The Big Question: Will They Cooperate?
December 01, 2005

By Staff
Appeared in Healthcare IT News

It’s not the $64,000 question, but the $18.6 million one – can the Office of the National Coordinator for Health Information Technology get vendors and providers to cooperate?

Essentially we can think of the recent awards for four National Health Information Network prototypes as posing that question. Last month, ONC chief David J. Brailer, MD and HHS Secretary Michael Leavitt announced that four consortia, led by IBM, Accenture, Northrup Grumman and Computer Sciences Corp., had won the right to build regional networks that could share information between different providers in different communities. What’s more, at the end of the day, the four regional networks had to be able to pass data between them.

As IBM’s Ivo Nelson says, it forces vendors to interoperate.

Maybe. As our story on this issue makes clear, providers are less than confident that technology vendors will suddenly reverse course after years of providing only the minimum connectivity that hospitals and physicians have been seeking.

“I don’t think, globally, vendors are pushing for interoperability,” said Marc Probst, CIO of Intermountain Health Care.

“The core health information systems vendors don’t see it as in their self-interest to interoperate,” adds Bill Spooner, CIO of Sharp HealthCare, because “they want to sell you everything.”

These two men – arguably two of the best and brightest CIOs in healthcare – aren’t alone. Kenneth Buetow, director of the NCI Center for BioInformatics at the National Institutes of Health, agrees with Spooner that vendors have profited from the lack of interoperability. “I understand why they have taken the position they have,” he said. “But I think it’s a mistake … and a lack of vision. As the practice of medicine changes, recalcitrant vendors will be leap-frogged.”

The problem with the NHIN prototype project, says Massoud Safaee of Syska Hennessy Group, is that “you’ll have competing technologies. That not only multiplies complexity, but conflicts of interest.”

Safaee notes that big vendors “would prefer to have proprietary, end-to-end systems that customers have to buy and maintain. It’s difficult for them to open their systems up. Although there are standards and everyone is supposed to adhere to it, in practice vendors don’t do that.”

Safaee says existing standards such as HL7 are only being implemented at the most minimal level to claim interoperability. “But in practice, minimal really is minimal.”

But it’s not only vendors who will need to cooperate to achieve transparent interoperability, notes Mitch Morris, First Consulting Group’s executive vice president for healthcare. Providers need to get with the program, too.

“It’s not a technology issue,” says Morris. “The struggles are around local, cultural issues – and how to solve them. The focus will shift to cooperation, not competition.”

Safaee agrees on that point. “You’re asking hospitals that compete to begin cooperating. Will they share information such as number of available beds? Specialties available? These questions are important when routing patients. But at the end of the day, hospitals want to be profitable.”

Ahh – there’s a real concept to prove. As Morris says, what the NHIN prototypes really need to develop is a business case. “Prove the concept, document the benefits and show that RHIOs aren’t just this year’s hype,” he says of his goals. “When you get to the point of asking ‘who’s going to pay for it?’, that’s when you run into trouble.”