Interoperability is personal

November 3, 2016
Julia Zehel -

Before joining Redox, I had no real idea what the phrase “healthcare interoperability” meant. Sure, I might have been able to parse out what it meant in the most superficial sense possible, but like many large-scale, nation-affecting problems, I could probably only tell you the general gist of it (and if pressed to explain in detail, I’d get incredibly flustered, mumble out something barely intelligible, and then promptly pretend to faint in order to avoid the question).

As I began learning about healthcare interoperability, I had an oddly difficult time grasping the concept. As a true healthcare-industry noob, the idea made enough sense, but the fundamental reason of why the issue was important—the deeper, “capital R reason” why—continued to evade me. Coworkers drew out diagram after diagram depicting the health system, the EHR, and our API, and while I could see they were connected and that something within the system was broken, the importance of the picture was lost on me.

This persisted for about two weeks. I don’t remember what the catalyst was, but one day it all clicked into place and everything suddenly made sense. I remember the elation I felt as I fired off messages to a few coworkers exclaiming, “Oh my god, I get it! I get what Redox does! I get why this is important!” Because my coworkers are extremely seasoned industry vets, I was met with rather tepid congratulations… but still, I was quite bushy-tailed about flipping over the last piece of the puzzle and finally jamming it into place.

From that point on, all the shapes in my mental diagram were no longer just shapes, they took on meaning and represented the major players in the healthcare landscape we work within; the “EHR Rectangle” was now drchrono, or Epic, or Allscripts; the bigger box surrounding the EHR became the Health System which used the EHR; the box floating above them in the cloud was now the health application designed to improve some aspect of patient care. And most importantly, the piece of the puzzle in the middle that allows the application to collect and use the data stored within EHRs is us, Redox. Voilá, the whole picture.

Truly seeing the whole picture is the first step in actually understanding what it represents, and really, that was an even bigger epiphany for me, as what it is shows is an immensely important industry plagued by a profoundly complex problem that will only get worse as the industry grows—the problem of Interoperability. Put as concisely as I can manage, interoperability means that while the medical industry is wildly innovative at the forefront, the companies pushing the envelope are stuck in line waiting to deploy their technology at health systems still trying to get their technology caught up to speed in the digital age. Simplified further, it’s a problem of translating foreign languages: the health system speaks Old English while the applications of today don’t even speak an English dialect—they’ve evolved and are using languages as different as Russian, French, and Tagalog.

Mastering a new language takes time, and normally that’s what application developers have to do each time they sell their application to a health system. But Redox acts a Rosetta Stone, translating the different coding languages spoken by each organization into whatever format they’ve been built to work with. This lets the technology being developed by crazy-intelligent medical technologists bypass the time spent configuring their product each time they sell it. While seemingly simple, the implications of this are enormous—it allows for expanded and quicker access to patient data, giving application developers more data to work with and the ability to arrive at more nuanced insight into how their product is performing.

In turn, this allows for faster iteration on already-innovative technology. It allows for more and more health systems to approve and use new technology that is capable of saving lives. It allows for people and families to improve their health and take control of it in ways they never have before. What interoperability accomplishes is pretty amazing, but without easy and efficient access to patient data, a fundamental link in the process of bringing innovation to market is broken.

Making the connection

Since joining Redox, the thing that I’ve been most curious about are the applications being developed to help cancer patients. With cancer being such a widespread affliction, I figured there had to be people devoted to designing products that would, at the very least, help manage cancer treatment plans. My coworker, Devin Soelberg, said that he believes technology will cure cancer, a sentiment that many people adamantly believe, myself included. So far, we power three cancer applications and have launched an active initiative to find more solutions in this specific field to partner with.

And this, for me, is where interoperability veers toward the personal: I have a specific interest in cancer applications because three years ago today, my father died from cancer. Like so many people, he had bouts of it throughout his life and finally succumbed after his body couldn’t withstand another round. It first appeared as a small battle in his thyroid, but once half of that gland was removed, the fight was declared over.

