Shawn Vincent, Vice President of R&D at MD Practice Software LP wrote a thoughtful article in Technology for Doctors titled “Interoperability: Banking did it… how hard can it be?” In the article, Vincent explores a common myth: the comparison that is frequently made between healthcare data sharing and the banking industry.
He states, “There are many reasons for HIT’s lag when compared with other industries. Politics and costs play a big role here, but we’re not going to talk about these just now. Instead, let’s concentrate on the technical problem itself. ‘Just add standards’ isn’t as easy as it sounds!”
He also points out that the complexity of healthcare information is significantly greater than information managed within the banking industry. Bank account elements have simple structures and attributes and in fact have to be simple in order for the banks to “function as businesses”. Whereas healthcare diseases and concepts are not restricted in the same ways as debits and credits. The relationships between diseases can be varied and multiple. For example, Diabetes Mellitus can be referred to as NIDDM, DM, or Adult onset Diabetes (and many others). A clinician would know that all of these terms mean exactly the same thing. But it is much more difficult for a software application to correctly categorize these different names as the same disease. This is where standards become extremely important. All of the diseases, definitions, descriptions, and associations need to be codified and then correctly linked in order to create logical relationships. SNOMED CT (Systematized Nomenclature of Medicine – Clinical Terms) is a global standard designed to be used in clinical systems. It evolved over a 30-year period from work done in both the UK and U.S. and now comprises more than a million clinical terms. However, SNOMED CT is not widely deployed in clinical systems and — although it is a goal of EMR programs to have all systems using standardized coding systems and vocabularies — it is extremely complex to integrate.
As Vincent explains, combining historical data with new data (standardizing the information) and the continued use of old (legacy) systems frequently requires modifications to the standard. This in turn results in the standard becoming proprietary to that system; as a result, it can no longer be used as a universal standard. Sound complicated? It is!
The bottom line is that the scale necessary to get all clinical systems to speak to one another using essentially the same language is of a significantly greater magnitude than that in banking and finance. When you hear someone in the future draw parallels between Healthcare IT and banking, remember some of these concepts.