International Lessons on Interoperability


A recent trip to Sweden reminded me about the similarities between countries. My Stockholm trip was the first of three European cities I visited as part of the International Initiative for Mental Health Leadership. This gathering expanded on previous efforts to share best practices in e-health and health information technology for behavioral healthcare. Because Sweden was the host, we heard more about their system than others, but the problems they’re trying to solve are fundamentally the same as in the rest of the participants’ countries.

One topic was particularly interesting to me.

Although Sweden has a well-established national health system, systematic and uniform policies are lacking. Sweden, like many parts of the US, believe counties, not the federal government, should decide what care is needed for its citizenry. This makes sense in many ways but it becomes problematic when standards are needed. Their approach to health information technology results in little to no interoperability between EMR’s throughout the nation. It’s where we were in the US prior to the adoption of Continuity of Care Documents.

This hesitancy to challenge traditional “home rule” must be overcome. The federal government of any country is already responsible for setting standards that all the citizens use. The width of roads, for example, or the gauge of railroad tracks. Information is like infrastructure. National standards must be established for data to travel.

Think about it; three decades ago you could only get money out of your bank’s ATM. Now you can get money from almost any ATM anywhere. The difference isn’t the ATM, it’s the backend communication protocols and networking.
As I discussed in a previous blog, I believe increased data sharing and visibility will help normalize and de-stigmatize mental health and substance use care. It’s heartening to hear other countries like Sweden are dealing with this. Perhaps our work on C-CDAs can be shared; after all we’re dealing with the same clinical issues. If we want “standards” why not develop international ones? It’s why IIMHL exists.

The IIMHL’s CEO Fran Silvestri oversaw a great set of meetings. Many thanks to my hosts in Sweden, Fredrik Lindencrona and Krestin Evelius. Both did a wonderful job in organizing the Stockholm gathering. Thankfully, their English was far better than my Swedish. What we all seem to understand is this – It’s truly a small world.