Guest Post - Sitting in the Middle (On Interoperability)


Our Trending Topics guest blog project taps the Cambia Grove community to share expertise relevant to issues that are shaping health care transformation.

Up next is Rick Rubin, the CEO of OneHealthPort and one of the Cambia Grove’s Advisors. Created by and for the Pacific Northwest’s local health care community, OneHealthPort solves information exchange and workflow problems shared across health care organizations.

"Interoperability is not something someone else is going to create for us at some point in the future to solve our problems in one stroke. It is something all of us can start to invest in now, and make progress on today." - Rick Rubin, CEO, OneHealthPort

Health care is a “many-to-many” industry – practitioners, hospitals, health plans, consumers and others all trying to forge stronger connections in order to better treat patients, improve health outcomes and solve business problems. Sitting in the middle of all this traffic is OneHealthPort, my organization. OneHealthPort was created by the Pacific Northwest health care community 15 years ago to help solve workflow and information problems that extend across enterprises. As an intermediary, we get a great view of the different needs, perspectives and insights of our customers as they compete, partner, and collaborate with their trading partners. It’s a unique spot to observe the industry and learn from all the many stakeholders.

One aspect of OneHealthPort’s work is that we operate at the juncture of health care and information technology. This, of course, means we always speak in clear concise language that is readily understood by all, right? We would never use - or hide behind - jargon, acronyms or obscure technical terms. For example, one of the popular terms making the rounds in the world of HIT (Health Information Technology) is “interoperability.” Notice how that just rolls off the tongue. The term is used constantly, I confess by me, along with many others. Generally, it is used in the context of “health care information systems are not interoperable.” This is assumed to mean that your system and my system can’t talk to each other and exchange information seamlessly. This statement is usually followed by one expressing hope that work is well underway to “fix this sad state of affairs.”

This is where it gets interesting. There are a couple of assumptions here that are worth exploring. One is that interoperability is binary. It either is present, or it is not; and today it is assumed, it is not. The other assumption is that this will be fixed someday, by someone else and finally “your” system will talk to “mine.” In the HIT interoperability discussion, a stark contrast is often drawn between the state of mobile technology and health care technology. “My Apple, ATT, or IOS device can talk to your Samsung, Verizon, or Android, device – why can’t someone do that in health care?”

From my perch, I would observe that interoperability is not binary. It is a continuum, and the dial is getting moved in degrees by those applying leadership and hard work. For example, the well-documented challenges of the EHR industry have left many to believe interoperability is hopeless and that it is impossible to get data out of EHRs to share with others. However, although it isn’t easy and it may not be widespread yet, there are organizations who have managed to successfully share data from different types of EHRs. This is hugely important. Over the last few years the health care industry has experienced a sea change of epic proportions. We have migrated, almost overnight in health care years, from an exchange environment driven largely by claims, to one that can now tap into far richer sources of clinical data. The potential payoff for care coordination, public health, administrative simplification and consumerism is tremendous.

Interoperability is not something someone else is going to create for us at some point in the future to solve our problems in one stroke. It is something all of us can start to invest in now, and make progress on today. We need to have a vision for why interoperability is critical in the long run, pragmatic ways to address urgent needs that will energize people in the shorter term, belief that improvement is possible, and a willingness to prioritize the investment. Today, you will find forward thinking enterprises taking a leadership role in accelerating the exchange of clinical information. There is room at the table for all of us to join this effort, but it will take an investment of time, energy and resources.

It would be great to hear from local folks about the work you are doing to move the interoperability dial and how others can join in. Feel free to email me at If you have a different perspective, I’d like to hear it. Thanks for reading, I look forward to your comments.