Chapter 11. Interoperability

The first thing to keep in mind when thinking about interoperability is not a particular standard or technology, but motivations for instituting data exchange. Widescale interoperability has been technically possible for more than 20 years, and major hospitals have had data worth exchanging for at least that long. But as with EHRs, exchanging health data has stalled due to conflicting and backward incentives.

Historically (with a few notable exceptions) most healthcare institutions have found little motivation for interoperability. There is a lot of motivation to profess interest in healthcare interoperability, which costs nothing. This creates confusion among those outside the healthcare industry. For example, if the hospital CEO says that interoperability is “critical,” why is there no health data being exchanged?

For most clinics and hospitals, making patient data portable makes the patient portable. Why would anyone invest in a technology that makes it easier for patients to migrate to competitors? For any healthcare provider, a patient represents a financial asset that is expensive to replace. And the easy exchange of records lowers one of the main barriers to patients leaving—information about their medical histories. For centuries, a doctor-patient relationship was something very difficult to replicate. Patients understood that their current doctor was familiar with their health story, and moving would mean losing that familiarity. In a world without ...

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