A nut about to be cracked (In Britain)?
So is the interoperability nut about to be cracked – and what will be necessary to make it finally happen?
For GP and IT leader Amir Mehrkar, the big change that is needed is less about the process and more about values. “For the NHS, I don’t believe the challenge of interoperability is technical. The technology exists – across the world, information is flowing,” he says.
“But I don’t think we in the NHS often think about the values around information sharing. Values are intrinsic to the way that we [as humans] behave but one of the problems has been that sharing patient information isn’t seen as an obvious value.”
Mehrkar is co-founder and co-chair of INTEROPen. The organisation brings together the NHS, industry and other stakeholders to work collaboratively on accelerating the development of open standards in the health and care sector.
As a practising GP with a burning interest in how IT can help clinicians and patients, he had felt there was a need for a forum where different stakeholders could get together in an open way to drive forward the interoperability agenda.
The board – which includes representatives from national organisations including NHS Digital, standards bodies and NHS England, as well as vendors and the health service – meets each month to discuss ideas and projects.
How the Things Are across the Ocean?
The organization of the U.S. Healthcare System is anything but centralized. This can be seen in evaluating the Financing and Stakeholder sections of the health system triangle. Financing of health care comes in many forms. There are public programs, also known as welfare programs, which are funded by the government through taxation.
Medicare, Medicaid, the Veterans Affairs, and Indian Health Services are just a few examples of these public programs. Because there is a mixture of payers, providers can opt to participate in a mix of these programs resulting in ‘preferred provider’ networks and physicians that are ‘out-of-network’.
There are private health insurers, which are usually employer-based, as well as government-funded welfare programs. As a result of this patchwork, the organization of the U.S. Healthcare System is described as a mixed market.
In this mixed market, healthcare is a privilege and patients are described as consumers because they consume the healthcare products and services. In a more traditional sense of the role of consumer, U.S. patients also play the role of ‘payer’ in that they share the cost of healthcare with insurers through co-pays and deductibles.
But the brunt of the cost is taken on by third-party payers. On the provider side, they can be self-employed or work for a government program and/or participate in providing care for private and/or public programs. Providers can also opt to take no insurance programs and all their services are paid ‘out of- pocket’ by the patient. This, however, is the exception and not the rule.
This brief look at healthcare in the U.S. through the Healthcare System Lens shows just how complex and fragmented the U.S. System is with multiple payers, out-of-network services, and unknown coverage for primary care provider referred services. The last of which can be a shot in the dark without due diligence by the patient/consumer. And let us not forget that the due diligence is required on the part of the patient, who is seeking medical treatment when they are not feeling well, or maybe incapacitated due to the dramatic injury.
The structure of healthcare may not be such a complex problem for policy wonks and the macro institutions of healthcare such as insurance companies and large health systems. These institutions have software with algorithms to protect their interests. But for the patient, their decisions can have devastating financial consequences.