Authors: Duncan Weatherston, Smile Digital Health & Sime Pavlovic, Deloitte Canada

The way we interact with healthcare today is virtually unchanged from a hundred years ago. Care practices and technologies have dramatically improved, but care delivery is still a bricks and mortar activity, delivered by highly trained specialists with minimal automation. Healthcare is an information driven business, based on evidence and empiricism. However, we have failed to build information-first approaches to care delivery that would link all of the participants together, enable real-time analytics support and drive cross-team collaboration. In healthcare, data remains isolated in silos, and while there are systems that attempt to connect those silos, they do not resolve the underpinning issues caused by the lack of interoperability. 

At this year’s Intelligent Health Data Symposium, Deloitte Canada discussed the idea of Radical Data Interoperability. It is an invisible, but foundational capability — of enabling data-sharing and insights for systems and users — which centers around patient empowerment, integration with governance models and aligning interoperability ROI to industry benefits. Data exchange and interoperability do not have to continue to be a pain-point for the industry. Radical Data Interoperability opens up a new world of care delivery that moves the healthcare community forward by collaborating on problems and sharing the benefits and value of solutions. 

“Organizations like Smile have shown that interoperability is available to us. Now it is up to all of us, as a community and industry, to move the discussion forward to include subjects like privacy, security, scalability, data exchange etc, and not halt the discussion because of those concerns. From Deloitte’s perspective, let’s be radical! Let’s not accept the norm that hospital data exchange is painful, and instead let’s work towards governance with the community so that we can leverage technology and move interoperability forward.” said Sime Pavlovic, Senior Advisor, Deloitte Canada.

But we also need to acknowledge some common pain-points that often limit collaborative discussions.

First, as an industry, Health IT is risk-averse, especially to things that are ‘radical’. There is a common idea that keeping the status-quo, keeps risks low. As such, it becomes important for technology players to keep our goal in mind — which is getting billions of people world-wide the care they require exactly when they need it. Maintaining the status-quo does not accomplish that. 

Second, the common assumption is that healthcare providers do not want to use new technology. This isn’t essentially true as there are often reasons and barriers against adoption, like incompatibility, inaccessibility or it just isn’t user-friendly. With this practice of radical interoperability, our job is to engage the providers and patients from day one and figure out how to architect the solution that solves their problem. Providers and patients need to guide the framework on what needs to be done.

“Engaging the community early and not assuming their resistance is what enables everyone to work towards a solution. This includes conversations about privacy and security because they are absolute pillars to how data flows.” said Sime. The framework then becomes the guiding principle that allows us to implement what we know, and also stay open to what we don’t know.

These conversations are not government-led, neither are they private-sector owned initiatives. They have to be community dialogues around innovation. While this may be new and radical in the world of healthcare, it is not in the world of technology.

Early Internet & Community Collaboration

Some of us may remember how the internet started. Back then, there were many standards and protocols in use at every layer of networking (connection levels and logical levels). There were a whole set of strategies on moving data from a desktop, and another set on how to get computers to interact with each other. It was a cacophony of implementation, storage, network and communication problems for the average technician who worked in those years. 

It was only when the community of developers at the time landed on a common standard for exchanging information, TCP IP, that we started to see the adoption of the broader solutions that we know today — like the HTTP and the expanded use of email. 

In hindsight, it is clear to see that companies who succeeded at that time were not the ones who created closed systems, but rather, those who developed systems that could work together for the benefit of all. 

“I see this as a corollary to healthcare today, because if you look around, you see a lot of people with different standards, protocols and data models for storing and sharing health information. This is fine if you need specific and singular information from one source, but when you have advanced needs, it just doesn’t work. We have to get to the point where we standardize on a mechanism for interchanging information that is secure and scalable. As a community, we have to come together and decide on a common model and I believe, like many, that FHIR is that model.” said Duncan Weatherston, CEO, Smile Digital Health.

FHIR® provides the healthcare industry with a range of standards and specifications for data exchange that are flexible and adaptable. It also offers open APIs, well structured ways of modeling and storing the information, as well as a set of guidelines and approaches (implementation guides or IGs) which describe how to use FHIR to achieve your organization’s goals — such as how to use social determinants of health, how to build on clinical research, how to optimize and store imaging are just a few examples.

