Interoperability needs an architecture in addition to APIs, HIMSS CTIO Steve Wretling says

Interoperability: There’s a lot happening right now. FHIR, as in Fast Healthcare Interoperability Resources. Open APIs. Blue Button 2.0. Carequality and CommonWell reaching a milestone this summer in terms of exchanging Continuity of Care Documents.

At the same time, however, a thorny reality persists: The average hospital has 16 disparate EMRs in place among its affiliated outpatient practices. Look more broadly at integrated health systems, and that number bumps up to 18.

So where is it all going? And what will it take to get to the point where interoperability, though perhaps not 100 percent solved, will be a less pressing issue for hospitals, EHR vendors and tech startups?

I spoke with HIMSS Chief Technology and Innovation Officer Steve Wretling about what the industry needs to achieve interoperability, his advice to aspiring entrepreneurs and the innovation that has surprised him most.

Q. You’ve been working on the tech side of healthcare long enough to have seen considerable changes amid the growing pains. What makes you the most excited right now about the future?

A. The unpredictability itself is really exciting. We’re in a data revolution time period where digital information and technology is opening many avenues to innovation on data that have not been there before. What’s also exciting is that one model is not going to prevail. The old models require standardization of many processes but digital health frees up the creation of completely new processes – more appropriate than a single model. The promise of innovation will allow the ecosystem to shift from treating a sick patient to a person seeking health.

Q. Speaking of excitement and unpredictability, let’s talk a bit about data interoperability.

A. There’s so much good happening and we could leverage it so much more. When the JASON task force published its Robust Health Data Infrastructure report in 2014 there was a rough draft of an architecture and what took hold was the APIs and that’s great, however, an architecture needs to be developed to see interoperability beyond APIs.

Q. Interesting, with all the buzz about open data, APIs and FHIR one does not hear as much about the need for an architecture. Where is this all headed and what should hospital IT shops and the startups looking to win them as customers be doing now to prepare?

A. What’s really clear is that API-based information exchange is finally taking root in healthcare and I believe version 4 of FHIR will be a normative standard. If you’re on version 2 and I’m on version 3, I can’t necessarily work with your FHIR. 4 will be a true go-forward standard. So hospitals and services providers should start demanding the types of apps they need to fit into their workflow. The emergence of SMART and SMART on FHIR will give them a second chance to build systems of the 21st century instead of just an EHR approach. Startups should be looking at APIs as the glue that will connect disparate systems.

Q. September being the HIMSS month to Focus on Innovation, of course, what advice would you give aspiring entrepreneurs, dreamers, developers?

A. I’d say look at the landscape: Healthcare is consuming 17 percent of our GDP. New models are urgently needed to provide better care at lower costs. The promise of health IT is beginning to be realized but there are so many great opportunities. Think outside the app and services you’re trying to create because silos are just not going to prevail anymore. Understand the adjacencies, that will set you dramatically apart, and whatever you do it must be evidence-based so find the best hospitals to innovate with and partner.

Q. Looking back at the course of your career, what innovation – in healthcare or elsewhere – has surprised you the most? Why?

A. What surprises me the most is the enigma of the smartphone. It has become a part of the person, a part of our culture more than I ever thought it would and the ability for it as a comprehensive platform to include features and innovate has stood the test of a decade. From a tech perspective, that is incredible – and it has no signs of slowing down but, instead, morphing into other things, like a phone or sensor on your wrist.