- Mark Battaglia, CellTrak CEO
The leader of a mid-sized home care agency realized that, in order to compete effectively, she had to find ways to run the business more efficiently. As she dug into how the agency operates, she found that some data had to be keyed into multiple systems, data from some systems needed to be manually keyed into other systems, and that her management team couldn’t combine data in the ways they needed to do analyses to optimize the business.
At first, the leader framed the problem in technical terms – what technology did the agency need to better use its data? But, after talking with the CIO, she realized the technology to make use of the data wasn’t the issue – access to the data was. “It’s our data,” she said. “Why can’t we just get it and use it?”
While the scenario above is fictional, the problem it describes is real. Every large- and medium-sized care provider has implemented technology to help it be successful at scale. And, sadly, nearly every provider executive has, at some point, realized that their business is being held back because the data in their systems – the provider’s own data – is being held hostage in the silos of the IT systems they’ve deployed.
The hidden costs to providers of closed systems are high. The obvious ones include inefficient workflows and sub-optimal decision-making that continually chip away at profit margins, employee job satisfaction, as well as difficulties in connecting across the care continuum in support of personalized, value-based care. The less obvious, but more strategic, ones include growing fixed costs due to constrained competition among technology vendors, an inability to easily take advantage of the many best-of-breed software innovations that are happening across the industry, and the creation of high switching costs that effectively lock providers into a vendor.
Interoperability is the Future. You Need Access to Data Now.
Interoperability is healthcare’s Holy Grail. HIMSS defines it as, “the extent to which systems and devices can exchange data, and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user.”
Many crusades have formed, and many battles have been fought, around technical standards for interoperability such as HL-7 and FHIR. Although progress has been made, it doesn’t seem as if any standards camp will declare victory soon. And, even if a standard wins the war, it will likely take a good deal of time for vendors to adopt it. No care provider can afford to wait to improve care quality and reduce operating costs.
So, why isn’t interoperability happening faster? Two issues are important root causes.
First, there’s a practical issue that’s one level down from the technical standard-setting that affects every “solution” for interoperability. Standards typically focus on the format and/or technical method by which data will be exchanged and the data that will be included. One level down, there are thorny practical issues to resolve.
For example, if the standard describes how to exchange a blood pressure reading, vendors still need to figure out how to deal with scenarios where one system has multiple readings from multiple sources at various times of the day, and another system only has a single field, or only expects to get one reading per day. Deciding what to do at this level is a many-to-many problem and, after decisions are made, time is needed make changes in software programs to implement them.
Second, there’s a commercial issue for the companies that supply software to providers. Some vendors would like to provide all of the software a provider uses, and providers like the promise of a single, integrated solution where everything works together perfectly—and there is “one throat to choke” if it doesn’t.
However, the reality is that software vendors need to interface with other vendors' systems. Most likely, software vendors also need to develop interfaces within its own set of products. A vendor—particularly one pursuing a sole-supplier strategy—almost certainly has interfaces within its own technical stack due to products that were acquired or have been added over time.
Here's the issue: vendors don’t make interoperability, or even access to data, a priority. Interoperability drops lower on the R&D backlog when vendors face pressure to continually invest resources to keep up with regulatory changes. Interoperability may even get in the way of sales: for example, the vendor may sell an integration software product. This “information blocking,” whether intentional or not, affects both providers’ day-to-day operations and their ability to use data to make better decisions.
Some, usually very large, software companies ostensibly mitigate this issue by establishing partner programs by which they permit other software companies to access the data in their systems. Typically, program participants must pay a significant annual fee, and they may also have to pay an ongoing percentage of their revenue. The rationale for payments is the cost of support of the partners and the providers who use the partner’s products.
In addition, if they even are allowed to participate, partners with software that is competitive to some part of the vendor’s offering must supply information about where their software is installed, putting them at risk for being targeted by the vendor’s sales staff for the vendor’s competitive offering. As a result, the prices providers pay are higher, their options fewer, and their deployment of innovations slower than they need to be.
It’s Your Data. You Can Easily Gain Access to it Now.
Interoperability won’t occur until sometime in the future. The timing is uncertain. Is there anything you can do today?
Thankfully, the answer is “yes.” As a provider, you can’t mandate interoperability across the ecosystem. But, you can, with minimal effort, gain unfettered access to your own data. Here “access” to data is defined as “the ability to locate and retrieve data or a data file.”
With the three simple steps that follow, you can gain unfettered access to your data and, by doing so, make meaningful progress on dimensions that can make a difference, including having the information you need to make better decisions about clients and operations; lowering the price you pay for technology; and enabling your organization to more quickly deploy innovative, best-of-breed technology.
Three steps you can take today are:
- Make understanding a vendor’s interoperability and data access a priority in your technology selection process. Most software selection processes focus on functions and features, workflow, and security risks. All of those things are important, immediate issues. Interoperability and data access are equally important in the “downstream” contexts of future expenses and strategy, especially if your organization is doing more care coordination with payers and other providers. As a result, they deserve the same well-thought out attention from decision-makers.
- Trust but verify. When asked, most vendors will say that they have an “open system.” Check with references and other vendors whose software that you use, or might use, to learn whether the vendor has a track record of co-operation that benefits providers, or if the vendor limits access to data, or puts a high price on, access to your data.
- Require that the vendor agree to contractual language that provides you with assurance of access to your data – and leverage if that access is constrained. If a vendor won’t accept that type of language, it’s a yellow flag as to the extent to which a vendor is really willing to be a partner to you. If you bring this up early in your buying process, you can save time by meeting with companies that aren’t willing to put your interests first or to compete on the merits of their offerings on a level playing field in the future. For example, you might insert the following language in a contact:
Customer’s license to Vendor’s Software includes Customer’s right to access Customer Data which resides in the Software solely for Customer’s business purposes. Customer also has the right to access Customer’s Data to retrieve, update, report on, and otherwise use Customer’s Data. Vendor will not prohibit, block or charge a fee for such access or use, nor will Vendor deploy any type of virus, software trap, or other malicious, disruption or corrupting program code or instructions within the licensed software that would purposely prevent Customer from accessing or using Customer Data. Vendor agrees to cooperate with Customer by providing any documentation for all interfaces and application programming interfaces and any technical support required by Customer to access and use its Customer Data.
In today’s highly-competitive, highly-interconnected health care ecosystem your organization must be able to access and use from, and exchange data with, many systems to survive. By taking the three simple steps above, you can gain access to your own data and take an important first step to making your organization more efficient, better informed, and more agile.