I spent forty years connecting medical devices to hospital records, and I helped write some of the standards that do it. So I want to say something that will sound strange coming from me. The plumbing was never the point.
In 2013 the West Health Institute measured what medical device interoperability was worth and put the number above thirty billion dollars a year [1]. That number was real then and it is real now. But it measured the pipe. The larger prize was never the connection itself. It is the data that moves through the connection once it exists, joined to the public knowledge the country already paid to build, carried in a common language all the way back to the UMLS, and reasoned over while the patient is still in the bed. In critical care, where the sickest patients throw off the most data and the least of it is used to look forward, that prize is almost entirely unclaimed.
I have written that argument up as a white paper. Seventeen pages, in the style of the West paper I admire, and free. It is not an article. It is meant to be handed to a CMIO, a pharmacy director, a pump vendor, or a standards committee, and to survive the person in the room who checks the numbers. So every number in it is cited to its primary source, an appendix lists each one and where it came from, and the two places where I am giving you my read rather than a sourced fact say so in plain words.
What it argues, in one paragraph. About 88 percent of US hospitals run smart pumps and somewhere between 9 and 15 percent have the pump talking to the record, thirty years into the effort. Closing that gap is worth doing and worth West’s thirty billion. But a hospital that has finished the plumbing and done nothing further has built a very reliable way to fill in a flowsheet. The value is in joining the patient’s live stream to the public knowledge, the FDA labels, the adverse event reports, the terminologies, through the common language that already exists, and reasoning over it forward, before a slow harm becomes an obvious one, then handing what it finds, with its evidence, to a human who can act. Two ordinary bedside cases show what changes. In both, the pipe did its job and the value was still left on the table.
The PDF is attached below. The permanent home, with a citable DOI, is pettusbook.com/plumbing. Share the link anywhere you like. If you find a number that does not hold, tell me, and I will publish the correction rather than quietly fix it.
It is the companion to my book, The Technology Was Never the Problem. The book says the technology was never the barrier. The paper says the plumbing was never the point. Same spine, next chapter.
Dan
[1] West Health Institute. The Value of Medical Device Interoperability: Improving Patient Care with More Than $30 Billion in Annual Health Care Savings. March 2013. All other figures are sourced in the paper itself, references 1 through 13.