COVID-19 Highlights the Need for Interoperability in Healthcare

Contributed Commentary By Baha Zeidan

April 16, 2021 | One of the most important and most human concepts that has come into focus in light of the pandemic is “connectedness.” And throughout this ordeal, we’ve been trying to figure out how to cope without it: 

• Early on in the pandemic, global supply chains were broken and we saw shortages of all sorts of goods.
• Face-to-face interactions were interrupted and have been severely limited for months on end, spurring mental health crises.
• Schools closed and educators had to figure out what remote learning could possibly look like.
• Life celebrations that bring us together were postponed to an uncertain future date.
• Nonessential businesses of all sorts shut down and offices went dark.
• Those that were deemed essential had to figure out new methods of producing and delivering.
• People fighting COVID-19, and in far too many cases succumbing to it, had to do so without the comfort and support of family enveloping them.
• Healthcare providers and researchers have been engaged in a race against time to figure out how to keep people alive and protected.

The Irony of Siloed Technology

If connectedness is human, circumventing this brokenness is entirely natural, too. As a species, we function better together. It’s undeniable. It’s peculiar, then, that we don’t see this same innate approach reflected in our technology, the tools we build to help us be better at being human.

Too many of our most ubiquitous technologies are siloed, working in isolation from one another despite their pervasiveness. This is certainly true of the vast majority of our data systems, capturing vital information that could glean valuable insights if data repositories weren’t locked away in a sort of digital solitary confinement.

The explosive growth of analytics as an industry is an acknowledgment that aggregation and systematic study of data can help us make better predictions and pursue better courses of action that can lead to preferable outcomes. In terms of “connectedness,” data analytics relies on the movement of data among systems so that information can be compiled to enable more granularly tuned analysis. When we don’t share data, we incur a potentially grave opportunity cost.

Data Analytics, the EHR, and a Lack of “Connectedness” in Healthcare

In healthcare, the primary means of collecting patient data, the electronic health record (EHR), is one of the biggest offenders of a siloed approach to data. On the micro level, the EHR provides a longitudinal electronic record of patient health information to streamline the clinician’s workflow and facilitate a better outcome for the individual patient. The EHR is inclusive of patient demographics, health problems, progress notes, medications, vital signs, past medical history, immunizations, laboratory data and various reports. On the macro level, EHRs allow for the systematic collection of these data points to fuel the analytics that can inform and improve treatment plans for entire populations.

At least, that’s what the EHR is supposed to be able to do. In reality, too many EHRs hold data hostage inside proprietary software systems that reject the connectedness that should be a benefit to individual patients and broader communities alike. One need look no farther than the current pandemic to see how the lack of data-sharing infrastructure has prevented healthcare providers from getting a complete picture of their patients’ medical histories and hindered research on what treatments are working against the novel coronavirus.

One could argue that technical integration is a higher level of sophistication than the current state of the market supports. But that’s not really it. The biggest players in the EHR marketplace are intentionally keeping their solutions siloed. They know that each new customer that they sign will be beholden to them for product updates, for new modules to be released, and for entering into lucrative service plans. By keeping patient data locked in a closed EHR system, big EHR vendors are locking out their competition. 

Breaking the Grip of Proprietary EHR Software

Passage of The Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 spurred the growth of the EHR marketplace. Stiff competition for market share among vendors cemented the concept of the proprietary solution; the silo model was firmly entrenched.

But in June of 2014, the Office of the National Coordinator for Health Information Technology (ONC) laid out a vision for a future health IT ecosystem where “electronic health information is appropriately and readily available to empower consumers, support clinical decision-making, inform population and public health and value-based payment, and advance science.” In short, ONC created a roadmap to interoperability for healthcare IT and for EHRs.

When EHR interoperability is absent, smaller community providers as well as those in socioeconomically disadvantaged areas, whose patients often have to visit multiple healthcare facilities for their care and have higher rates of chronic conditions, suffer the most. When medical care is distributed across providers using different EHR solutions that don’t talk to each other, no provider has a holistic view of the patient, which can compromise the care plan devised for that patient.

While the ONC roadmap stands to benefit smaller and under-resourced providers the most, even the largest hospitals and care networks will benefit from escaping the grip of vendors fighting to keep their EHRs closed. Because interoperability breaks the stranglehold the largest EHR vendors maintain on their customers, these vendors have stood in firm opposition to the ONC provisions. In fact, just last year Epic CEO Judy Faulkner emailed executives of Epic’s hospital customers urging them to speak out against the ONC rules that would standardize data sharing. Noticeably absent from the CEO’s comments was an acknowledgment that maintaining the status quo meant maintaining EPIC’s control over the IT spend of its customers.

Interoperability: The No-Holds-Barred Approach to Fighting COVID-19 and Other Maladies

With new variants of the coronavirus igniting new surges of COVID-19 around the world, data sharing through interoperability grows even more urgent. From understanding any single patient’s complete medical journey to analyzing aggregated data at the community level, frontline providers and researchers need access to the most complete data sets available in order to track the disease, understand which protocols are most effective, and get out ahead of the virus. The notion that anyone or any company should want to impede this initiative is wrongheaded at best and dangerously outrageous at worst. 

Certainly, the fight for interoperability is about far more than combating just COVID-19. The lack of connectedness last year meant that countless patients deferred preventive care and put off vital treatments for other illnesses as care facilities shut down elective procedures and patients practiced isolation. Our already overburdened healthcare system is in a deeper hole today across the board because of the pandemic.

On the population level, interoperability has incalculable benefits for measuring vaccine efficacy. When data can be shared at the macro level, scientists can study the impact of vaccines on different populations and the implications of distribution inequities in traditionally underserved populations. Interoperability will allow us to understand and shed light on the effectiveness not only of the medicines we develop but also on the healthcare system’s ability to deliver these medicines to the people who need them. Public health depends on the data that interoperability can provide.

Interoperability is an essential approach to improving care for everyone. We’re better when we work together. Let’s embrace that concept and demand that our health IT does the same. Our patients’ lives are depending on it.

Baha Zeidan is the Co-founder and CEO of Azalea Health Innovations, a leading healthcare IT company whose mission it is to help underserved healthcare providers improve patient care and profitability. Under Baha’s leadership, Azalea has established itself as a high-growth innovator and leader, developing a comprehensive, cloud-based health IT platform for ambulatory practices and hospitals—including introducing the industry’s first fully-integrated proprietary telehealth solution with its EHR. Azalea Health Innovations has achieved Inc. 5000 rank of fastest-growing companies in the U.S for three consecutive years and has been named a Top 40 Innovative Technology Company by The Technology Association of Georgia (TAG). Baha can be reached at bzeidan@azaleahealth.com.