Interoperability: A Brief History

By Jim Tate, EMR Advocate
Twitter: @jimtate, eMail:
Host of The Tate Chronicles#TateDispatches

Since the days of Hippocrates, a primary goal of medicine has been the collection of records related to diseases and treatments. Someone along the bumpy trail of history had the clever thought to begin keeping patient specific records. Soon after that someone came up with the bright idea that perhaps the ability to move those records around from point A to point B would be an advantage. So birthed the concept of healthcare data interoperability.

When I worked in a hospital decades ago all medical records were physical. Charts were stored in giant spinning circular wheels like something you might see in a Las Vegas casino. More times than not it was hard to find the chart you needed because it was being used by the medication nurse or had traveled with the patient to the X-Ray department. Even if you could locate the chart there wouldn’t be much past medical history. What you saw was what you got.

After my hospital days I began working as the Clinical Director at a large pulmonary practice. Frequently patients would be referred to us by their primary care provider. Often those patients had no idea why they had been sent to us and just as often we didn’t know why either. Referral notes spent days traveling through the US Postal System and often arrived days after the patient had come and gone. I was there when the communication marvel, the fax machine, arrived and provided us the ability to receive information on a patient with minimal effort. It wasn’t discrete data, it wasn’t codified, but it allowed us to receive and send information quickly and care for a patient. To me, this was a giant step in the right direction of information exchange. Dear Reader, let us not forget the importance of those fax machines, which still bring forth reams of useful information even in these heady days of AI and machine learning.

A giant advancement in healthcare data interoperability can be traced back to the 1990s, when the use of electronic health records (EHRs) began to become more widespread. Early EHR systems were often proprietary and not designed to share data with other systems, leading to the development of data exchange standards and initiatives aimed at improving interoperability.

In the early 2000s, the Office of the National Coordinator for Health Information Technology (ONC) was established to oversee the development and implementation of health information technology (HIT) policies and programs. This was followed by the HITECH Act in 2009, which provided funding to support the widespread adoption of EHRs and the development of standards for interoperability.

Over the years, numerous initiatives, standards, and regulations have been established to improve healthcare data interoperability, including the Fast Healthcare Interoperability Resources (FHIR) standard, the Common Clinical Data Set, and the 21st Century Cures Act. Let’s not forget the Regional Health Information Organizations (RHIOs) and the Health Information Exchanges (HIEs). Despite these efforts, interoperability remains a challenge and ongoing work is needed to achieve seamless data exchange and sharing in the healthcare industry.

The history of interoperability is a tale of two steps forward and one step back. It is my belief that with the looming Trusted Exchange Framework and Common Agreement (TEFCA) project we might be taking three steps forward. Here’s hoping that the benefits of this novel network become obvious and lead to wide acceptance and use by healthcare providers.