From booking flights and hotel reservations on our smartphones to making online payments and calendar reminders, interoperability — the exchange of data across systems — is the essential functionality that makes these everyday modern events possible.
While interoperability has become routine in so many industries, it is one of the biggest challenges the health care industry faces right now. The lack of interoperable infrastructure prevents patients from being engaged, prevents providers from efficiently delivering care, and prevents health systems from operating more effectively as an organization. It’s the underlying problem that makes it difficult for the industry to adopt novel technologies.
How did we end up here? It’s easy to blame technology vendors who gain market position by data blocking. It’s also easy to throw the government under the bus and say they didn’t do enough or, conversely, that the regulatory environment itself caused our current problems. The reality, in my view, is that there was, and still are, a lot of moving parts that contribute to the ongoing challenges. I’d like to dive into these factors to understand how a holistic approach should guide the way industry players, from patients to providers and payors to health systems, can solve the problem together in the years to come.
The Ideal Impact Of Technology In Health Care
Health care happens at the intersection of patients and providers and is rooted in an empathetic relationship, where providers attempt to understand what is going on with a patient. This is as much art as science. Physicians will tell you that so much of a diagnosis is looking into a patient’s eyes and knowing that something is wrong, even though everything may appear fine. Ideally, technology should support, not replace, this interaction. It should help providers become more efficient and perform better while empowering patients to be engaged and giving them tools to manage their health.
It’s this application layer that turns data into the information users need to change behavior.
What Technology In Health Care Is Actually Doing
Unfortunately, the current technology landscape in health care holds back the application layer, leaving consumers uninformed and causing good doctors to burn out.
Instead of an empathetic relationship supported by technology, the rapport between providers and patients has become commoditized as providers are expected to increase the number of patients they see per day while using mandated software designed to streamline billing, not care delivery. On the patient side, in my experience technology has led to apathy at best and fear at worst when it comes to their interaction with the health system.
Recently, the Office of the National Coordinator for Health Information Technology (ONC) filed a report to Congress that found providers and patients are often frustrated that data is not easily shared and have proposed legislation to penalize “data blocking” with steep fines.
Provider burnout has also become paramount. A 2018 study by the National Institute of Health (NIH) concluded that more than half of U.S. physicians are experiencing burnout, citing “treating the data, not the patient” and “electronic health record woes” as primary causes.
Crossing The Chasm On A Subsidy
The interoperability issue can be traced back to the government subsidies that propelled electronic health records (EHRs) to widespread adoption. EHRs were invented in the late ’70s as an early application of emerging database technology. Over the following decades, the software evolved into large enterprise systems held in basement data centers of the early-adopter hospitals that used them. Each EHR implementation was a highly customized and expensive effort. By the 2000s, the technology had not organically reach mainstream adoption.
In 2009, the Health Information Technology for Economic and Clinical Health Act (HITECH) passed, introducing incentives to meaningfully useEHRs. After decades of climbing through early adopters, EHRs suddenly were able to hitch a ride on subsidies that pulled them across the chasm to mainstream adoption.
The proverbial market adoption chasm is a reasonable and necessary pause in the evolution of new products and services. Innovators are forced to move from a minimally viable product to a mature offering that performs to expectations and scales effortlessly. While the government subsidies pushed EHRs to near-universal adoption, it also may have forced the technology to market too soon, without the typical 10 times improvement. As a result, the industry replaced paper silos with digital silos.
In the decade since the EHR mandate began, many EHR vendors stopped flexing their innovation muscles as they allocated more resources to regulatory requirements than acting on the needs of the market. When EHRs were first created, there was no internet or cloud. This wasn’t a problem in yesterday’s “disconnected” world. But fast-forward to 2019 and sharing data outside of a health system’s data center is far more difficult than it should be.
There are thousands of new health care software solutions on the market. These are modern applications that could engage patients, create workflow efficiencies for providers and bring smarter decision making into health care delivery. But most of these innovations get stuck. The EHRs that government subsidies dragged across the chasm are now a barrier, preventing them from being adopted at scale. These are the very same technologies in high demand for efficiency and cost savings to our overburdened health care system.
We do not have an innovation problem in health care; we have a technology adoption problem.