Three Things Healthcare Can Learn about Interoperability from Monty Python

I have always loved Monty Python and the Holy Grail. My conversations are frequently peppered with quotes like, “I’m not quite dead yet,” “Message for you, sir,” and “I told them we’ve already got one.” That movie seems to apply to so many situations in real life. I recently heard someone describe interoperability as the “Holy Grail of Healthcare.” This made me wonder what lessons healthcare might learn from the adventures of King Arthur and his band of knights. I came up with three ideas.

1. Black Knights, killer rabbits, and lonely women are just the beginning.

On his quest for the Holy Grail, King Arthur is stopped by the Black Knight with “NONE SHALL PASS.” He successfully defeats the overly persistent knight by cutting off his arms and legs, but this is not the only trial Arthur will have to overcome. The list includes rude French knights, castles of lonely women, and rabbits that will bite your head off, just to name a few. Likewise, the pathway to interoperability is proving to be full of obstacles—the use of data from disparate systems is limited and mostly done outside of the normal workflow, and standards are not yet standardized. We need to not let the difficulties of the quest deter us from pursuing the Grail.

2. It doesn’t matter that strange women lying in ponds distributing swords is not a viable basis for a government.

True interoperability is more dream than reality—at least for the time being. Getting there is a quest likely to be undertaken by the few before being obtained by the many. It will be messy and there will be naysayers all along the way. When King Arthur met the peasant Dennis and his wife picking up filth, Dennis was not impressed with the king or his quest and tried to invalidate the king by explaining, “Strange women lying in ponds distributing swords is no basis for a government.” Even though Dennis probably had a point, King Arthur pressed on in his quest—and so should we.

3. The quest for interoperability will be harder than Arthur’s quest for the Holy Grail.

Interoperability will take cooperation between payers, providers, the government, and vendors of all kinds. The biggest challenge will likely be gaining alignment among these parties, which each have different incentives. The equivalent in King Arthur’s quest would be getting the rude French knight, the killer rabbit, and the Black Knight to coordinate efforts and allocate resources in order to facilitate Arthur’s success. King Arthur did gain some allies along the way, but he mostly just fought through the obstacles and he never did obtain the Grail. It will be interesting to see whether the end solution for interoperability proves vendors who have touted openness as being ahead of their time.

The bottom line is that we are all in this together. It will be important to learn, improve, and mark progress as we go. To that point, KLAS is doing our first study (scheduled to publish this fall) to mark the current state of interoperability. Let us know if you would like to share your interoperability experiences or want a copy when the report publishes. 

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