Jitin Asnaani sees energy and passion around truly improving patient care. “Physicians want to provide the best care,” he says. “Hospitals, health systems and care givers truly want to innovate and lower the cost of care.”
Still, for all that excitement, Asnaani says a basic commodity is still lacking: data. “It’s like home builders building bathtubs and showers and even fountains – but there’s no running water. That’s the problem with interoperability today.”
Asnaani is the executive director of the CommonWell Health Alliance, which describes itself as a not-for-profit trade association of health IT companies working together to create universal access to healthcare data. This week, we sat down with him to get his honest perspective on interoperability.
Q: How do you personally think we should be tackling the challenge of interoperability?
What’s really been missing in the discussion so far is the hard, nuts-and-bolts question of how we get to the distribution of information within healthcare. When we talk about interoperability today, we’re primarily talking about connecting to my health system, my healthcare provider or my Fitbit. Thus, we’re looking at this as a point-to-point problem.
The fact is, we have 900,000 providers in this country and more than 5,000 hospitals and 300,000,000 people who present as patients in many different ways and at many different times over the course of their lives. Solving the problem by going point-to-point is completely unscalable.
I believe that we have to tackle this problem of information distribution head on. Vendors are a key part of solving this. Everybody involved uses software of some sort today. Patients go to patient portals. Providers have EHRs. Pharmacies have information systems. Labs have information systems. Everybody has a mechanism in front of them – they just have no way to connect these systems.
What if interoperability were built into those systems directly? Then everybody would have access to the data and the distribution problem would be solved. That’s what’s been lacking so far.
Q: What about the costs involved with interoperability?
Let’s talk about that in two buckets – first in terms of incentives and then in terms of technology. From the incentives point of view, we all realize that the healthcare industry has been running along for decades in an environment where incentives are completely misaligned. Patients aren’t really paying directly for their healthcare. Hospitals and physicians are buying software that isn’t necessarily helping them with patient outcomes. There’s this whole ecosystem of misaligned incentives which doesn’t encourage the sharing of information.
It’s very hard to pin blame on patients or on providers. It’s much easier to pin blame on corporations. It comes down to the incentives across the economy that have driven these behaviors – they’re far from ideal. We all have to work together to solve this.
On the technology side, the thing to realize is that it costs the vendor an engineer’s time – that’s real money – to build an interface. Even from a pure cost perspective, let’s just think about what it costs to build an interface from one location to another. This is about ten hours of work for an engineer who’s making $100 an hour. So, we’re talking about $1,000 per interface, even without any mark up by the vendor.
And this interface is being built on a point-to-point basis. That’s a really grossly unscalable process that causes struggles for vendors. They have to struggle with how many interfaces they create and what they charge for them. This creates a false scarcity in the market of availability because of the technology that people use today. It leads to the scarcity of data being exchanged today, too.
Q: You’ve recently become the Executive Director of CommonWell. How does CommonWell try to tackle this problem?
The vendors in our alliance each make a connection to CommonWell exactly once. And because those connections are built into the software, vendors are always able to connect to that interface and the interface can be exchanged with everyone else on the network. That dramatically reduces costs, which is why so many CommonWell members are offering the service for free to their clients. Because it really requires no work.
Q: What about handling patient information captured on Fitbits and smart devices? Is that something to look forward to in the future?
That future’s actually not so far away. There are companies like Validic and Human API and others that are enabling connectivity among these devices. Companies like athenahealth and Cerner are allowing applications to be built so that information can be shared with these devices. This is at a very early stage right now.
Even as the technology is well underway, there’s going to need to be a shift in the thinking of providers in terms of the data they’re looking for and relying on for their patients’ care. And that requires a cultural and intellectual mind shift that will take some time, especially with a lot of the consumer-based devices that don’t necessarily have great empirical evidence behind them. As providers get more confidence in that data and get more comfortable using that data for the consumer, we’ll see that usage really happening and that data coming together.
Aine (“ONya”) Cryts is an on-staff contributing writer for MedTech Boston. She's a political scientist by education, a writer and marketer by trade. She has written for various healthcare technology publications and also served as marketing director at several healthcare software companies in the Boston area. Cryts is an avid volunteer, pet lover and long-distance runner. Story ideas are always welcome.
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