Just prior to HIMSS23, Healthcare World hosted a virtual panel discussion called The Global Digital Health Agenda. Moderated by Healthcare World Managing Director, Steve Gardner and HIMSS President and CEO, Hal Wolf, the discussion centered on the current state of the digital health revolution around the world. Panelists shared their perspectives on the state of digital health in the countries they represented. As Steve Gardner put it frankly: “We’ve got so many different solutions, so many different ideas and technologies, how the hell are we ever going to get them all to talk to each other?”
Participants shared their responses to this question, among others. Participants included:
Panelists discussed the fact that the U.S. doesn’t have a healthcare system, per say, but rather a healthcare market. Conversely, the UK’s set-up can more accurately be referred to as a healthcare system. Drew Ivan, chief strategy officer for Rhapsody, shared how this concept of a U.S. healthcare market impacts interoperability. Here we share excerpts, edited for clarity and brevity, from the discussion.
We don’t actually have a healthcare system in the United States. The NHS in the UK is a healthcare system. The United States has a healthcare market. Over 50% of healthcare now in the United States is paid for by the government…We’re shifting more towards that type of a system where the government is already the main provider of care, not physical care, but of the funding of care. It’s having an impact on the prices, the identification of anomaly, and all the components we’ve talked about. So, the United States is shifting.
The UK is probably behind at the moment. It’s a really interesting paradigm when both healthcare systems are fundamentally broken. If both ends of the spectrum are broken, how do you find something in the middle that works from different systems around the world?
We can’t have a conversation about digital healthcare without mentioning the word interoperability. Ultimately, we’ve got so many different solutions, so many different ideas and technologies, how the hell are we ever going to get them all to talk to each other?
Interoperability has been one of the core elements that HIMSS has worked on for years, both trying to facilitate in the definitions of interoperability and where we go next. Interoperability used to be just purely the semantical components of how we exchange data and information.
But we also talked today about organisational interoperability. How does the information even move across a single domain, where you can have continuity of care? That interoperability has to occur as well.
We have had a desperate need for a long time for data and information to be exchanged easily and with a consistency of format.
It’s why wonderful organisations like HL7 and other institutions exist, which helps exchange that information. Beating against it is the proprietary and private sector that believes that by the unique use of its information, how they exchange it, it gives them material advantage in the development of applications. Until we get to a point legislatively, and from a regulatory standpoint, that dictates them, it’s going to continue to be a mishmash.
That being said and the capital market being what it is, there are organisations that have been developing, if you would, ‘Rosetta Stones’ that sit in the middle for that exchange.
So, it really comes down to a choice. Open source or proprietary?
There are a lot of discussions, and of course agreements, that have been built slowly but surely, but we need to move faster for the fundamental exchange of information, or at the very least, it’s semantic integration. Meaning, of course, ‘a rose is a rose by any other name’, would help us dramatically.
We did that during the pandemic. We stripped down the definitions quickly in terms of ICU capacity and definitions around the unit. We can do it. It’s just a question of the design and the push, and it’s going to have to come from the top because it won’t come organically from the system itself. The systems of the healthcare ecosystem are fundamentally designed for interoperability not to exist, and yet the need of society is for it to exist.
You’re almost saying the strength of the American healthcare system is its very weakness in the fact that you don’t have a health system; you’ve got a disparate group of providers spread across the whole country, but actually that fuels innovation in its own sweet way because you have a market of different organisations and different companies that want to do things in different ways.
Drew, that brings me on to you guys with Rhapsody; you solve this interoperability problem. That description that Ernesto [Chanona] has given of the U.S. healthcare system, is that why your organisation has grown out of the U.S., because of the need to be able to adapt from one healthcare provider to another across such a broad landscape?
I do love the framing of the U.S, healthcare system as a market because once you look at it from that perspective, everything else that’s happening here makes perfect sense. That’s why we’re spending more every year, because markets grow, that’s what they do. Ernesto has it exactly right: it fuels innovation, but that comes with a cost.
From my perspective, all of these digital health applications, or even the traditional IT applications like an electronic health record or billing system, they all need to be fed data.
Each system takes data as its raw material and does something with it. They turn it into workflows. They turn it into information and insights. They turn it into whatever it is that an application is intended to do. But that starts with getting the data in, and that data is generated from some other system. So that’s the driver for interoperability.
