Comment My perspective from the inside (Score 1) 228
Being unwilling to cough up the cost of the paywall, I haven't read the Rand report, but the second hand descriptions of it, as well as many of the comments, seem overly focused on the big names (Microsoft, Google) or reflections of the author's preconceptions.
I have worked in the medical interoperability industry for 15 years; here is my perspective: The medical industry has been working towards patient record interoperability for well over two decades. The first major accomplishment is there is now a firmly entrenched, ubiquitous standard for medical images. That format, DICOM, allows medical transfer between medical scanners, display, and long term storage systems. It is a complicated standard, and has evolved as medical imaging devices have become more sophisticated, so transferring images between systems is not always painless, but if you can transport DICOM images from one system to another, the receiving system can nearly always use them.
The bigger hurdle is to transfer a patient's diagnostic reports and medical history between medical providers, for example, two different doctor's offices. That's a difficult problem for numerous reasons, and for nearly a decade, the medical industry has been working of approaches to make that happen. An international cooperative effort, called Integrating the Healthcare Enterprise (IHE), has been working on standards and approaches, the flagship of which is Cross-Enterprise Document Sharing (XDS), although technically that is just one of a number of related sets of standards.
It's taken time to define the pieces of this, and has changed over this time thanks to trial and experience. Product vendors meet for multi-day cooperative testing and evaluation held once a year in the United States (near Chicago in the dead of winter – now that's dedication) and once a year elsewhere in the world at varying locations.
Either XDS (and its related "profiles") or some local variation has gained acceptance in many parts of the world; the United States is a trailing adopter. That's largely because the USA was a leader in establishing medical systems, so there is now a large, established infrastructure that predates these efforts; countries that modernized their healthcare more recently have been able to just adopt the new standards.
The key piece of this, as RAND correctly points out, is having a format for patient history that all systems can understand. But, rather than being a missing piece, this is a success in the making. Different organizations have tried to define a common format; in 2007 HL7 and ASTM, the organizations between the two major contenders, joined forces to define a harmonized Continuity of Care Document (CCD), which is based on HL7's Clinical Document Architecture (CDA). It is used in numerous countries, and is part of the US effort for "Meaningful Use".
Recognizing the costs of replacing systems, the government has a program providing financial assistance and incentives for medical organizations to adopt interoperability standards. The money comes with strings: they have to use systems that have been certified to support these standards, and they have to show that they are actually using these systems in ways that promote interoperability, hence the common term "Meaningful Use" for this program. Recognizing the difficulty of replacing systems, this is a multi-year effort that we are still in the middle of.
In addition, many states and regions are experimenting with regional health information exchanges, and the Federal government has a national health information network backbone. These may grow into the systems that will provide better medical information exchange, or they may help provide experience and information for whatever will come to replace them.
It's slow. For a very long time, medical reports came by mail, by FAX, or by other physical delivery. Electronic reports today tend to be either PDF or a barely formatted text approach (HL7 ORU). Not great, but good enough to slow down the migration CDA. Within the industry, that direction is clear and it's coming, but it's just not here yet. We're all standing on the platform, looking down the tracks, waiting.
One more thing: This industry is filled with highly competitive companies, and yet when it comes to DICOM, IHE, and HL7, I have always been amazed at the high level of cooperation they give, and the dedication and expense they provide towards advancing them. The people who work (very, very hard) on these guidelines and standards truly put the quality of the results above their company's proprietary interests.
