- There’s no debate that achieving true interoperability in healthcare is a tall order. But current and emerging technologies — along with an overriding philosophy of openness where warranted — have healthcare organizations poised to deliver desired information to stakeholders of all sizes and capabilities.
“We’re trying to wire up the largest industry on earth, and it’s still a cottage industry with a lot of endpoints out there. Those endpoints range from high-tech — a big, multi-physician, multi-specialty practice on a modern EHR — to home health, which is still largely undigitized,” explained Nancy Ham, CEO of population health management firm Medicity.
In certain situations, lack of technical interoperability causes real business pain. For example, participants in accountable care organizations (ACOs) suffer from the high cost of even marginal interoperability among different EHR systems that may be used by different entities within a payment model, according to Tom Lee, CEO and founder of pay-for-performance automation firm SA Ignite. “CMS didn’t even provide a way for ACO quality measures to be reported electronically,” said Lee. “It basically has to be done through custom queries and data abstraction. If I have 10 different EHRs and I’m given a list of a couple hundred patients from CMS, those patients’ data could be fragmented on all 10 EHRs.”
Nonetheless, forward progress has been made via the meaningful use (MU) program, which has dramatically driven EHR adoption across healthcare over the past five years. Certain aspects of meaningful use place financial incentives or penalties in line with achieving interoperability. And, assuming MU continues on its staged path, optional measures will be supplanted by mandatory requirements over time.
The question for consideration is whether interoperability will be able to keep pace.
One practical way to examine the status of healthcare interoperability is to start with internal systems and look outward.
“When you look at all of the effort that goes into providing great patient care, if you don’t have systems that support interoperability — that don’t give providers access to accurate information quickly using interoperable systems — it’s amazing how fast the quality of care degrades,” observed Matthew Hawkins (pictured left), president of Sunquest Information Systems, which develops software to automate the operations of laboratory and diagnostic processes.
“I think the industry ought to start ranking systems on their openness and have that be a vendor-selection criterion,” added Hawkins. “It’s not just software-to-software openness. It’s not just EHR-to-EHR openness. It’s not just EHR-to-laboratory-information-system openness. It’s being able to move data — making it more liquid from the lab, or even from a lab instrument that does the analysis — back to the lab software to the EHR or to the health information exchange, and ultimately to the patient.”
In today’s environment, rigid approaches do not necessarily help create effective, safe and productive workflows for clinicians, noted Bruno Bendavid, co-founder and senior vice president of product management at PeriGen, a provider of fetal monitoring solutions.
“On the administrative side the hospital needs to ensure that things like user management, authentication and long-term storage are all part of a single, concerted approach to help the hospital meet its regulatory obligations,” said Bendavid (pictured). “On the flipside, on the clinical front, there is a slightly different objective. There’s a need to establish the workflow, and make sure the workflow is effective. For instance, does it really reduce errors? Does it help make sure the data is correct? Does it help the nurse or physician reduce the time spent on the computer? Flexibility is the name of the game in order to meet all of these requirements.”
Real-world benefits and the road ahead
Looking more broadly over the spectrum of healthcare, the aspect of interoperability that may have the greatest long-term impact is health information exchange.
“To empower population health, you have to connect across the entire clinical community — everywhere the patient goes, from long-term post-acute care to skilled nursing to home health,” said Ham (pictured). “Patient information must be truly ubiquitous. It’s really important for the 5 percent of patients who drive 40 percent of healthcare costs. They typically have many co-morbidities. They have five to 10 doctors, five to 10 medications, and they have many encounters all over the system. We’ve really expanded from a narrow pie slice of the community to going across the whole community.”
An example: A five-hospital healthcare system standardized on a single EHR platform needs to provide data to clinics in the community that don’t share that EHR. By changing its discharge workflow, the health system can now send continuity-of-care documents over a network connection to the clinics. As a result, the clinics can perform medication reconciliation when the patient arrives. “That’s a really important clinical task that has often been a challenge because it’s been hard to get all that information,” said Ham.
Bendavid sees additional opportunities for advancement through mobile-enabled solutions. “Very soon, mobility will be a ‘must-have’ in vendors’ platforms. Users are expecting systems to be more mobile-friendly with more intuitive, easy-to-use interfaces. The way things look and operate is going to be a big advantage to vendors investing in the design of their systems,” he continued. “We’re also seeing more and more cloud-based technologies serving real respectable systems in the market, and I think that trend will only grow.”
Lee (pictured) expects patients to be the vital piece of the interoperability push, just over the immediate horizon. “The patient and the payer are probably the only two players in this entire scenario that have a real stake in sharing data across provider organizations,” he explained. “However, payers are not going to share their data with competing payers, so they’re limited. At the end of the day, the patient has to have complete incentive, unconflicted, to enable interoperability. The question becomes, can the patient become a vector for interoperability?”
In the meantime, providers should examine interoperability with an eye toward “safety nets,” as described by Bendavid. “The complex systems that are sending data back and forth need to have real-time tools that will tell you when you are wrong, when you are out of range or when you have specific clinical events that can complement the EMR or provide you with a notification that something has happened.”
Hawkins summarized interoperability’s prognosis: “When you think about the real important variables in healthcare today, they are time, cost and patient safety. In other words, it comes down to accurate diagnosis.”
Ham added, “I couldn’t be more excited about where I think we’re going as an industry. I think we’re moving from data exchange — which is important in and of itself — to recognizing what can be done by creating strategic data assets. As we create these increasingly interconnected networks, as we bring together all these new data types — clinical data, plus claims data, plus socio-economic data — we’re really igniting new insights that we’ve never had before.”