Health Care?s Dirty Words

Thursday, June 9, 2016 | Larry Sobal

 

If the title gave you hopes of picking up some new profanity, you should know that this is a family blog. I’m taking a liberal approach to the idea of “dirty,” to mean murky, mucky, unclear, opaque—and in some cases—downright disgusting (depending on your point of view). Let’s get started.

The first dirty word that comes to mind is “interoperability.” According to the Healthcare Information and Management Systems Society (HIMSS), interoperability describes the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and subsequently present that data so it can be understood by a user. HIMSS goes on to convey that there are three levels of health information technology interoperability: foundational, structural and semantic.

There’s only one level that I know of: nonexistent. As I travel throughout the country and interact with health systems, interoperability is much more a concept than reality. Inpatient systems aren’t connected with ambulatory systems. Different diagnostic systems are stand-alone databases. The next time I hear someone say that full-scale interoperability is on the horizon, I want to scream, “In whose lifetime?”

The next time I hear someone say that full-scale interoperability is on the horizon, I want to scream, “In whose lifetime?”

My next dirty word is interoperability’s sleazy henchman, “interface.” It is often sent in to create, in theory, some interoperability; however, it usually takes much time and expense, and, in the end, leaves you feeling like you’ve been taken by a con-artist. I can’t keep track of all the interface scams I’ve seen. They all start with the innocent idea that somebody will just write some code and magically make two systems (that aren’t meant to) talk to each other. No doubt, you’ll hear that they’ve done this in other parts of the country.

Baloney! The next time you get quoted a $25,000 fee for an interface and are tempted to move forward, I suggest instead you open that e-mail from the falsely-imprisoned European prince, who can double your money in just a couple of months. You’d have much better odds of success.

I could spend more time on other IT-related dirty words such as “upgrade,” “conversion,” and “functionality,” but it’s time to move on.

Let’s spend a minute on a word that’s getting dirtier by the day: “attribution.” In the race to correlate cost and quality with physicians, attribution ultimately rears its ugly (and dirty) head. We all get the idea. Somehow, we should be able to determine which physician ultimately bears responsibility for things like resource utilization and outcomes. But the treatment process doesn’t always align that easily with a single physician—and the formulas being used to determine patient attribution can be messy and wrong.

The same can be said for a distant cousin of attribution: “allocation.” It’s very similar, in that it often has good intentions of associating something, usually cost, with a formulaic methodology that will always have some degree of subjectivity. For that reason, it will be argued all day long, with no possible resolution in sight.

I’m tempted to spew on about value, appropriateness, alignment, outlier, risk and some of health care’s other dirty words—but I think I’ll stop right here.

What are your favorite dirty words?

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Larry Sobal is Executive Vice President of Business Development at MedAxiom. He has a 35-year background as a senior executive in medical group leadership, hospital leadership and insurance. As part of his current role, Larry consults, writes and presents on topics relevant to transforming physician practices and health systems.

 

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