The Costs of Interfacing
In a great post on Caristix.com, Sovita Chander writes about the reasoning for the high costs of healthcare interfaces and the unique conundrum it presents to both consumers and developers. Consumers - hospitals and other healthcare facilities - are confused when presented with large bills for interfaces because surely these companies have had to interface before, why the staggering price for work that must have already been completed?
Developers - health IT companies providing the services - are awkwardly positioned to explain (as Chander does) why each interface is a digital snowflake, unique and unlike the others that have come before it. There are obviously shared traits between all the interfaces, and the trend is toward standardization, but it nonetheless requires real work by IT staff to make the two systems function the way consumers need them to. It's (theoretically) easy to send a PDF between two systems and just send them into a file to be read later. What's difficult is identifying the specific data elements you need from each system, in what format, and sending them back-and-forth to populate and kick off various other functions. How McKesson captures diagnoses may not use the same language/data/formatting as how Cerner kicks off orders. And if you do it once between two companies, like Epic and Meditech, it may only work a certain way for those particular products/programs/clients used.
Make no mistake - this is an apologia for the time and costs of interfaces, not an excuse for them. These costs shouldn't be something the health IT community has to deal with and the facilities have to pay. And, hopefully, they won't be for too much longer. The key to reducing these costs is standardization. Standardization not just of the methods of sending information - HL7, CCDA, etc. - but also the type of data being captured. We've long talked about the push for standardization in structured data capture - but there's also a need in defining templates for the reports. National and International organizations need to start supporting, creating, and disseminating agreed upon templates for reporting in radiology, surgery, and many other specialties - much like CAP has done for pathology and CPAC is beginning to do with cancer surgeries. If there's a standardized set of types of data, forms, reports, and formats that will always be in the same location and can be transmitted using the same formatting language, then interfacing costs will go down as there will be less need for customization.
It's a great piece by Chander and you all should read it. These facilities all exist for one purpose only - to improve the health of people. No matter what else they specialize in or research they perform or services they offer, that is the underlying goal for every single hospital, ASC, clinic. However, within that one facility with its one objective lie a whole host of semi-autonomous sections. This body politic relies not just on each department doing its job to the best of its ability, but also to work in tandem with others in order to progress in delivering excellent care to its patients. Right now, the cost of these disparate elements working together is high - but hopefully by instituting standard messaging languages and unified templates for reporting, it won't have to be for much longer.