We regularly use our smartphones to transfer money from one bank to another without much consideration about how each bank’s systems support the transaction. We log in to an airline app and have our boarding pass in hand moments later, ready to be scanned at the gate. These are simply expected behaviors from consumer digital solutions that we’ve been using for most of the current generation, thanks to the creative work of technologists across multiple industries. Seamless interoperability—in which multiple information systems trade their data so easily as to be imperceptible to the users—is an expected reality in almost every aspect of our lives, with the exception of healthcare.
That’s not to say that healthcare is completely lacking in those expected conveniences, but it has been a laggard in general. It is still a common experience in this day where we call in for a doctor’s appointment as the digital capability is not accessible, many visits still require the filling out of paper forms with repetitive details, and for some services our provider may require an authorization for services to be faxed. Surely, we can do better.
Now and then, we do encounter healthcare transactions that display the kind of interoperability convenience that we’ve come to expect in other consumer experiences. Some practices provide online scheduling tools or the option to fill out paperwork online in advance. Direct e-prescription means we can swing by the pharmacy on the way home from the appointment and our medications will likely be ready. In the emergency department, the clinician stitching up a nasty cut might ask when we had our last tetanus shot, and perhaps—with the right connectivity in play—we can look up that information in the patient portal app on our phone.
In a truly interoperable healthcare system all of these advances, and many more, would be available consistently for everyone, at all times. We could be confident that every healthcare provider we see has access to all our information—without transporting it ourselves using outdated tech. We would no longer have to ask for copies of our records or images when we change doctors or make an appointment with a specialist. An up-to-date list of our vaccinations would always be immediately available to the emergency department doctor or any other provider who needed it.
Why doesn’t health information flow as freely as financial transactions or travel reservations? Unfortunately a good portion of the challenge lies with information systems that were created before interoperability was even considered as a core requirement or a true value add. Many of those systems were created to capture charges for billing purposes, with clinical support and consumer participation as an afterthought. Moreover, in a world so accustomed to instantaneous, real-time transactions where users may not wait 10 seconds for a website to load, a lot of health information systems still batch transactions for overnight processing. This means that the information in a record may lag significantly behind the current reality.
Bringing those systems en masse into the modern age would be a significant undertaking, even if more modern options existed—which they don’t, yet, or at least not at the scale needed. Fortunately, better healthcare interoperability doesn’t depend on the replacement of billion-dollar legacy systems. Much of what we need can be accomplished by wrapping the current systems in a larger ecosystem of nimble apps built for specific purposes.
The industry’s largest payer, the federal government, recognized the value of liberating the flow of health information in the 21st Century Cures Act, signed by President Obama in December 2016. Among its many provisions, it requires health information technology vendors to comply with standard application programming interfaces (APIs) so that information can be shared in a consistent way among applications from different vendors. The final rule, approved in July 2020, requires compliance with FHIR (Fast Healthcare Interoperability Resources), a standard API for using the internet for health data exchange. This API had already gained wide industry support because it builds on previous standards and embraces more exchange models widely understood in common consumer systems.
This requirement to comply with a standard API finally breaks the proprietary strangleholds that have crippled earlier attempts at interoperability, and opens the way for non-traditional development teams to apply their imagination and ingenuity.
Conversa’s virtual care and communication platform is just one example of the many capabilities that providers will be able to easily add to their existing systems in this newly interoperable world. We employ artificial intelligence to interact with patients via our smartphone app. These conversations draw on information from the patient’s records, and they also update the record with any new information that the patient shares during the conversation. The technology can be used in many contexts: from management of chronic disease to our recent development of a COVID-19 screening tool for employers.
We understand how to engage patients in a conversational paradigm to improve their care. We are experts in this highly focused area. As healthcare embraces interoperability at the level of other industries, we can easily share this expertise with any provider. Providers will never have to worry about developing it in-house, or about how they are going to make it work with legacy systems.
Our organization is just one of many working to solve aspects of consumer health engagement with technology that is highly relevant and accessible. We want solutions like ours to blend in effortlessly to the expanding tapestry of consumer health offerings, with relevant health information moving seamlessly and routinely. We want patients to be able to expect that their information will be where it needs to be, every time, and to take healthcare interoperability just as much for granted as their bank transfers and boarding passes.