Editor’s Notebook
January/February 2011
Editor’s Notebook
The Lowest and Best Common Denominator
Interoperability is a buzzword with legs. At the moment, it’s everywhere, including on the cover of this issue of PSQH. I’m usually wary of buzzwords and hot topics since they often fade as quickly as they appear, but interoperability will continue to be a challenge as our healthcare system undergoes major changes in the next few years.
The concept of interoperability applies to many aspects of healthcare, including medical devices (see pp. 20 and 24) and electronic medical/health records. It’s also an important feature for patients taking an active role in their own care and demanding better access to their own health information.
In “Putting the Patient First, Literally,” Adrian Gropper, MD, observes,
For more than 5 years, interoperability has been approached from the perspective of doctors and hospitals. The results speak for themselves…it’s time to put patients first and technology second by giving patients (and their designated agents) convenient access to their health records in their choice of electronic formats… (www.thehealthcareblog.com)
Gropper refers to the requirements for Meaningful Use in the federal HITECH incentive program for electronic medical records and a report issued in December by the President’s Council of Advisors on Science and Technology (PCAST). The PCAST report calls for adoption of an alternative “exchange language” for health information that would preserve privacy and expedite information exchange (http://www.whitehouse.gov/sites/default/files/microsites/ostp/pcast-health-it-release.pdf). The details are technical and controversial, but underlying PCAST’s approach is a central role for the patient in information exchange. Gropper also points out that the shift to Accountable Care Organizations (ACOs) creates an additional and potentially compelling reason for physicians to exchange health information with patients. ACOs depend on information exchange, require patient engagement, and may represent a business model that serves most interests well in the new environment.
An essay posted on the Center for Connected Health’s website (www.connected-health.org) highlights another facet of the patient’s stake in interoperability. Rob Havasy, business analyst and mHealth Strategist for the Center, reports,
One of the problems we face daily at the Center is not the lack of some new device or some awesome new wireless communication method. It’s the difficulty of getting a simple and inexpensive combination of devices into someone’s home that doesn’t require outside technical experts to help install and use them. …the biggest problem we are experiencing is mixing devices built for an analog world with new digital phone services and old in-home wiring.
He concludes that the “landline phone, digital or otherwise” is the lowest and best common denominator for data exchange that allows people—especially those will chronic illness—to support their health with home monitoring in a cost-effective way.
Havasy’s essay is another reminder that patients and consumers taking care of their own health needs are the principle beneficiaries of interoperability. Patient safety, public health, efficiency, and clinical advancement are benefits of interoperability, but the interests of patients and consumers may be the lowest and best common denominators of change.