Let’s say I’m a hospital Electronic Medical Record system and I want to allow other applications to access a patient’s temperature. I have all the functionality that allows the clinical staff to record the info, so nobody else needs to develop that. But if I want to make that data available to outside systems, I write a public API that says, “To access a patients’ temperature, call my ‘Get-Patient-Temperature’ function with the ID of the patient you’re interested in. I’ll pass back the temperature, the time that the temperature was recorded, and the date it was recorded as well.”
A calling system doesn’t care whether I pass the temperature in Fahrenheit, Centigrade, or Kelvin, as long as I have documented the units. The caller also won’t care whether the format for time is a 12 hour AM/PM format or a 24 hour military format. As long as the format is publicly documented, the caller knows what to expect, and can write an internal routine to convert units if necessary. (Although if I was a really friendly EMR, I might provide a way for callers to specify the units they wanted so that they wouldn’t have to do the conversions themselves. Friendly platforms get more support from applications programmers, encouraging more apps to be written, which, as Apple knows, makes your own software much more valuable to the end user…)
That’s it???? Yeah pretty much.
Not such an Earth-shattering concept, is it? So what’s the hold-up in the healthcare world? Why doesn’t my medical data move with me as easily as my music?
I can’t really answer that, but here are some possibilities (all speculation on my part):
Speculation #1: Vendors want all IT dollars spent in hospitals to be spent only with their company. Closed platforms do indeed create a situation where all new ideas need to come from the vendor themselves, often as extra-cost options. They also make it much, much harder for the customer to switch to another vendor – because there’s all that data trapped in the systems that would have to be extracted somehow, and then laboriously converted to the format used by the new system. This actually turns out to work against the vendors’ best financial interests (see below). And it clearly holds back the state of the practice — again, just imagine if Apple would have had to come up with all the apps that are currently available for their phones…
Speculation #2: There’s a data security problem; it’s not “safe” for private patient data to flow freely between systems. Security and privacy of patient data is without question a high priority, and that responsibility must not be taken lightly. But, for example, the financial industry has billions of dollars of transactions flowing between disparate systems every single day. And please don’t try to convince me that security of their financial data is not top of mind for them. Yet somehow they’ve managed to interoperate securely.
Speculation #3: “We’ve always done it this way.” I have trouble coming up with too many other players in the high tech world that aren’t itching to constantly innovate – from hardware (“Moore’s law”), to programming languages, to computers, to smartphone apps…you get the point.