| | DECEMBER 20188UTLOOK Healthcare Tech IN MY OPINIONConnecting the Railroads: Reflecting on Healthcare and the Future of Interoperability By Gail Kalbfleisch, Director of Federal Health Architecture, U.S. Department of Health and Human Services (HHS)Every American connects with the Healthcare industry at multiple points in their lives, interacting with medical care providers like primary care physicians, dentists, pharmacists, surgeons, nurses, psychiatrists, optometrists, and OBGYNs. In these interactions, we expect and depend on innovation and new advancements in medical technology and computing. However, the Healthcare community is often criticized for its lack of, or very slow advancement in, leveraging computing technology in the area of information exchange. In many areas, much of our Health information still exists in paper and pdf formats, siloed within the confines of an individual doctor's practice. This makes it difficult for information to move with the patient where and when it might be needed. That is why, over the course of my career I have been asking: What does an interoperable future in healthcare look like, and how do we get there? In many ways, Healthcare is no different than any other industry that needs to be interoperable. Consider the similar transition once faced by the American railway system. American railroads began as individual organizations with their own individual standards. Eventually, the American public realized it was in the country's best interest to build a national railway system--where cargo and passengers did not have to disembark from one train and move to another, all because their train was not compatible with the tracks in the next area. With interoperability, however, came necessary change. Tracks were replaced in some areas, cars replaced in others, companies had to invest in standardized equipment (some actually had to find new areas of business) and some companies ceased to exist. But in the end, it had an overall positive effect for the individuals and companies who relied on the system.Striving for interoperability in Health IT means that as a nation we should be moving toward electronic storage and exchange of Health information at the process, data, and context levels. Automated computing requires repeatable processes and data. One obvious industry which successfully integrated electronic record keeping and data management into its processes is the banking and finance industry. The recording and movement of financial sums, calculation of interest, distribution of withdraws and transfers--are everyday activities for which the industry has had repeatable processes for decades (or centuries). Conversely, the difficulty with electronic records and data processing in healthcare is that, until recently, defining and agreeing on common, repeatable processes have not been a priority.The nature of Health data and the methods of collection make for an overabundance of variables and unpredictable results. For example, when a nurse takes a patient's blood pressure, the number she records would seem to be an easy data point to add to the patient's electronic Health record (EHR). But the context of the patient's blood pressure is
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