There is always a lot of angst about healthcare interoperability. A lot of finger pointing at vendors, if only they would all agree to support the official standards then everything would interoperate smoothly. If only we would all listen to the standards group… Unfortunately there is more to this than meets the eye.

I would like to help explain why this is difficult. Let’s look at a simple problem that everyone can relate to.

Phone numbers.

Back in the 50’s everyone had 2.5 children, lived in the suburbs, had a job for life with a big corporation and only had two phone numbers.

At most each person had a Business and a Home Phone number.

As a result when hospital information systems emerged into this brave new world they were designed to store only two phone numbers. One field for a home phone and another for a business phone.

How things have changed!

First FAX machines were invented, then pagers and cellphones. Now we have VOIP, Skype and other technologies like Email, Facebook, Linked In and Twitter – with many more to follow… I have a Ukrainian friend who runs a outsourcing company and lists the following in his email signature:

• USA phone number
• Ukrainian phone number
• Israeli phone number
• FAX number
• Skype ID
• Googletalk ID
• Email address

Simple contact details have exploded into a crazy ever-evolving set of data!

How do these changes affect interoperability? Unfortunately technology changes slowly within enterprises. Enterprises are like cities. You cannot just rip out the entire infrastructure every time something changes. The city needs to keep on running, so compromises have to be made, upgrades must be introduced gradually.

As a result hospitals often have backbone systems thtat were designed in simpler times. One very popular choice of health information system (HIS) in Canada is Meditech. Meditech is a very solid mainframe based system written in an old language called MUMPS. There are many good things about Meditech which make it popular despite its age. But last time I checked, most hospitals were not running versions of Meditech which would support the rich contact data model of say an iPhone 4.

This creates challenges for interoperability.

Modern systems can store complex contact details, older systems generally cannot. So to interface these systems together compromises have to be made. I call it putting a square peg in a round hole. Here are some typical solutions:

• Format extra contact information as text and put it into a text field.
• Use URLs that link back into the more modern system to allow access to richer data

These compromises are not perfect but they keep things ticking along, it is just part of day to day reality of interoperability.

This is a simple example – just imagine how much more difficult it is to deal with changes to complex clinical data, for example.