It’s Time to Take People Out of the Interoperability Equation

Earlier this month, Micky Tripathi, Assistant Secretary for Technology Policy/Office of the National Coordinator for Health Information Technology (ASTP/ONC), wrote a candid post for the Health IT Buzz blog. For those keeping track, ASTP/ONC is the new name of the former U.S. Department of Health and Human Services’ Office of the National Coordinator for Health Information, or what we used to call ONC.

Anyway, Tripathi said the root cause of information blocking in healthcare is people, not processes or technology.

“What is abundantly clear is that it is behavior, rather than technology, that is far and away the biggest impediment to progress,” he wrote.

It’s not that healthcare organizations can’t share protected health information. It’s that they won’t share protected health information.

We said that in more than a few blog posts and columns like:

• “Hospitals Should Be Embarrassed by ONC’s Latest Interoperability Progress Report”
• “Don’t Drink ONC’s Glass-Half-Full Hospital Interoperability Report”
• “I’d Like Some Interoperability with My Value-Based Care, Please”
• “Healthcare’s Epic Problem & the Audacity of Liberating Patient Data”

Or, if Uwe Reinhardt said it, it’s the people, stupid. He always could get to the point quicker than most. Certainly much quicker than me.

Because here’s the point to this blog post. ASTP/ONC published a little-noticed data brief in September that said clinical laboratories are a big interoperability offender when it comes to sharing lab results with health information exchange organizations (HIE/HIOs). HIE/HIOs used to be called health information exchanges (HIEs). The brief is based on a survey of 77 HIE/HIOs. For the purposes of this blog post, let’s just call them HIOs, OK?

The report broke labs down by four ownership types: hospital-based labs, physician office-based labs, independent/commercial labs and public health labs. The survey asked the HIOs to point the finger at the type of lab that electronically sends test results to the HIO to share with other providers and the type of lab that electronically views or receives test results from an HIO. Basically, who gives and who takes.

In ranked order, the biggest givers in 2023 were:

• Hospital-based labs (89%)
• Physician office-based labs (79%)
• Independent/commercial labs (79%)
• Public health labs (71%)

In ranked order, the biggest takers in 2023 were:

• Hospital-based labs (71%)
• Physician office-based labs (67%)
• Public health labs (37%)
• Independent/commercial labs (34%)

Across the board, labs gave more data to HIOs than they took from HIOs. Almost as if they felt obligated to send lab results but not obligated to look at lab results from others. That’s a people problem.

Here’s another people problem: 36% of the HIOs said labs across the board limited or refused to provide access, exchange or use electronic health information. In other words, more than a third of labs didn’t want to play nice with HIOs. That’s a people problem.

By far the biggest offenders were independent/commercial labs. Ninety-six percent of the surveyed HIOs said it was independent/commercial labs that refused to cooperate.

In fact, 38% of the HIOs said independent/commercial labs “often,” “routinely” or “sometimes” engage in information blocking as prohibited by federal regulations.

The survey asked the HIOs why labs didn’t want to place nice with them. The top reason? The labs didn’t see value as a data contributor only, cited by 61% of the HIOs. That’s weird because the labs could view and receive data if they wanted to. So that’s just an excuse, or another people problem.

Maybe it’s time to take people out of the interoperability equation and let machines talk to machines through the Internet of Things.

Thanks for reading.