Healthcare interoperability: A parable of 2 bridges

This is a parable of two bridges. One is a modern wonder, used by only a select few. The other is an ancient structure, barely standing, used by everyone else.

How did this come to be and what can bridge building teach us about today’s healthcare system?

Bridge 1: An engineering marvel

Imagine that you are about to cross a long bridge. The bridge is beautiful. It was an engineering feat in its day. Like many bridges, it has toll gates at each end.

It also has one very unique feature: No entrance or exit ramps. You will need to figure out your own way up to the toll gate. Once you’ve paid your toll, you are free to make your way to the other side.

This bridge also has very strict rules. You can only walk on the bridge with special shoes that are very expensive and must be hand-crafted for your feet by experts. The shoemaker must have a deep technical understanding of the bridge and shoes, and of course, be fluent in Latin. A pedigreed standards committee made up of bridge and shoe experts created and enforce technical specifications for the shoes, including an implementation guide that is 1,306 pages – available only in Latin.

Of course, once you have your shoes, you will need to test them on the bridge. This may take weeks or months.

This bridge is called healthcare interoperability. Complex standards, voluminous implementation guides and a language seemingly made up of only acronyms are the rules of this bridge.

Bridge 2: Old, but (mostly) works

As it turns out, there is a rickety, but reasonably reliable bridge, right next to the fantastic new bridge. A Scottish inventor built this bridge in 1843. People generally don’t like his bridge, but virtually everyone uses it.

And it’s not very user-friendly. People get lost on the bridge. Sometimes, unwittingly, they break laws crossing the bridge. Periodically, people even get robbed crossing the bridge because it has no security. But, even with all of its problems, it works. Since people have used the bridge as long as they can remember – and because they don’t need special shoes or toll money – they use it.

This bridge is called the fax machine. It is the most widely used form of manual interoperability in healthcare today. Did I mention a Scot invented it way back in 1843?

The last mile of interoperability

Clearly, what we need is to get rid of the rickety old bridge. We need to make the new marvel of a bridge usable for a greater number of people. What we need is something simple that gets you that first mile on and last mile off the bridge.

I call this “The last mile of interoperability.”

The last mile of interoperability is all about getting data – and documents – to the people who need it so that they can do their jobs improving the wellness of our communities. Right now, there are a number of standards attempting to make data and documents more easily sharable between healthcare organizations. The problem is that they only deliver information between the organizations. They don’t deliver information to the people who need to do the work in a format that is useful to them.

Using my bridge analogy, they only go from toll gate to toll gate.

Workflow and ECM: Enabling interoperability

Workflow management and enterprise content management (ECM) are the entrance and exit ramps for success with healthcare interoperability. The technologies take information as it passes across the bridge and asks: “Where do you want to go?”

Then, they automatically deliver it. Through business rules, routing logic and work queues, workflow gets that information to the right team or user. ECM stores that information as it arrives in a secure document repository so that people can find the information in the future.

Workflow is a simple conversation, interoperability should be too

Another key consideration for workflow is that, unlike many file transfer approaches that simply transfer data across the bridge, it allows users to have a conversation between organizations. Requests for additional information can simply travel back across the bridge to the other organization where it can be attached and sent back.

Hyland has invested heavily in building the entrance and exit ramps for healthcare interoperability through OnBase Mackinac. Mackinac is a point-and-click configurable workflow and ECM solution that reduces costs, improves administrative and clinical coordination and increases stakeholder satisfaction across organizations.

I really am interested in your comments. If you would like to talk about bridges, interoperability or OnBase Mackinac, post a comment here or send me an email at mike.hurley at

Mike Hurley is a veteran health insurance expert and contributor to the Hyland Blog.
Mike Hurley

Mike Hurley

Mike Hurley is a veteran health insurance expert and contributor to the Hyland Blog.

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