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Interoperability remains huge hindrance to improved care quality


High customer satisfaction has been linked with stronger loyalty, sales, and profits. So why hasn’t the healthcare industry caught on?

High customer satisfaction has been linked with stronger loyalty, sales, and profits. So why hasn’t the healthcare industry caught on?

During my father-in-law’s recent visit to my home, we found ourselves at the emergency room (ER), where the admissions process took hours. Via the triage process, the ER staff determined that he should be admitted. This took several more hours because the inpatient registration staff-in the same hospital-had to duplicate the process of inputting his information in “the system,” though the ER staff had done exactly the same thing just a few hours before. 

Growing frustrated, I asked why there was such a delay, and was told only, “Our systems aren’t connected.”

That’s simply not an acceptable answer-not anymore. But it’s the answer patients get at almost every juncture when they interact with the healthcare system.

Lack of interoperability leads to poor outcomes

The ER doesn’t connect with the nursing floor, so patients have to register twice. They leave the hospital with a sheet of discharge instructions, and don’t get a follow-up call to see how they are doing.  They go to the optometrist and get a glaucoma screening, but if it’s positive, it’s entirely their job to make sure they follow up with an ophthalmologist. If they have a drug allergy, they have to inform every single provider they interact with.

Furthermore, it’s well known that periodontal disease is associated with heart attacks and strokes. But do dentists know whether their patients see a cardiologist? Do cardiologists know when patients last had their teeth cleaned? Does either provider exchange information with the other? Probably not.

It’s no wonder that consumers are often exhausted and frustrated.

In a time when we can transact every type of business imaginable on our phones-from banking to booking airline tickets to buying shoes to ordering takeout-there is no technological reason why healthcare can’t be better connected.

Patients, and their healthcare providers, should be able to go to one place to access all of their information, including medical, dental, vision, pharmacy records, insurance coverage and the information from a wearable device like Fitbit or a WiFi connected scale.

Like many people, I have access to portals from my insurer, my health system, my physician, my dentist, and my pharmacy. Each of them helps me do, at best, two or three tasks more efficiently. If all of that information and all of those connections were available through one portal, though, it would transform my relationship with the healthcare ecosystem and with my own health.

A step further

A single source of information could even help patients pick the right health plan by showing them at a glance how much healthcare they typically use, and what kind, so that they don’t spend the money for a platinum-level plan when a silver or bronze will suffice. As patients age and use more healthcare services, they should be able to easily see when they need to increase their coverage.

This “super-portal” might even alert patients to clinical trials that are recruiting patients with their medical conditions: a potential boon for both patients and medical research. It would also benefit providers, who would see potential problems and intervene before they become a larger medical issue.

Who should be the aggregator of all this information?

This is an excellent question to which there is no obvious or easy answer. Theoretically, it should be the party that has the strongest financial incentive to keep patients healthy. That could be the patient, especially if the patient has a high-deductible health plan that puts him at risk for thousands of dollars before insurance kicks in, or his health insurer, or even his healthcare provider if the patient is covered under some value-based care arrangement.

Unfortunately, there is not enough consistency in the way we pay for healthcare to automatically focus the incentives for keeping everyone as healthy as possible.

But sharing information is a key step in coordinating care and making sure that everyone gets the right services at the right time for optimal health. We must find a way to start looking at all of our health data holistically. The U.S. currently spends more than $9,000 per person per year on healthcare, according to The Commonwealth Fund, and yet our overall health is poorer than countries that spend half that amount.

If we don’t find a way to aggregate our information to improve our care and our health, we will continue to spend more and receive less.

Rohan Kulkarni is vice president of healthcare strategy and portfolio, Xerox.

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