Interoperability: Getting the Water to the End of the Row
We often use or hear the term getting the water to the end of the row, a farming metaphor suggesting that water sitting at the front of a row of plants or stopping half-way through the row is not adequate or acceptable. A plentiful harvest is dependent on water flowing freely and easily all the way down the row. Simply making the water available without actually sending it down the row or without making it easy for the water to flow effortlessly to the end will not produce the desired outcome.
Our current situation with interoperability is one where the water rests, figuratively, at the head of the row with tremendous potential to water a fertile field. But, in a few instances, we have not really opened the irrigation gate at all; and more often, we have started the flow but have not adequately cleaned the weeds or debris out of the watering row or haven't created a path that extends to the end of the planted area.
Early results from our current interoperability study suggest we have barriers (weeds) remaining that must be resolved (hoed) if we are truly going to be able to move out of a situation where clinicians see the use of data as possible. The information is sitting there at the head of the row, but clinicians do not view it as practical for use because of the difficulty in effectively and efficiently using the data. From the clinician/provider perspective, out of the several weeds or blockages in the way of the healthy flow of information, the single largest issue is that data is outside the clinicians' workflow. Nearly 60% of early respondents suggest that this interruption to the clinician workflow is the greatest barrier to the use of outside patient records.
The water to the end of the row interoperability panacea would include sharing outside data that is (1) easy to find, (2) in the clinicians' workflow, and (3) has high impact on patient care. Again in early data, these cases where the field is fully watered are more common when providers are connecting to outside organizations using the same EMR as their own organization compared to when they are connecting to disparate EMRs. But frankly, the ideal occurs infrequently in both scenarios (35% for same EMR and 8% for different EMR). No farmer would be happy with watering only one-third of each row and certainly not less than ten percent.
Vendors cannot be satisfied with simply providing the water to the head of the row or with sending a trickle halfway down the water row. They, with their provider partners, have to hoe and dig and heft to remove the barriers that impede an easy, high-impact flow of information that is not only useful but, more importantly, used by providers. There is a lot of talk about removing barriers, but at least in our early data, there appears to plenty of room for overalls and rolled-up sleeves to get the water to the end of the row.