More fragmented information systems
The care of most health conditions has become more complicated, due to more sophisticated treatments and more complex investigations. This leads to more “islands” of technological equipment, information and information systems supporting them.
Reality check
On average, hospitals used 16 distinct EHR platforms, according to a report by Health Information and Management Systems Society (HIMSS) Analytics published early 2018.
And 62% weren’t using patient information outside their own EHRs because external providers’ data wasn’t available within their workflows, a Black Book Research survey reported early 2018.
Lack of awareness/understanding
Some stakeholders are still more or less ignorant of the importance and benefits of interoperability in health care. And even if they are aware of the existence of interoperability standards, there is poor understanding due to their complexity.
There are so many, produced by different developers, some of them with an overlapping scope. They do not fit together well. It is hard to recruit skills to implement them. There are many optional features within standards: it is not easy to work out which ones should be used. It is not easy to prove that a standard has been used correctly within an IT system.
Health ICT decision makers, including procurers who actually purchase the information technologies used by e.g. hospitals or GPs, do not understand well enough the nuances of the different standards that are in existence, the role they each play and what portfolio of standards should be required to deliver a certain connectivity (if they can work together, which is not always true). The inclusion of one or more standards in a procurement often does not result in the delivery of useful interoperability.
Health ICT SMEs (small companies and start-ups) are driven to invest mostly in their chosen innovation area, and often lack the expertise and the budget to understand why they should invest in standards and which standards they should adopt.
Patients and the public could have a powerful influence on decision makers to speed up the adoption of standards, if they understood more about them and what impact they would have on their own health and care.
Supporting interoperability does not yet offer enough business value over non-standard connections
Lack of pressure and incentives
There is a lack of pressure by governments to make wide-scale interoperability a reality. The health ICT marketplace, and the business models of most health care provider organisations, do not favour the adoption of interoperability because of lack of financial incentives to share information between health care organisations.
Reality check
57% of hospital network physician practices operating on assorted EHRs reported they continue to lack the financial and technical expertise to adopt complex interoperability, which is “compulsory to attain higher reimbursements built into value-based care initiatives by both public and private payers,” said Black Book Managing Partner Doug Brown (2018).
