Cricket

Cricket: The Sport of Interoperability

If you’ve read the recent KLAS report on the state of interoperability, you know that they appreciate a good baseball metaphor. At the risk of taking this too far, I felt it appropriate talk about KLAS’ work in the UK with a lesson from cricket.

If we turn the word “cricket” into an acronym, I think we can identify seven key areas that need to be focused on to bring about successful interoperability:

Cultural Interoperability – Shifting culture to accept interoperability may be the most difficult piece of the puzzle. The partners in data exchanges need to willingly have their data, their workflows, and ultimately their outcomes influenced by the outside world. Clinicians might be concerned about trusting what they see or losing control as they allow appointments to be booked directly. Moving the cultural needle on interoperability will only come through education, persuasion, peer pressure, and incentives to move forward.

Return on Investment – Unfortunately, the areas of interoperability that we spend the most money on  aren’t always the areas that yield the most benefits. For example, primary care facilities may have less to gain than hospitals do in terms of sharing their clinical records. We need to provide incentives or find ways to prove that it’s worth the investment for all stakeholders to work as a system. At the core of this effort, we must uphold the expectations of patients and give the best care we can deliver. That means building the best information flows.

Information Standards – Definitions are often subtle and can have shades of meaning. Things that look the same on paper may be radically different in practice at two organizations. In order to come to a truly interoperable state in healthcare, the organization of our data must truly be identical.

Coordination – The Internet has unlocked endless possibilities, but only because of buy-in from the world. If you were the only one online, the Internet wouldn’t be so great. Some of the current developments around SMART and FHIR can sometimes feel the same way; we need to coordinate these advancements to maximize their effectiveness.

Knowledge – As with any push forward, it is important to identify those who know how to get the job done. That can be tricky when it comes to interoperability. While many may understand the workflows and requirements of their respective organizations, people must learn how the whole ecosystem functions in order to successfully exchange data. They must also understand how the whole system will fit together under new models of care. Emerging standards like those of SMART and FHIR will take some time to understand and master. We need to invest not only in the tools our teams have, but in team members’ knowledge if we want to make interoperability a reality.

Evolution – It’s unrealistic to expect that we will change a whole community of systems overnight. Instead, we need to seek the opportunities where they arise or create them along the way. We need to let the evolution of interoperability work much like evolution does in the natural world by adapting, filling gaps, solving problems, and allowing our strongest solutions to rise to the top.

Technical Interoperability – Also known as “the plumbing.” This is mainly a matter of investing in current systems or replacing the systems that can’t be made to interoperate. While the technology behind interoperability is far from perfect, it is in many ways much further along than some of the other areas required for “hitting six” in interoperability (that’s a home run in cricket terms, Yankee friends).

Culture

Return on Investment

Information

Coordination

Knowledge

Evolution

Technology

Cricket.

I anticipate that as we continue to work with KLAS in the UK, we will bring the findings from their US efforts and apply them in our own way. The core technical issues are likely to be similar, but the context between the two healthcare ecosystems of our countries will make for differences. I’m looking forward to the opportunity to understand these differences in the light of new research.