Healthcare’s Interoperability Problem: A Q and A with HIMSS CEO

First published in MedCityNews.

The idea that providers own patient data is still prevalent in healthcare today because payment models encourage it, and that’s one of the big barriers still standing in the way of widespread interoperability, according to H. Stephen Lieber.

First published in MedCityNews.

The idea that providers own patient data is still prevalent in healthcare today because payment models encourage it, and that’s one of the big barriers still standing in the way of widespread interoperability, according to H. Stephen Lieber.

I got the chance earlier this week to talk with Lieber, who heads up the Healthcare Information and Management Systems Society (HIMSS), the not-for-profit membership association devoted to transforming healthcare through information technology and management systems.

Lieber is set to appear in Cleveland today at the new Global Center for Health Innovation (the $465 million project formerly known as the Cleveland Medical Mart), where HIMSS is opening an interoperability-focused innovation center on the fourth floor.

At the event, hosted by local technology non-profits Civic Commons and OneCommunity, he’ll be addressing how access to high-speed broadband plays into health IT innovation. But I wanted to tap his in-the-trenches view on some broader topics, like how the industry will keep health IT implementation and innovation moving forward.

Interoperability seems to be the biggest hurdle standing in the way for the most tech-savvy providers. What needs to happen to change that, and who needs to make it happen?

SL: There is some fine-tuning around how technology is adopted, but fundamentally it’s not a technology barrier. It’s a cultural barrier and it’s also a lack of a compelling case.

The cultural barrier is a still-prevalent mindset that the data belongs to the practitioner. This philosophy is fairly rapidly diminishing, and publicly almost no one will say that data belongs to institutions, but they act that way. Institutions and practices want to hold onto that data for competitive reasons. We don’t operate in a culture yet where there is absolute recognition that the data belongs to the patient.

Another is the lack of compelling case for interoperability. As much as we’ve tried for a dozen or more years to say that interoperability is critical for reduced errors and increased patient safety, it hasn’t become such a compelling case that the healthcare profession recognizes it. There is no financial disincentive or penalty – in fact there is an incentive not to be interoperable, because if I can’t get data about you, I repeat the test. I re-do things, and I get paid for it.

Is it eventually going to be policy that pushes the industry toward those changes?

SL: That financial barrier is going to play out in policy. Work is already being done in Washington to redesign reimbursement. Once Medicare heads down that path, commercial insurers will follow. There are already steps around this for not paying for certain services in certain situations, or for issuing bundled payments based on outcomes. If reimbursement mirrors the policy of data exchange, then it will happen.

What about the physicians who aren’t as far along with health IT implementation? How do we help them move the needle forward?

SL: It has more to do with resources. The value (of IT) is recognized, at least within the field. There is no debate about the value of IT in reducing medical errors, improving safety and lowering the cost of care. (But) there’s a significant difference in terms of financial viability from high end to low end in reallocating finances for information management versus medical devices and diagnostics, because (the latter) are things you get paid for. The majority of physicians practice in groups of three or less, so it’s a small business system. The decision to acquire IT comes right out of doctor’s pocket.

Let’s shift gears and talk about what’s happening at the Innovation Center. What is HIMSS’s role here?

SL: One thing we currently do once a year is testing of interoperability and a demonstration of competing products exchanging data. We felt like we would be more effective if we could do that on a more regular basis. We will have a testing and demonstration center, so that as a doctors start to look at acquiring a new system, they would be able to test it against others to see how it works. We’re also going to use it as a place to ensure that emerging technologies have a chance to be seen. It’s a great venue for bringing thought leadership together by virtue of having multiple organizations together in that building.