Interoperability: What does it mean?

I hear and see interoperability talked and written about frequently in the discussion of how to improve medical care delivery. 

Interoperability can mean a lot of different things. For example, it may mean that many different platforms work together within a single organization to bring different data points into one single data base.  Interoperability may also mean that the various electronic health records  an organization uses can exchange information with each other so that all the different health records can display a complete picture of the patient to those using the record.  Interoperability can also mean that different organizations’ electronic health records can share patient information back and forth to avoid the siloing of information in any one health care organization.

Interoperability may also mean the ability to incorporate non-traditional health care data, such as food insecurity, housing insecurity, or other social determinants of health into the health care record to enable a clinician to address those issues when providing care. The real definition of interoperability probably encompasses all of these examples and more.  I am drawn to the concept of interoperability, in all its meanings, because I believe it is a critical tool that significantly improves the quality of healthcare. All facets of interoperability are needed. 

My perspective on interoperability is that of a primary care clinician and healthcare administrator. When electronic health records were first being introduced, clinicians were told that although they would spend more time documenting, their additional time would provide dividends by creating a richer and fuller picture of a patient, which in turn would make the clinician’s life easier and their patient’s care better. Having all of a patient’s information — ER and urgent care notes, primary care and specialists’ notes, and care notes from other systems—together at one time would eliminate time wasted tracking all that information down.  The unfortunate reality is that this has not happened. 

Electronic health records have not always provided the promised easy interoperability. This unfortunately has led clinicians to simply accept the information they have in front of them and not seek any additional data because of the time-consuming process required to do so and the significant additional time they already spend documenting.  There just isn’t enough time.

So, if we hope to improve the completeness and quality of care we provide, interoperability will have to come to pass in a different way.  Our commitment as medical providers should compel us to have all of the information, we need to make sure that every patient has all of their needs — wellness, prevention, acute care, chronic condition care, and social determinants of health — available whenever and wherever care is provided to that patient.

We should have interoperability, either from electronic health records or other solutions, now.  This is the time for fresh thinking and new tools that live outside the EHR to help manage all of the data needed to effectively empower population heath with the highest quality of care.