There is a global taskforce of people skilled in FHIR trying to find ways to ensure how best to communicate, identify and secure the exchange of sensitive information in a timely manner over the internet. In the coming years we expect many more solutions that show us how we can manage health data efficiently from this global taskforce community.

The early days of the internet were driven by community engagement. “I know that, because I was there. I knew people who were building types of tooling for fun, just to make it easier to copy files. Then, they would share it with the rest of the community. I see the same spirit today everytime I go to a conference. Small companies with great ideas on how to build and add value atop the FHIR standard. There was some overlap of effort and solutions, but that was because it was new and we were all trying to figure things out, but the important thing was the grassroots engagement. It was the ability to express what someone discovered in an easily distributable fashion, which enabled a breadth of adoption. That’s a huge focus for me!” said Duncan.  

Just as community collaboration enabled the evolution of the internet, Radical Data Interoperability enables the Internet of Health (IoH). With the FHIR-powered Internet of Health IoH, collaboration through interoperability in the healthcare sector allows for better decision-making, more prompt and timely care and intervention, better health outcomes and enhanced value for payers, providers, clinicians and patients.

Learn more about the Internet of Health in this 6-part deep dive series.

What Does Radical Data Interoperability in Healthcare Mean for Organizations

EHRs and patient portals are commonplace today, but information-first, patient-centric digital solutions have made little headway. Now that FHIR — the first internet-based standard with interoperability at its core — exists, the healthcare industry can finally join the IoH revolution with simplified data exchange and opportunities for efficiency in service delivery. “There was a time to debate which standard would lead the way, and you can probably keep debating that. But you have to choose one. That’s where we are right now and the technology is here. So now, there is a joint call to action, industry-wide, to leverage the technology that is already here and build upon the FHIR open standard, to do what we need it to, in terms of the move to truly interoperable data.” said Sime. 

When COVID hit, the virtual ER (Emergency Room) took shape quite fast to serve the needs of the population. One of the outcomes of this was that patients were diverted appropriately and quickly to the proper care settings without setting foot into a hospital. This required the ministries to come up with new billing codes to enable this level of service, in a really short time-period. That innovation shouldn’t be left to the unfortunate time of a pandemic. “There is an opportunity now to leverage that momentum and co-designing a system of care with clinicians and patients. Then, technology companies like Smile and Deloitte, along with other firms can bring this together so data flows into the required setting, with privacy and security at the core.” continued Sime. 

One of the current global healthcare patterns is the reduction of available clinical services, due to many care providers leaving the industry. “It’s hard. In addition to that (reduction in clinical services), there are billions of people world-wide who aren’t getting good, basic and timely care by any meaningful standard. Now this seems like a losing proposition, but if we go back and think about how to make things more efficient, we arrive at the opportunities that the Internet of Health allows.” said Duncan. What it allows is the ability to make better diagnostic and decision tools for clinicians; and deliver better, timelier health services to patients. With truly interoperable data available, we can automate, specialize and incentivize care properly, which in turn expands care delivery without adding administrative burden on the system. 

At the end of the day, our community conversation goal should be: How do we make healthcare better? How do we leverage the technologies to create more value and reduce burdens? When concerns come up, we should resolve them together and be engaged in the solution, rather than avoid engaging in conversation at all because of those concerns. 

The road to interoperability is long and no-one walks it alone. There is a lot of work to be done and healthcare technology has a way to go to catch-up and maybe even surpass other safety critical, information-dense industries, with respect to interoperable systems.

This is how each organization can start to position itself and start their data transformation journey towards #BetterGlobalHealth

This blog is inspired by the Closing Keynote Panel at Smile’s Intelligent Health Data (IHD) 2023 Symposium with Duncan Weatherston, CEO of Smile Digital Health and Sime Pavlovic, Senior Advisor, Healthcare & Life Science, Deloitte Canada. The keynote and all symposium videos are available here.

Better Global Health was the north star of our Intelligent Health Data (IHD) Symposium 2023. The two-day event was packed with talks and workshops on all aspects of digital health, FHIR®, open standards adoption, interoperability, changing regulatory and compliance landscape and how large healthcare systems can proactively evolve, improve their health data infrastructure to serve growing population needs. 

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