Episode Details

Interoperability. Let's just review a few key points that probably everybody listening knows but certainly bear repeating because they matter.

I don't want to dig into the technical or regulatory details of interoperability. That is above my pay grade. But I want to talk about the really important stuff that maybe doesn't get talked about a whole lot because you say the word interoperability and it's like the magic word that transports the unwary into the land of shadow and smoke and mist. It's like a self-published YA (young adult) novel half the time.

But let's start here: First of all, consider that a lot of healthcare these days is conceived of as a scattering of micro-moments. It's not even like we think of patients one at a time. We think about patients one ICD-10 code at a time. And we think about those ICD-10 codes in 20-minute increments whenever a patient happens to show up in clinic. The average Medicare patient these days sees five specialists and more than one PCP a lot of times. So, we're not only breaking that patient down into codes per minute or something, but this is further broken down by clinician or practice.

Now consider that everybody knows—and when I say everybody knows, I mean it's inarguable at this point—health happens at the whole-patient level, at the whole-person level, more accurately. It happens at the community level: 80% of patient outcomes are going to derive from what that patient does when they leave the office and whether they are able to and health literate enough to construct a reconciled treatment plan for themselves from the bits and pieces of information they've received scattered all over the place. You know in Star Trek when someone gets into the transporter to beam down to a planet and their whole body splinters into a gazillion little pieces? That's how our healthcare industry treats patients. They are frozen in that moment and rarely, if ever, become whole on the other side.

So, when we talk about interoperability, what we're really talking about is a means to an end. What we are discussing is creating the ability to treat the whole patient or—Heaven forbid!—consider the whole community because we have enough data that we can accurately and adequately see the whole picture. We are able to avoid prescribing a treatment that is dangerous to the patient, inefficient, duplicative, or low quality—which is what happens over and over again. It's no amazing surprise that our healthcare industry wastes $1 in $4 we spend and doesn't net outcomes that are great in almost any respect when compared to other countries.

Let me say this more bluntly, as if that wasn't already pretty blunt: If I don't know relevant and important details about my patient, then I cannot consistently deliver care that is high quality, safe, or cost conscious due to service duplication or uncoordinated care. I mean, how is anybody supposed to deliver evidence-based care when a lot of evidence may or may not be missing?

So basically, without interoperability piping in the right patient information, I cannot succeed in any risk-based arrangement, right? If care provided is consistently lower quality, uncoordinated, unsafe, or inefficient, how am I supposed to optimize my care delivery? Said another way, interoperability is essential for anybody who wants to succeed in a value-based arrangement. I need all the data on my patients, and I need it in a way that I can separate the signal from the noise. Of course, getting 40 pages of duplicative SOAP (subjective, objective, assessment, and plan) notes that are semi-accurate and that no one bothers to look at is just unhelpful.

Quick counterpoint: FFS (fee for service) loves siloed data. You know how much money everybody talks about could be saved if we eliminate duplicative services? Well, that's how much some fee-for-service health system is gonna lose if you make it easy for clinicians to see that the p