Ĉu vi parolas Esperanton? — What Esperanto Can Teach Us About Integration

Novigi means ‘to innovate’ in the made up language of Esperanto. All languages are, of course, made up, but Esperanto was very deliberately concocted by Polish ophthalmologist L. L. Zamenhof in an attempt to create a universal language for international communication. Given that most of us would answer the question “Ĉu vi parolas Esperanton?” with a resounding “huh?”, it might seem that Esperanto fell somewhat short of Zamenhof’s laudable though lofty ambition. Yet in key episodes in modern history Esperanto did indeed serve as a lingua franca for people from different cultures striving towards a common goal.

There are — unlikely as it may seem — striking parallels between the premise and ideas that drive Esperanto, and system integration. And of the industries in which we work, perhaps none has a greater unfulfilled need for integration than aged care.

What’s the problem?

Accounting firm StewartBrown recently found that 38 out of 111 aged care providers surveyed wanted better integration. In a similar vein, the Royal Commission into Aged Care Quality and Safety repeatedly highlighted the lack of integration of both systems and data to be a significant issue throughout the aged care sector, claiming that “data systems need to be able to work together and share information—also called being ‘interoperable’”.

The problem in aged care is twofold. Firstly, the applications and systems within an aged care provider need to integrate with each other. Secondly, each aged care provider needs to be able to integrate with a range of external parties: other aged care providers, GPs, hospitals, pharmacies, allied health professionals, regulators, other government bodies etc.

A lack of integration between internal systems leads to some obvious issues for aged care providers. A 2016 time and motion study found that nurses in aged care spent approximately 20% of their time on documentation. Given that requiring the same data to be manually entered into two systems effectively doubles input time, the benefits of integration here are clear. If system integration could halve the amount of time spent on documentation, care staff could have an additional 45 minutes to an hour each day to spend caring. Data quality issues and an inability to derive analytics and insights from data spread across multiple systems are also common pain points.

Similar issues exist due to aged care providers’ inability to integrate with external parties. A 2020 study found discrepancies in 70% of residents’ medication records when comparing those held by the aged care provider with those of the resident’s GP. The elderly often have complex medical needs, requiring care from multiple institutions and healthcare professionals. As they move between these, having their data follow them is essential to ensuring positive care outcomes.

Esperanto for integration

When trying to solve these problems, the example of Esperanto is instructive. In the early decades of the 20th century, young revolutionaries from across Asia were struggling for national independence. They shared a common cause, but not a common language. Esperanto allowed thinkers and activists from Japan, China, India, and Vietnam among other places to come together and exchange ideas. Crucially, to converse with one another, each person would only need to learn one language, not four or five. And in choosing a purely constructed language, independent of the countries and politics of its speakers, dependence and dominance of any one nationality could be avoided.

Most aged care providers run dozens of applications, many of which need to exchange information. Unlike Esperantists, however, they often lack a common language. We can see that if we try to fully integrate just 8 systems by translating data from the language of one system into another, we require 36 translators — each one an adaptor that needs to be built by an integration engineer. By adopting a common data model — an Esperanto for integration — data in each system only needs to be translated into one, common format.

When talking about integration of systems between aged care providers and external parties — other aged care providers, GPs, hospitals etc. — the Esperanto analogue is the ‘interoperability standard’. In healthcare, the most notable of these is FHIR (pronounced ‘fire’ and short for Fast Healthcare Interoperability Resources). Used globally to allow the integration of electronic health records across systems and providers, it may form the basis of an interoperability standard for Australian aged care — an approach currently being taken by the Digital Health CRC’s ‘Aged Care Data Compare’ project.

Translators

The role of the translator in system integration is played by middleware, the ‘something in the middle’ acting as a hub between many applications. Common types of middleware include:

  • Enterprise service buses (ESBs).
  • Application programming interfaces (APIs).
  • Event streaming platforms.

Each of these have strengths and weaknesses, and different contexts will favour different solutions. Aged care providers just need to be mindful that something needs to sit in the middle and translate.

Sed mi ne parolas esperanton (but I don’t speak Esperanto)

Our choice of analogy forces us to address an obvious question: given that Esperanto has largely failed as a universal language, should we really be drawing inspiration from its example? Perhaps, though, even here we can find instruction. Theories about why Esperanto failed to realise its potential abound, but one factor is undoubtedly its lack of endorsement by any country’s government. The language commonly cited to have the largest number of native speakers is Mandarin Chinese. Mandarin has been the language of government in China in some form since the 14th century, undoubtedly contributing to its dominance today.

For integration projects to succeed on the industry level, government endorsement of standards — as in the aged care data compare project — will likely be crucial. At the provider level, endorsement from executives and senior leaders is equally important. Implementing and maintaining standards is as much a governance challenge as it is a technological one.

A small but important part

Esperanto is not the reason that the Asian independence movements of the 20th century succeeded. Neither will system integration be the principal solution to the problem of how to provide high quality, compassionate care for our elderly. It may, however, allow for the efficient and seamless distribution of information that carers need to support them in their roles — much in the same way that Esperanto did, all those years ago.


Kevin Fernandez leads the consulting business at Novigi, and is based in the Melbourne office.

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