We’ve all heard the old saying, “You can lead a horse to water, but you can’t make him drink.” Today, the same could be said for healthcare providers and many of the interoperability tools available for their use.

The lack of adoption of interoperability tools by providers is a significant issue that hinders the smooth exchange of patient data between different health systems. Despite the development of interoperability standards and tools such as Fast Healthcare Interoperability Resources (FHIR), Digital Imaging and Communications in Medicine (DICOM), HL7, IHE, and others their adoption has been limited, with many providers still relying on outdated methods like faxing or handing patients a piece of paper. For example, most provider referrals are still sent by fax even though digital options exist.

Don’t just take my word on the matter. Even the National Coordinator for Health Information Technology (ONC), Micky Tripathi, noted recently in a panel discussion that, “When it’s easier to fax something, people will continue to fax things. There are adoption issues.”

And these issues are not necessarily limited to specific specialties or geographies—the entire sector has been slow in embracing new tools and standards designed to enhance interoperability among providers, which will ultimately lead to improved patient outcomes.

Depending on who you ask, the resistance to change could be attributed to a variety of factors, from cost and complexity of implementation, and data security and privacy concerns, to insufficient incentives.

But at its core, this reluctance stems from the perceived ease, convenience, and familiarity with older practices, suggesting that a significant shift— something akin to a comprehensive 12-step program — might be necessary to phase out outdated, inefficient, and time-consuming methods like faxing.

First, the adoption of industry-wide standards for interoperability is a relatively recent development. It will take time for healthcare organizations to establish the necessary connections and infrastructure to fully leverage these standards. The transition from fax-based communication to digital data exchange requires significant investment in technology, training, and process redesign. Until providers see tangible advantages in terms of improved workflows and patient outcomes, they may be hesitant to embrace change.

Second, the lack of a comprehensive clinical dataset hinders true interoperability. While standards like FHIR have been developed to enable data exchange, they currently cover only a limited set of domains such as medications, lab results, and diagnoses. Providers require access to the complete medical record of a patient to make informed decisions and provide optimal care. So, where’s the advantage for provider? The Office of the National Coordinator for Health Information Technology (ONC) must aggressively push for the inclusion of the full set of FHIR elements in data exchange processes. This will ensure that providers have access to all relevant information, not just snippets.

Third, ease of use always plays a crucial role in the adoption of any new technology. In many cases, healthcare professionals find it more convenient to fax or hand over a physical document rather than navigating through complex interoperability tools. After all, who wants to add to the administrative burden or further delay treatment by introducing codified data into their workflows? This preference for simplicity and familiarity often outweighs the potential benefits of digital data exchange. To overcome this hurdle, providers need user-friendly interfaces and seamless integration with their existing workflows. Single sign-on and embedded patient lookup tools within EHRs can greatly facilitate the transition to digital referrals.

Also, the absence of strong incentives or penalties has allowed the status quo to persist. While interoperability has been on the radar of healthcare IT for years, the lack of strict enforcement has hindered progress. The introduction of penalties for non-compliance with newly adopted rules could accelerate the demise of faxes and drive the adoption of interoperability tools. When providers face financial consequences for not embracing digital data exchange, they will be more motivated to adapt.

The lack of adoption of interoperability tools by healthcare providers is a complex issue that requires a multi-faceted approach. Improving ease of use, expanding the scope of data exchange standards, allowing time for implementation, and introducing strong incentives or penalties are all necessary steps to drive change. As providers begin to see the advantages of importing codified data into their workflows, attitudes will shift, and the healthcare industry will move closer to achieving true interoperability.

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