Despite being “cured”, he actually wasn’t—it lied dormant for ten years, deciding to make another stand as an incredibly massive tumor on his right kidney. Again, they went in and removed the tumor, this time playing it safe by taking out the entire organ as opposed to just the offending tissue. The process, surgery, and recovery were incredibly tough on him, both mentally and physically, but he made it out without any major complication, and we were relieved as he was sent home with another declaration of being cured.

Six months after the operation—and without the hospital having scheduled a single post-operative visit—my dad found himself doubled over on the bathroom floor one night with intense stomach pains. Struggling to avoid saying what we were all thinking, my mother and I helped him into the car and took him to the ER, assuring ourselves it was just a kidney stone or some other minor issue. He was evaluated quickly and we were ushered into a small room where we were presented with an X-ray showing clusters of tumors riddling his lungs, stomach, and liver. Beyond the point of being stopped and having spread all over, it was clear this was his final diagnosis.

I remember the X-ray looking like an inverted picture of a Christmas tree. Cured, I thought, sure. I had never felt more bitter in my life. My mother and I cried. My father, stoic for us, didn’t.

Thankfully, his decline was swift and he died a few months after this episode. To this day, when people ask what kind of cancer he had, I don’t know what to tell them. I think if pressed, I would say the ambitious kind.

A few years past his death, some things still stick out to me. Aside from the troubling lack of follow-up visit and without delving into further details, there were ways his care could have been improved, things that could have been accounted for that would have made his end easier. To be clear, I know having and treating cancer will never be an easy thing, but I don’t think that means we can’t make strides in how care is delivered, how patients are cared for, and what help is available to them.

I think my father could have benefited immensely from health applications designed specifically for cancer patients. I know he struggled to keep hope throughout his diagnosis; he struggled taking his medicines; he struggled eating and keeping on weight. What if there had been ways to schedule cancer screenings more easily? What if there was an application that helped him meet nutritional requirements throughout his treatment? Would he have been stronger? Would that have given him more time? What if there were ways to have helped him that I’ve never thought about?

Would he have used them? Would it have made a difference?

I can’t help but think that the answer to each of those questions—both for him and the healthcare providers simply working within their means with the tools they had—is an anguished and resounding “yes”. I know he would’ve done everything possible to prolong his time with his family and improve the quality of his care, and if that was true for him, it must hold true for millions of people who stand to gain comfort, peace of mind, and even extended years with the people they love from improving and expanding what patient care can do. From someone who knows how meaningful even an extra hour could be, I assure you that cancer patients, their spouses, children, and friends could all benefit from advancements in the technology being used in cancer patient care.

This is why I care about interoperability. This is why I see the value in what we’re doing and want to make it work. I feel lucky to work for a company whose sole mission is to make the adoption of medical technology easier, safer, and faster. I know this borders on cliche, but if what we’re doing can help one person spend an extra afternoon with their father, then this is worth it. If we can play a part in helping millions of people spend extra years collecting memories with a loved one, it’s well-beyond description.

Interoperability is personal, for everyone

This is where my little personal bubble of interoperability ends, and someone else’s begins. Cancer is just one ailment. Every single type of illness and the way it’s addressed has the capacity to be improved. Every single person who suffers from an illness and their families, friends, and loved ones have something to lose from this problem being left unaddressed. That’s the “capital R Reason” why interoperability is important: it has the power to positively impact literally everyone alive. That statement is as astounding as it is true, and it’s one of the primary reasons working to solve this problem and establish a viable long-term solution is so immensely important.

So far, I’ve found that working on something large scale like this can sometimes distort my perspective—as they say, I miss the forest for the trees, and I think this holds true for a lot of people. Pulling back and realizing the direct implications of what you’re doing can be quite powerful—thinking “I’m fixing the problem of interoperability” is rather lifeless, but thinking “I’m fixing the problem of interoperability so that my dad might have lived to meet his grandchildren”, or “I’m fixing the problem of interoperability so that a kid might be able live a childhood untethered to a medical bed” makes the reality of what we’re doing less tangential. It shows that this work can really mean something to someone.

It really means something to me.

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