I’ve blogged a lot about Open from a technical perspective. But there is a market perspective of Open, too. As international standards bearer for interoperability, HL7 plays a vital role in health care today.
But that doesn’t mean that HL7 fosters an Open marketplace. Why? Because transactions in an Open system shouldn’t be so costly. Open can help solve two of the chief complaints about Health IT 1) the cost of interfaces, and 2) the lack of scalability.
There’s more to Open than standard forms
Let’s think about transactions as they occur out in the marketplace. Suppose you owned an office supply store, and I wanted to buy things from you every week. We agree to use fax machines to conduct our transactions.
I’ll fax you my orders on your order sheet. If you’re out of something, you’ll fax the error report back to me every day on a special form. And if there is a special on some items, you fax those to me, again in a special form that we agreed to in advance. If you need a brand new item, we’ll create a brand new form.
You could argue these transactions are Open, because we’re using a standard form and a standard technology (albeit it one from the 1950s). It’s very similar to the HL7 standards for interoperability
HL7 describes the basic layout of messages, much like we would have decided on the layout of our forms. Every vendor and customer would have a different layout, but all forms contain the same pieces of information.
Why HL7 interfaces are typically so costly
HL7 has different message layout options and specific message configurations that vary from place to place.
Many fields in HL7 are “Optional.” In fact in the “update patient demographics” message, of the 26 segments that may be included, only 6 are actually required. And in one of those segments (PID), of the 39 elements in that segment, only 2 are actually required.
This approach creates a problem for the interface programmer. Does this particular system send (or expect) a home phone number? If I receive the optional home phone number, what should I do with it? Should I ignore the scheduling message patient phone number and wait for the patient demographics message (ADT)? That’s why HL7 interfaces typically cost tens of thousands of dollars to set up.
There are so many different specific message layouts (much like the fax machine layouts would be different). Unfortunately, even after you set up the first interface, it will cost the same amount to set up the second one. Generally, you have to start over when with each HL7 interface.
There’s a joke in the interface business, “When you’ve seen one interface, you’ve seen one interface.” Referring to the fact that every interface is unique, and that “deployability” is not inherently part of the HL7 standard. HL7 is more like a toolkit than a blueprint.
Open frees you from heavy transactional costs
From a market perspective, there is an issue in both examples: huge overhead in transaction costs. The time and money spent on HL7 protocols is as cumbersome as faxing orders. In my mind, that’s not truly Open.
Open implies a level of easy (and cheap) exchange of information. If you decide to change office supply vendors, it shouldn’t cost you $25,000 and several months to set up new interfaces.
An Open market enables freedom to make and remake decisions. The cost to implement a decision should entail very little friction.
An example from our own shop: Allscripts has several partners that are cloud-based solutions, like Healthfinch. To implement this medication refill solution, all Healthfinch needs to know is the web address of your EHR. Allscripts and Healthfinch can connect in literally 10 seconds.
That’s what a friction-free, Open marketplace looks like. The cost, in both time and money, to make these communication channels should be virtually zero.