- More recently the national conversation about healthcare interoperability has shifted away from the means of enabling health data exchange to the motivations behind needing to share information.
“If we’re not solving a real business problem, a real clinical care problem, a real need that our clinicians and patients have, we can have the best technology in the world and it will go nowhere,” Rich Elmore, Senior Vice President of Corporate Development and Strategy at Allscripts, told HealthITInteroperability.com.
This month, the Chicago-based EHR company published a framework for achieving true interoperability that aligns with the HIMSS Analytics Care Continuity Maturity Model, with the ultimately level being the ability to support precision medicine.
According to Elmore, a significant gap still exists between the capabilities of current health IT systems and services and those necessary for personalized patient care. Despite the progress made by private endeavors such as the Argonaut Project or federal initiatives such as the EHR Incentive Programs or the Quality Payment Program, true interoperability is not yet tangible.
“It’s still a Tower of Babel,” he said of today’s health IT. “Inside these systems, it’s different. Even though there are standards for exchange, the ability to rely on that information is not yet mature enough for clinicians to make determinations based on all these different sourced coming into me directly.”
“They’ve got to get that same information in a way that they can get a holistic view of the patient,” he continued, “and then they need to be able to see that community view tied into their local EHR view where they are doing their work.”
As a member of the Health IT Standards Committee and co-chair of the 2017 Interoperability Standards Advisory Task Force, Elmore has a realistic view of the work thus far toward achieving semantic interoperability. “That is only going so far and the level of maturity there is not getting you to the point where you can do updates and a bunch of the other things we know ultimately will be needed in this world,” he added.
While the healthcare industry is still short of reaching the goal, a vision of that goal has crystallized.
“You need to be able to understand the whole patient across settings of care, normalize that information so that it’s comparable, have access to that information at the point of care in a way that is in the provider’s workflow, and do dynamic care planning with a care team that’s broader than what’s in any one organization,” Elmore explained.
For its part, Allscripts began work on opening up its EHR technology more than a year ago with the hopes of fostering innovation and supporting use cases for health data analytics, work should prove instrumental moving forward. The work relies on the use of application programming interfaces (APIs) to give health IT developers the means to work with Allscripts EHR technology.
“We have built industrial-strength infrastructure and APIs tied back to our EHRs that are giving us the foundation to adapt to an open standards interface that is going to open up the app community that heretofore has been really closed off to most of the health IT technology providers,” Elmore said. “It makes for greater, more rapid innovation. It provides a foundation for new ways of thinking about interoperability and exchange that will be different, meaningful, more timely, better able to scale, and more open.”
The challenge ahead for EHR companies such as Allscripts is communicating to end-users the ability of their technologies to support use cases. The latter, however, depend upon regulatory and financial drivers that will force providers to change their behavior relative to information sharing.
“We are not the drivers of that. We are the enablers of that change. But it has to start with that clinical care, quality, or financial problem squarely in mind and with a compelling need to do something about it,” Elmore explained. “There are other competing issues. Organizations competing with each other in the absence of those drivers being serious enough have competing interests not to exchange information.”
Elmore’s comments echo those made by contributors to Xtelligent Media’s Value-Based Care Summit such as Massachusetts eHealth Collaborative President & CEO Micky Tripathi.
“Anyone who starts with technology, I guarantee, is going to be a failure,” he told attendees last week. “In order to succeed generally, you have to start with what it is you want to accomplish — which has nothing to do with the technology, but it’s got to do with what are the goals that you have at the end of the day.”
In other words, the means are only so useful as the ends they help reach.