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December 2010

Crossing the Quality Synapse: Interoperability is the Neurotransmitter Propagating 21st Century Healthcare

Yesterday at the 2010 ONC Grantee Meeting in Washington, D.C  I was invigorated by the optimistic energy, realistic networking and paucity of pessimism from over 1,000 participating grantees whose collective repository of health IT knowledge is astounding.   And it got me thinking, maybe the Institute of Medicine (IOM) got it wrong and that it is not actually a chasm...maybe we are...crossing the quality synapse?

Imagine for a moment that electronic health information is a charged impulse using health IT neuronal circuitry to propagate 21st century healthcare.  This neuronal circuit provides the infrastructure needed to enable charged impulses of the right information on the right patients to be sent or received wherever it is needed, whenever it is needed.  However, as we physicians know, the neuronal circuit is made up of many individual neurons that are not physically connected to one another.  Each neuron can individually propagate a charged impulse along its long, tubular-shaped axon, but the axon ends blindly at its terminal end.  Between it and the next neuron there is a space, called the synapse, across which the electrical impulse cannot travel.  This constraint prevents an individual neuron from transmitting the electronic impulse to its final destination.  On the other hand, an absence of such constraints and uncontrolled releases of electrical charges between the neurons of our brain would result in seizures.   So, some type of trusted intermediary is needed to enable the neurons to talk with one another in a standard and controlled be an interoperable neural circuit that coordinates and directs the traffic of electrical charges to their permitted destinations.     

In medicine we recognize the complexity of this synapse.  Although we have learned much about it, we remain humbled by what we do not yet know.  What we do know is that at the "receiving" end of a neuron there are tiny tentacles, or dendrites, that stick out into the synapse toward the "sending" neuron's axonal terminal.  When the charged impulse reaches the axon terminal, the action potential stimulates the chemical release of neurotransmitters from the terminal into the synapse.    The neurotransmitters physically travel across the synapse to the dendrites.  At that point the neurotransmitters become a catalyst for the transformation of the chemical process back into an electrical one.  The new electrical impulse travels from the dendrite into the neuronal axon and propagates down to the next synapse, where interoperability will again have to occur. 

Health IT interoperability is the 21st century neurotransmitter that is catalyzing the transformation of the healthcare system.  Without interoperability we know that electronic health information is severely devalued as it remains trapped in individual silos, just as an an absence of neurotransmitters would limit electrical impulses to a single neuron. 

Concurrent with ongoing neuroscience research on the complex synaptic neurotransmitters, medical researchers used what we already knew to initiate trials and studies in an effort to improve psychiatric care.  Breakthrough research demonstrated that a synaptic deficiency of one of the neurotransmitters in our brains, serotonin, can cause depression.  Through additional trials and experience we then discovered that SSRI medications, which elevate serotonin levels by inhibiting their "reuptake" in the synapses after being released, are useful when treating people with depression and other mood disorders.   Similarly, a deficient level of interoperability between EMRs depresses our ability to transform our healthcare system.  We need to use what we already know about interoperability to initiate trials and studies in an effort to raise our interoperability to optimal levels that will propel our healthcare system into the 21st century.