Stop the Presses: Healthcare IT Fails at Interoperability…Again

A recent report has come out from Premier and the eHealth Initiative that details a survey they conducted on the current state of affairs of data portability within Accountable Care Organizations (ACO) across the country. The report is focused around the Health Information Technology (HIT) being adopted and used by ACOs and how those systems are affecting interoperability and the challenges that poses. ACOs were initially set up to improve care among a more disparate population by creating networks that allow for the sharing of data from various sources, practices and specialty groups. While the concept is great the technology required to facilitate that data sharing was not brought into consideration. Therefore, all 62 ACOs responding to the survey reported that “access to data from external sources was a challenge.”

FierceHealthIT summarized the report and highlighted some key findings:

  • 88 percent of the ACOs face significant obstacles in integrating data from disparate sources
  • 83 percent report challenges integrating technology analytics into workflow
  • Interoperability of disparate systems is a significant challenge for 95 percent of organizations
  • At least 90 percent of respondents cited the cost and return on investment of HIT as a key barrier to further implementations

Once again I am frustrated by yet another report citing lack of interoperability between HIT platforms. Above and beyond the additional costs this adds to the industry, interoperability is a problem that has been solved in other industries.

The lack of interoperability among Clinical Information Systems (CIS) – namely Electronic Medical Records (EMR) – is a massive problem within the healthcare industry. The wasted costs due to interoperability are almost unquantifiable. Yet the cost for a new EMR is quantifiable and astronomical. Adopting an entirely new EMR system is not the answer. This is especially true for ACOs as they rarely have a HIT mandate, which would standardize all physicians on one platform. This leaves ACOs with a vast amount of disparate IT systems and clinical data silos. The recent shift in course from the major EMR vendors to Open APIs is a great start but it will take more than just acutely focused applications to improve the connectivity and data flow amongst these massive proprietary systems.

The healthcare industry should take a hard look outside of the “walled garden” that is healthcare and learn from examples in other major sectors and how they have solved data portability and IT communication challenges by adopting Open Source Technology. Enterprises in the Finance, Media, Entertainment, and Publishing industries have all shifted away from proprietary Content Management Systems (CMS) and digital infrastructures to more flexible Open Source solutions, which are vastly improving the flow of data between 3rd party applications and the digital experience for their customers. The Government’s technology perspective and footprint has been revolutionized by the adoption of Open Source platforms. I understand the hesitation from the healthcare industry, people’s lives are literally at stake, but if they took examples from outside their own sector they would see that there are tools and platforms such as; Drupal, Mulesoft and Alfresco, that offer flexible APIs, huge pools of developer talent and military grade data security.

Just because it wasn’t created in healthcare doesn’t mean it cannot work in the clinical context. What I mean is that these problems are being solved in other industries with and because of Open Source tools and the flexibility they provide. The proof is in the pudding:

  • The state of Georgia decided to standardize on Drupal and they integrated all of their 50+ state sites onto one platform, fully integrating the numerous legacy systems and databases onto the Drupal platform.
  • provides data from thousands of sources to anyone that has access to a web browser…it’s like night and day compared to healthcare.
  • UCSF Medical was able to extend their Epic platform by leveraging the Open Source Enterprise Service Bus (ESB) Mulesoft.
  • I could go on!

These problems have been solved; they have even been solved in a clinical context, so there are no more excuses. Hospital CIOs, CMIOs, CTOs etc. can make real gains by adopting a broader perspective and thoroughly vetting Open Source solutions as potential answers to the challenges plaguing their organizations.


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