A Missed Opportunity

“Interoperability.” The word rolls off the tongue as if a wedding vow. It is the Promised Land on the other side of the river. It is the field of milk and honey where we long to be. It is where the lion and the lamb live together in perfect peace. Too bad we will never get there.

I guess all the striving to achieve interoperability is a good thing. It keeps us getting out of bed every day and tinkering on the ever more complex Rube Goldberg machine created to overcome all the new challenges that keep appearing. Actually, except for one fatal foundational flaw in the healthcare data ecosystem, we wouldn’t even need to deal with this hodge-podge of duct tape and dental floss that is striving to hold together the fragile cobwebs of potential interoperability. If each person had one medical record, and anyone with permission could access that record, the information would just be there. No need to exchange, aggregate, or collate health information. End of story, but those are not the cards we were dealt in the good ‘ol USA.

Promise vs. Reality of Interoperability

We don’t live in a world of one medical record for everyone, so as a necessity, an entire industry has arisen to solve the problems created by that deep and early error. Technology, workflows, best practices, less learned – all have been efforts to fix the unfixable. There is a giant well-funded army of warriors fighting to reach the highest hill and plant the flag of interoperability. I know the story all too well for I am one of those soldiers.

We’ve had the Regional Health Organizations, the Health Information Exchanges, and all the other mazes that held the promise of “the right data at the right place at the right time.” Who doesn’t remember that phrase? If I had been braver, I would have opted to have that slogan tattooed over my heart. At every healthcare information conference, year after year, the Year of Interoperability was announced, and I have certainly been part of that chorus.

Now we have TEFCA. Lumbering through the backdoor, it holds the promise that this will indeed be the framework that will finally achieve interoperability. If not, then maybe blockchain, FHIR, AI, or whatever comes next will do the job for us.

When the US was locked in the dreadful downward spiral of Vietnam there appeared to be no option that would assure any withdrawal plan. Then some geniuses came up with a solution. “Declare victory and get out as fast as you can.” That is what we did. Now I’m not suggesting we abandon the continuing work to achieve interoperability. Progress is progress but it may be time to admit that the promise of “the right data at the right place at the right time” is a fantasy. A beautiful tale told to a hopeful world.

The Fight Continues

So, fight on you brave and loyal warriors. Robert Browning, the English poet, said “a man’s reach should exceed his grasp” and we know what he meant. We should try to accomplish things even if they are impossible. That is good for the human spirit. But maybe we should stop fooling ourselves by saying that interoperability is just over the next hill or around the bend. Let’s just agree to take a step back and come to an agreement that we have done the best we can and maybe a few tweaks from time to time can make things better. We will never get to a place where the systems and networks will be able to mimic what is truly needed, a single health record for everyone. Let’s admit that what is desired, and often promised, will not come to be.

I’m hoping this diatribe has not been too negative, but as David Bowie used to say, “It is what it is”. So, I’ll see you at the next Global Interoperability Conference. You’ll find me at one of the flashy booths fawning over some new algorithm, app, or device that promises the final solution that will deliver the Golden Chalice of interoperability. Even I am not without hope.


Photo by JJ Ying on Unsplash