The wire services lit up yesterday with news that six of the largest tech companies in the world had issued a statement in support of interoperability in healthcare at a developer conference. It’s a righteous goal, to be sure. In an interoperable healthcare world, anyone’s entire, life-long health record could be accessed anywhere, anytime, by anyone who was giving you care, from your primary physician to an emergency responder. Such a virtuous goal, in fact, that everyone, including the US government, has been trying to achieve it – without success – for over a decade. Will yesterday’s news bring us any closer to that goal?
Let’s start with the facts. First, the six companies are Microsoft, Amazon, Google, IBM, Oracle, and Salesforce (yes, Salesforce).
Second of all, it was just a statement (reproduced in full at the end of this post). There is no call for, or any commitment to, any specific action. The supporting, individual posts are similarly fluffy (here’s the one from Microsoft; Google’s equally vague commitment is here).
Third, the essential tools necessary to achieve this goal have been in place for years, most notably the FHIR standards developed by HL7 (disclosure: HL7 is a client of mine).
So, what’s the point?
One clue comes from the current business strategy of the companies involved, which include all of the biggest cloud services providers. Historically, when it comes to application software, the enormous healthcare marketplace has been dominated by smaller IT vendors with no incentive to adopt standards that would make it easier to switch to a competitor’s products. Healthcare providers have no incentive to make it easier for a patient to shop out of network, either.
Cloud providers, though, have an incentive to make interoperability real. Interoperability makes it easier and cheaper for them to host a wide range of technologies, and, crucially, it makes it easier for existing businesses to migrate into the cloud.
So, it makes sense. But if it makes sense, why such a limp statement, especially since getting six such prominent and competitive companies to agree on saying anything together is always a heavy lift?
Certainly, there’s a feel-good public relations benefit. A joint statement also reassures potential customers that if they become unhappy with one cloud vendor, it will be easier to move to another. It will reassure those considering a move to the cloud. And it will encourage open source projects, as well as independent developers, to participate in related open source projects.
But that’s not a strong enough incentive to put in the kind of hard work and investment it will take to solve what has been one of the most intractable interoperability problems ever. I wrote at length about this way back in 2008, when achieving interoperability in healthcare was proclaimed as a major goal of the Obama administration. Billions of dollars were poured into providing incentives to doctors and other health providers to purchase electronic health care software and systems, to be followed by financial penalties for those that did not do so by a deadline date.
The result? Everyone bought the software. But the software vendors didn’t adopt the standards. So, we’re still living – and may die - in a world where doctors still fax and mail records back and forth.
So, it’s difficult to be optimistic about this latest announcement. Someday, perhaps, the stars will align in such a way that healthcare technology vendors and customers all agree that they will make more money if healthcare technology is pervasively and effectively interoperable. Until that day arrives, if ever, we’re likely doomed to remain exactly where we are.
Here’s the joint statement:
We are jointly committed to removing barriers for the adoption of technologies for healthcare interoperability, particularly those that are enabled through the cloud and AI. We share the common quest to unlock the potential in healthcare data, to deliver better outcomes at lower costs.
In engaging in this dialogue, we start from these foundational assumptions:
- The frictionless exchange of healthcare data, with appropriate permissions and controls, will lead to better patient care, higher user satisfaction, and lower costs across the entire health ecosystem.
- Healthcare data interoperability, to be successful, must account for the needs of all global stakeholders, empowering patients, healthcare providers, payers, app developers, device and pharmaceuticals manufacturers, employers, researchers, citizen scientists, and many others who will develop, test, refine, and scale the deployment of new tools and services.
- Open standards, open specifications, and open source tools are essential to facilitate frictionless data exchange. This requires a variety of technical strategies and ongoing collaboration for the industry to converge and embrace emerging standards for healthcare data interoperability, such as HL7 FHIR and the Argonaut Project.
- We understand that achieving frictionless health data exchange is an ongoing process, and we commit to actively engaging among open source and open standards communities for the development of healthcare standards, and conformity assessment to foster agility to account for the accelerated pace of innovation.
Together, we believe that a robust industry dialogue about healthcare interoperability needs will advance this cause, and hence are pleased to issue this joint statement.