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.
Let’s take just two current examples of interoperability efforts, CommonWell and TransCelerate BioPharma. Both of these initiatives have excellent goals, and I wish nothing but success for them both, however, let’s fast forward and assume both succeed. Once they are both done being interoperable within their own narrow confines, electronic health records (EHRs) for the former and clinical trials for the latter, they will then need to figure out how to be interoperable with each other and every other part of the health information value chain. If we keep “exchanging” information, then we will simply never keep up. The problem will continue to scale, and we will always be behind, no matter how successful each individual project is.
As David Weinberger put it in “Everything is Miscellaneous
,” we must move beyond the physical geography of information.There are so many words that reveal our physical approach to information: collect, store, transmit, aggregate, exchange and interoperability all show the two-dimensional way in which we look at data. This is something I first called ‘chartopomorphism” in a comment on New Year’s Day at Susannah Fox’s post, “Thinking Critically About Big Data and Health Care.
” Chartopomorphism is paper-centric thinking. We used to think the universe revolved around the earth (geocentric), then we “advanced” and thought everything revolved around the sun (heliocentric). Of course, we now know that there is no center to the universe, and for that matter, there may not even be just one universe. Ours may be one of many in a multi-verse.
The challenge with interoperability is that it is a paper-centric way of thinking, one trapped in the limitations of two-dimensional words. Interoperability makes it seem as if all we need to do is find a better way to move around digital manila folders (EHRs, financial statements or education records) from one digital filing cabinet (database) to another. We need to be digital, not just digitize. The following two pictures provide a small glimpse into a new paradigm, a paradigm enabled by CLOUD’s future language; a paradigm of ME1.0, modeled around people or data; an Internet without any centers:
CLOUD believes that we must move beyond the idea of “exchanging” information and start adding new dimensions. By becoming multi-dimensional, we can begin to “make use of information,” rather than being masters of how we move data around. Think about when you flip the switch at home or the office, and the lights turn on. We don’t know which power plant or which transmission wires on the electric grid delivers the specific electrons to our homes or businesses to power our lights or appliances. Our data needs to work the same way.
Relational database technology focuses on the power plants; contextual databases™ (CLOUD term) focus on the grid. By adding dimensions, we can wrap our databases around the data, rather than the data around the databases. When we do, interoperability will be irrelevant. It simply won’t matter anymore. We will be pulling data contextually, rather than figuring out how to push it around. We will live in a virtual geography of information, enabled by a truly multi-dimensional Internet. We will be creating a new physics of both people and information.