There needs to be this method for starting that process by getting data into the application. I think the challenge we see is that the types of data that we’re talking about are constantly changing and growing and improving.
One of my favourite examples is social determinants of health. Today, there are standards for expressing data about social determinants of health standards and for transferring that data. Those standards are not well adopted yet, but if you look back five years or, especially if you go back further to 10 years, we weren’t even talking about social determinants of health.
That’s an example of the reason that interoperability will never be finished. Today we have pretty universal adoption of certain types of interoperability, like electronic prescriptions. Those are quite common everywhere. But once we have that done and adopted and flowing well, we’ll move on to the next type of data like social determinants.
There’s not a way to transfer those around, but once it becomes useful to move that data around, then we see a fresh interoperability problem emerging.
I think of interoperability not as a single problem to be solved and accomplished and moved beyond, but rather, as something that goes along with all these other problems for solving.
An example I sometimes use is road work. If you’re going to have roads, you’re going to have road construction and it’s never going to go away because you always need to maintain them and improve them and keep them up to date with the different types of traffic and the different destinations that that you’re trying to get to.
Same thing with interoperability. It’s part of the infrastructure and therefore it’s always going to be under construction. That’s the perspective that Rhapsody is coming at this problem from. We know that everyone who’s engaged in developing digital health has this problem of, how do I get the data that’s going to bring my raw material? We’re trying to solve that problem for everybody so that they don’t have to solve it for themselves.
I’ve used that analogy a few times. The idea of healthcare, particularly the way I often describe integrated care, as being the idea that you dig up the road once, and you put the sewers in and the broadband and the electrics and the gas mains and the water pipes. You do it all in one go rather than having to dig up the road multiple times.
What gets kind of interesting there is the fact that interoperability, it’s kind of the same thing. How do you integrate between the different levels of the health system? If you’re going to have integrated care, you need to have interoperability between the layers of the health system. Am I thinking about that the right way?
We think about interoperability at many different levels. There’s interoperability between devices and software systems. There’s interoperability between the software systems within an organisation. There’s interoperability across organisations, and we talked about some of this earlier in today’s conversation.
The reason we break it down like that is because they all sort of go by the name integration or interoperability.
But there are very different concerns at each level. There are different standards in use. There are different data governance concerns that you need to think about. There are different vendors in play. There are different regulations. You really have to take a step back and think about the interoperability problem in general terms. But then as you get closer to the implementation, some of these specific differences start to crop up.
I look at the digital health market as obviously one of the newest. You have a lot of emerging and smaller companies pushing their product to the market, so they’re not talking to each other because they’re all trying to compete with each other. Perhaps it’s a function of how young the market is?
I wonder if you think in 50 years from now there are going to be a lot of mergers and acquisitions of these companies into larger digital health companies, and so big digital health will become a thing where then it’ll be the company’s responsibility to start then integrating all of these applications into a solution that’s a little bit more interoperable.
I’ve seen this with a couple of groups that I’m aware of working across different markets where you’ve got venture capitalists and investors buying up individual SME digital health companies with the intention of putting them under one roof and making them interoperable. Drew, is that something that you’re aware of?
Yes. The industry is cyclical, and one direction of the cycle is we start bundling functionality into bigger and bigger applications. We saw that in the U.S. with the EMR movement. Electronic health records were widely deployed starting in about 2008 when funding made that an imperative.
Hospitals spent a lot of money implementing electronic medical records and trying to get as much of their workflow into that single system as possible.
Now that’s effectively done, electronic health records are implemented and starting to become optimized, we’re starting to see the places where they don’t do everything perfectly. That opens up opportunities to unbundle that piece of the problem and create a digital health company around it.
There will be a period of time when this unbundling process occurs, and it’s inevitable that we’ll start to see some of these digital health inventions overlapping or duplicating each other’s functionality. Then it will be time to bundle it again into a new type of offering. This happens on different time scales. It’s hard to say that at a certain time, the trend will reverse. We’re going to see it starting to take off in an uneven fashion. You’re seeing it in some places. There are probably other places that are still a ways off. We’re definitely seeing it, though.
Watch the full panel discussion from Healthcare World.
If any of these digital health data challenges sound familiar, discover how the Rhapsody Interoperability Suite can help solve them, or go direct to speak with one of our interoperability experts.