improve health outcomes.  The use of ‘Big Data’ to do with actual people is a topic of much debate – the furore around security agency access notwithstanding, there is much to debate.  But I’ll leave that to one side, for another day.

The line that really woke me up (to be fair, I was on the red-eye train into Dublin) was this:

Some equate it to finally catching up to where the banking and airline industries have been for years:

And that’s a position I’ve sympathised with (and even moaned about) in the past.  How, moaned I, can I get cash out of a hole in the wall in a foreign country thousands of miles from home in a matter of seconds, but two hospitals a couple of miles apart have such trouble sharing X-Rays?

But I’ve changed my position over the last 12 months or so.  While the 2012 IT failure at RBS didn’t end there for the bank , for those of us thankfully unaffected, it does offer an interesting – if brief and transitory – insight into the backoffice working of those august institutions.  Combined with some recent direct experience in the backoffice workings of financial services (FS) I can offer a different perspective.

While the pre-automation form of the two sectors are similar in terms of process depth and complexity, there are a number of differences in the two sectors, and between perception and reality:

  • Firstly, and perhaps most importantly, FS systems are seen from the outside as being superbly architected artifacts of elegance.  In fact, they are more like the angry-looking swan above, gracefully gliding over the surface while paddling like the clappers down below.  Behind the super-efficient delivery of flawless process and documentation lies (still!) a small army of humans greasing the wheels.  That isn’t to say that is bad, but it is contrary to many people’s expectations.
  • It may well be true that cash transactions between relatively unconnected organisations can be fairly efficient in real-time, but in fact, many transactions do not occur in real-time, especially at a consumer level.  Those who check bank statements might see debit card transactions from retail outlets batched over 2 or 3 days – especially at the weekend (of course – those statements can be botched as well as batched). Other batches might run only once per quarter or even once per year.  In the meantime, data/hardware/software can be cleaned, cranked and patched into position.
  • For many FS systems, daily operation is on a 12/5 basis.  When the small army of humans go home – the system is done for the day.  Life would be so much easier if all hospital IT systems could be switched into ‘maintenance’ mode at 6PM ready for backups, updates and general TLC.  Yes, there are the very-low latency, intensive systems for Trading and ForEx, and the like – to the point where folk are talking about firing neurinos through the middle of the earth to get milli-second advantages in network latency, but they are in the minority.
  • Even those statements may well be batched – to a point in the day when an intense period of dispatch can be prepared for in advance.  This is a luxury not afforded with anything like the same frequency in health IT (clinical, at least).
  • The transactions that do cross organisational bodies – whether in real time or not – are driven by legislative mandate and international agreement.  Despite  HIT having much more complete and overarching standards than FS, it is the lethargy of implementation that is holding it back.
  • The money invested in FS IT far outstrips that in health. Of course, all of the wolrd’s money goes through the banks – not once but many times as as it is transformed and re-invested, spent, or just plain lost.  The world’s economy in 2011 was 70 trillion – so there is plenty of incentive to invest heavily in systems and processes.
  • It doesn’t help that culturally, health IT investments tend towards the monolithic, one-size-fits-all solutions while banks and FS are much more prepared to engage in bespoke solutions – including self-help in many circumstances.  For me, that part is a mistake from those involved in HIT – I believe in having the capabiltity to adopt whichever approach offer the most benefit. But I know there are other opinions, and there are no answers that are right *all* of the time.
  • There is a constant ‘debate’ in Health IT about the quality of end-user applications, their user-experience (UX), sub-second response times, consistency of UI etc., that slows down system implementation and sometimes downright stops it.  FS-IT doesn’t seem to have that problem, even though some of the UX in end-user apps is pretty poor indeed – and the consumer -visible software is only a small part of it.

It isn’t really fair to make comparisons, HIT is at so many disadvantages.  But still, IHE offers a great way forward.  It has been slow, and there have been (still are and will continue to be) disagreements, but it is quite possible to conceive of a time when a significant proportion of the clinical record is fully interoperable.

There are still plenty of hills to climb and the gradient is somewhat steeper for H-IT than for FS-IT.  But what is there for HIT – as we speak – in the form of the standards being implemented internally within organisations as well as those standards that will allow for wider collaboration – offers a platform for expansion that many other industries can only envy.  It has yet to come to fruition, and work has yet to be done, but its not a bad place to be.  Its good to learn from the mistakes (or otherwise) in other sectors, but remember apples ain’t oranges -  GM notwithstanding.

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