Why the Noun Interoperability is Pointing Us in the Wrong Direction

Language is not only a way to communicate but also a glimpse into how we think. Our choice of words reveals the way in which we understand the underlying subject matter. This could not be more true than with the word, interoperability. It is not that interoperability isn’t a noble and worthy goal. The challenge is that it comes with assumptions. For something to be interoperable, it assumes that the “exchange” is occurring between two fixed systems. Our goal is to push things back and forth between these systems. In my mind, the more powerful piece of the definition of the adjective, interoperable, is the second part, “make use of information.”

If our goal is to make use of information, then current approaches to interoperability will simply not get us where we need to go.

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EHRs: There is no “There” on the Internet

Just over a year ago at the Personal Democracy Forum in NYC, I posted an item to my personal blog at The End of Linearity on this topic, the idea that there are no destinations on the Internet.   Having wrestled with this topic for many months, it became clear that the challenge of ‘destination thinking’ from the real world was complicating solutions to topics like health care because it was focusing us on areas other than patients by which to find solutions.

The quest for the holy grail of the electronic health record is particularly difficult because of fundamental disagreements about matters as general as the scope of the “health” domain. What are the proper relationships between records made by examining physicians, diagnostic experts, health insurance companies, parties paying for health insurance, patients themselves, and others? What about schools that require particular vaccination records or physical examinations for athletic participation? Or financial service providers pricing annuities based on actuarial estimates?

This piece by Tevi Troy at the Washington Post highlights key issues that CLOUD can help address as we seek to solve this electronic health record challenge through new vectors and a change in your horizon.