Wednesday, February 25, 2015

EHR Interoperability, Part 2

The following comment was posted on the Mr HISTalk web site, in response to my earlier blog about interoperability:

"Dale, why hasn’t Health Catalyst published its data model and algorithms to the world? You want all the EHR vendors to bow down and provide their Intellectual Property to you for free so that you can make money building on it?

Where are your APIs Dale? Where is your data model published Dale? Get it published and make it available to all your competitors, other startups and innovators in general and then feel free to throw stones.

You’re just one more self interested wanna be in the healthcare start up game talking tough while holding yourself to a different standard."

This is my response:

Your comment is a little snarky, but the underlying theme has merit—I cannot expect from others what I do not expect of myself.

My blog was written as a practicing CIO, motivated by the best interests of our country, our patients, our physicians, and… get ready… EHR vendors. As evidenced by Epic’s recent decision to create an app store, I’m by no means the only person in the industry who believes that open APIs are the right thing to do for interoperability and innovation, as does the DoD. The DoD has been the historical leader of open systems in the world—ASN.1, SGML, DCE, CORBA, Ada, POSIX, TCP/IP and many others. Epic’s app store decision in light of the DoD procurement is a great recognition of that DoD legacy. The Epic app store will benefit the entire industry.

You can try to discredit my comments about interoperability by firing back at Health Catalyst, but the criticism just won’t hold up. Health Catalyst is a tiny little startup, fighting it out in the best interests of our clients, in the trenches of American capitalism. We are economic and market influence gnats on the rump of today’s EHR vendors—the same EHR vendors that have benefitted from billions of tax dollar subsidies. And when you benefit from that sort of tax money, along with that benefit comes a new level of scrutiny and accountability back to those tax payers to do the right thing. When and if the healthcare analytics market benefits from $25B in tax subsidies, the bar of national accountability will raise for Health Catalyst, too.

You would be surprised at how little influence I have on the way that Health Catalyst operates. I cannot and do not speak officially for the company. My contract with Health Catalyst stipulates that I can continue to speak, publish and blog on matters that reflect my personal opinion about the healthcare industry, which is the case in this discussion. In that context, I sit on the Canada Health InfoWay External Advisory Panel for Interoperability and that panel is in the midst of developing Canada’s roadmap for healthcare interoperability. We are hoping to help Canada avoid the ills that have plagued the US.

I will go out on a limb and offer speculation—I bet Health Catalyst leadership would love nothing more than to publish all sorts of open APIs around their platform and products. As soon as any other vendor, including EHR vendors, asked or wanted to build products around the edges of the Health Catalyst platform, Health Catalyst would open the API doors– and not out of naïve altruism, but out of common business sense. The bigger the ecosystem of products that can interact with Health Catalyst, the better for Health Catalyst and the better for Health Catalyst clients and the industry. The Health Catalyst web site is an open cookbook for analytic success in healthcare. Take a look at any other healthcare IT vendors’ web sites and compare it to Health Catalyst. We don’t even offer a login-protected portion of that web site for clients. Everything we do is in the open because that type of openess raises everyone’s game, including ours.

The only thing that Health Catalyst wants from EHR vendors is EHR data and data tags so that Health Catalyst clients can analyze their own data. It’s interoperability at the data warehousing level. I don’t see how EHR data can be considered IP that belongs to the EHR vendors. That data belongs to EHR clients and their patients, and I bet patients would like to know that their data is easy to access for analysis that benefits them clinically and financially.

I will close by asking: Is there anyone out there who genuinely believes in their heart that our national healthcare IT interoperability and innovation strategy is working? Is there anyone out there who believes that anything in my blog is asking or expecting too much of EHR vendors? I guess one person does, but would guess that most do not.

As usual, my thanks to Mr. HISTalk for providing this unique forum.


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