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The real challenge with interoperability

December 7, 2016
In a recent survey by Premier Health, well over half of the responders stated that they could not exchange clinical information with their affiliated physician networks.[1] While interoperability is still a challenge, this number seems out of kilter. Since first beginning to make payments to eligible providers in May 2011, more than $24 billion in Medicare Electronic Health Record Incentive Program payments have been made to over 500,000 eligible professionals and hospitals.[2] These providers must use a certified system to qualify for these payments. Therefore, the capability is certainly there to exchange data.

The real challenge with interoperability is not the technical capability. It lies within the actual usage of those certified systems. Many physician practices do not have the technical staff who are capable of using the system for anything beyond simple data collection. The Stage 2 requirement for data sharing only specifies that data be shared; not that it be meaningfully useful on the receiving end. Each of these EHR systems has the ability to send and receive basic information. But when it comes to detailed clinical data, shared in various sub-versions of HL7 versions 2 and 3, the majority of physician practices do not have the technical staff or the technical ability to manage the translations between versions. In order to accomplish this task, basic EHR systems need a message broker, a third-party software “engine” that, at its most elementary level, has the ability to understand the content of an electronic message, and based on the content, determine where that message should be sent, and then translate the message content to match the format of the receiving system.

The challenge of sharing basic clinical information was accomplished in the early 1990s with the inception of the message broker. The more mature systems today provide capabilities far beyond basic data translation. Some, but not all, of these “engines” are HIPAA compliant, encrypting data at rest and in motion. They provide advanced capabilities for monitoring the message flow from beginning to end. And they have the ability to empower analytics, the next stage in managing population health.

This brings us back to the original question, “Why are over 50% of affiliated physician practices unable to exchange clinical information with their peers?” The technical capability is there, and has been for over 25 years. We trust our bank to share our financial information with other banks in order for ATM machines to link to our accounts. Why can’t we trust our physicians to share our clinical information with other providers to provide comprehensive care?

Jerry Malone, Senior Consultant for Cloverleaf Integration, Infor Public Sector

Learn more: Modernizing Federal Healthcare; Infor Federal Healthcare

[1] “Economic Outlook Health System C-Suite Trends,” Premier Health (, Fall 2016

[2] “Data and Program Reports”, Centers for Medicare and Medicaid Services (
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