Do We Misunderstand the Scope of the Healthcare Interoperability Need?

For quite a while now I’ve had this cognitive dissonance in my head about healthcare interoperability.  On the one hand, I’d see all these announcements about the success of interoperability projects and the literally millions and billions of health records and data that’s being shared.  On the other hand, we all have seen and experienced times where health data isn’t being shared.  Just go into any clinic and you’re handed the same intake forms as a perfect example of this.

Just to share a few recent examples of what I mean.

DirectTrust has been tracking their messages sent and we’ve seen billions of direct messages sent and that pace is accelerating. They just passed the 3 billion threshold in the first quarter of 2022.  See more of their latest stats below.

eHealth Exchange just reached a new milestone of 1 billion transactions per month in May 2022.  My simple math estimates that will get to about 12 billion transactions per year.   Do we comprehend billion?  Here’s a look at the data sharing network they’ve built:

Looking at this a different way, let’s look at what commercial data sharing vendor Redox has shared.  What’s interesting about the Redox data is how their quarterly go-lives with organizations has grown over time.

We all know that healthcare organizations want their vendors to be connected to their other systems.  They don’t want silos.  This chart illustrates that this is happening.  Redox also shared this fun animation which shows the growth of their network over time:

I could go through all the other exchanges and companies and share something similar.  Billions and billions of healthcare transactions are happening every day where a lot of health data is being shared.  This begs the important question:

Why can there be billions of health data sharing transactions happening and it still feel like healthcare is not interoperable?

As I thought about this disconnect, I finally came to the conclusion that the issue with interoperability is that we don’t understand the scope of the need.  Let’s look at some numbers.

Let’s say right now we’re sharing 10 billion transactions per month or in other words 120 billion transactions per year.  That feels like a lot doesn’t it?  If the number of records that would ideally be shared is 200 billion, then about 60% of the time your records would be shared with the right person.  Sounds pretty good until you think about the reality that 40% of the time the data isn’t being shared where it should be.  Of course, if the ideal record sharing is 150 billion, then we’d be sharing records about 80% of the time.  Not bad, but still providing a bad experience 20% of the time.  You can do the rest of the math, but I think you get the point.

There’s also this reality.  If you’re part of the percentage where your records are being shared, then you probably are take it for granted and don’t really appreciate that it’s happening.  Let’s say by some miracle we were sharing 99% of records that needed to be shared.  If you found yourself in the 1%, then you’d still feel like healthcare interoperability failed you.  Now, think about how many interactions patients have with healthcare and multiple doctors and healthcare organizations.  I think the chance that a patient is going to have an experience where the patient was seen without the right information being shared approaches 100%.  Basically, I think we’ve all had experiences where our health data wasn’t shared with our provider so in some way healthcare interoperability has failed us all.  Luckily, our health system is designed to treat patients with partial information, but I digress.

Let’s shift gears back to the numbers and try and imagine how many health data sharing transactions should be happening.  These will be rough with lots of generalizations, but I think you’ll get the point.  Here are some stats to get us started.  In 2019, they estimated 145.6 million ER visits a year and estimated 900.6 million outpatient hospital visits per year.  In 2016 (sorry I couldn’t find more recent data, but this number has likely gone up since then), they estimated 883.7 million office-based physician visits in the US.  Using round numbers, that’s about 2 billion hospital and office-based visits per year.

This then begs the question of how many interoperability transactions do you need per visit?  This is a hard one to estimate.  Office based visits may be easier, but it’s not hard to see how their may be health data sharing with pharmacies, labs, other doctors, your PHR, outside systems, etc.  In the hospital, there may be interfaces with dozens of other IT systems within the healthcare organization and possibly dozens of other healthcare organizations before, during, and after the visit.  Plus, a hospital visit may be a day, weeks, or months with various sharing needed throughout.  Given the silos in healthcare, it’s easy to see where each visit could have 100s and even 1000s of transactions per visit in an ideal world.

Assuming each of the 2 billion visits per year need 100 health data transactions, that’s 200 billion transactions per year which would be 60% of the ideal records shared using our 120 Billion estimate of what’s happening today.  Of course, if each visit needs 1000 health data sharing transactions, then that means we should be doing 2 trillion transactions per year and we’re only 6% of the way there.  You can use your own numbers to see where you think we are in this.  My gut experience in healthcare is that we’re closer to the 6% than we are the 60%.

This is obviously a very high level analysis.  Not to mention it doesn’t include things like public health that would like the data or payers that need a lot of this data or government entities or many more non-provider organizations who all want that data shared.  However, I think it illustrates the point.

Having billions of health data sharing transactions happening each year is huge progress over where we were 10 years or even 5 years ago.  That’s a massive undertaking, a great sign for the future, and represents a massive amount of work and culture shift in healthcare.  These efforts should be applauded.

That said, if the size of the problem is actually trillions of transactions (which I believe it is), billions of transactions is going to still feel like we’re falling short when it comes to healthcare interoperability.  In other words, we can say and be proud we’ve made massive progress on healthcare interoperability and still feel like we’ve barely made a dent in the problem.  That’s just the reality of challenges with this size and scope and I think that’s true of healthcare interoperability.  It’s a much larger challenge than most realize.

I’d love to hear your thoughts on this in the comments or on social media with @hcittoday.  How many health data sharing transactions do you think we’re doing today and how many do you think would happen if we had full interoperability where it’s needed?  Let’s hear your estimates and how you’d approach estimating it.

UPDATE: Be sure to check out a number of Twitter replies to this article from @motorcycle_guy and @Healthbjk.  I certainly may have [grossly?] underestimated here, but it just reinforces the point that healthcare interoperability is a massive challenge and we’ve barely made a dent.

About the author

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

2 Comments

  • You made a nice argument for a single payer public health system not that we in the US are or ever will be ready for that although I’m not sure that is where you were going. Interesting just the same. Thank you.

  • Bob,
    Single payer may solve some of the complexity, but not most of it. This article would be true in every country when it comes to the scale of the need to share data.

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