I spent last week at the 20th IHE North America Connectathon. This is my 14th year involved in IHE, and my 13th year attending the Connectathon. This year my role was to serve as an IHE Ambassador to assist others in understanding what is happening at the event and to be a member of the welcoming party to new comers.
I was asked to share a few thoughts for the video crew around what my experience has been with past IHE Connectathons, what has changed over the years and what I think some of the successes and challenges have been in interoperability over the past year, so it seems a good opportunitiy to write about it here.
My first Connectathon was in 2008 when I worked for digiChart, a software company focused on obstetric care. As a still fairly green software developer I spent the year prior writing the Antepartum Summary (APS) IHE Profile in the IHE PCC Domain and implementing that profile along with XDS, CT, ATNA, and a few others in the digiChart product. I took that implementation to Connectathon and tested with other software vendors. This was my first foray into IHE and I was hooked. I have continued to stay engaged in IHE in one form or another since that time, through six employers supporting at least seven organizations. My roles have included: software engineer, development lead, HIMSS Showcase Technical Project Manager, strategic guidance, and IHE Ambassador.
Over the years I have watched the Connectathon tooling improve greatly. The first tool used was Laverne Palmer and a giant pad of paper, but this was legend I’ve only heard others speak of as it was prior to my involvement. Sometime after that came the Kudu tool, to which those of us participating learned how to use with its quirks, but at the end of the day it did it’s job well enough (which is not simple!). The successor to Kudu was Gazelle, which is still in use today. Gazelle was a redesign of Kudu and used a much improved architecture allowing for greater opportunities for continued improvement over time. Automation was provided year after year in support of vendor testers being able to execute their tests and receive feedback and results with faster and better accuracy. The interaction with test monitors through the Gazelle tool also greatly improved over time providing further efficiencies.
Another change I have seen over the years is the increase in number of middleware vendors bringing their products to the Connecathon. In earlier Connectathons these vendors were not encouraged, or even not allowed. An end user experience with every product was a requirement of participation. In other words, a user interface of some sort was required to demonstrate that interoperability was happening. As the market changed and middleware, or integrator systems, became more prevelant they were allowed to attend. This was a natural and expected progression as the market began to specialize more in specific interoperability areas.
Some things have not changed at Connectathon over the years, and one of those is the culture of extreme collaboration and cooperation that exists among the participants. One will observe that participants on the Connectathon floor that may compete out in the open market will be found working together at the event to solve interoperability problems. This was a culture that was established early on as it was recognized that the benefit of such an approach would result in higher levels of innovation and creativity. By breaking down the competitive walls, ideas could more freely be shared (and let’s face it, due to the craftsmanship nature of coding if you actually got a copy of another company’s source code it very likely wouldn’t do you any good unless you were to get it in totality which wouldn’t ever happen at an event like this). This culture still exists today. Many of the same faces appear each year at the IHE Connectathon, but new faces also show up to take advantage of the collaboration and interoperability testing that happens there.
In terms of successes and challenges of interoperability over the past year the answer is a little more difficult. There really isn’t any blockbuster news like The Most Important Interoperability Story of 2016, however, there is an expected ONC rule that will soon be released that supports much greater levels of patient data access and this is something that has been in the works over the course of 2019. This is significant! This is how we will continue to innovate, to create. We must provide patients with the opportunity to work with their data to gain greater levels of control of their healthcare data. Dave DeBronkart (“ePatient Dave”) discusses this when he speaks on “paternalism” and how that prevents patients from being able to have a say and postive influence in their own health outcomes. So while this is not a specific success marker in 2019, there is a lot of groundwork that has been laid in support of the regulation expected to released within a week or so.
A challenge in 2019 is the lack of organic adoption of interoperability. The driver still seems to be federal incentives. Perhaps that’s how it will always be, but I don’t think that’s ok. We have to find a way to tip the scales so that software companies will innovate to provide value-add services to patients such as those that exist in other markets. We do need continued help from our federal government (here in the US), but once we have the initial push (via upcoming regulation) I suspect that creativity and opportunity will eventually take over and we’ll see interesting and effective solutions on the market that allow patients to engage with and have better control over their data, and thus better understanding of what their healthcare options are for their specific situation.
All in all I think healthcare IT and interoperability continues to move in the right direction. I am thankful to be a part of this industry despite it’s challenges and sluggishness as compared to other industries. We ARE moving forward. We ARE getting better. We WILL succeed. Let’s keep pushing for access to our data!