One of the most significant requirements in providing high-quality care also is one of the most difficult to achieve — true interoperability between healthcare providers, systems, technology and the healthcare information each of these parties needs to achieve their respective goals. Interoperability is a problem throughout healthcare as disparate vendors, complex processes and clinical standards create tremendous barriers to delivering improved patient experiences and better patient care outcomes.
Rising costs, reduced Medicare reimbursements, increased pressure to improve the patient experience, and a shift to value-based care all mean that providers (and the entire healthcare industry) must move toward improved healthcare interoperability. Health information technology, those creating the information systems, other healthcare parties (including payers) and providers must be able to speak to one another to achieve an interoperable healthcare system.
Healthcare as a whole must take on these challenges, but there are several major hurdles in the way. Until these are addressed, interoperability in healthcare might remain little more than a high-browed talking point. Here, we examine the four primary challenges that those of us in healthcare face.
Currently, there is no consistent way of identifying a patient across the healthcare spectrum, throughout large healthcare systems or even across a network of providers. How are patients identified? By their name, date of birth, Social Security number, most commonly. The problem is that each instance of this information is stored in different ways in different systems meaning patient identification errors are possible.
According to many patient advocacy groups, one solution is the creation of a national, unique patient identifier. A patient identifier would be similar to an individual’s Social Security number in that it is theirs throughout their lifetimes and would be used at every point of care. The benefits of a patient identifier are that it would be a code that sorts, categorizes, and identifies an individual no matter what system or provider used. As in all things “political,” the efforts for moving such an effort forward seemed locked in a stalemate.
For years, organizations, including advocacy groups HIMSS and CHIME, have pushed for a national patient identifier. They reason that as health data exchanges continue to evolve, the need for a consistent, accurate way to identify patient health records is becoming more and more pressing. Thus, the lack of a nationally uniform patient identification system has resulted in increased healthcare facility costs, health data exchange inefficiencies and patient safety threats, among other pervasive problems.
The creation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) called for the creation of a unique patient identifier. Congress subsequently overruled this mandate because of patient privacy concerns. A highly vocal minority fear governments or industry will exploit patient data and that privacy might be even harder to protect if an identifier were to be used. However, without one, it’s challenging to link disparate data to obtain a comprehensive picture of anyone patient’s healthcare experiences. Thus, before industry-wide interoperability can become a reality, federal agencies will need to prioritize standardizing all aspects of patient health record exchange.
Currently, the healthcare technology offered by today’s vendors makes it difficult to simply copy or share information from one electronic health record software or other healthcare technology to another. Mismatched fonts, external data fields, and proprietary formats mean that data has to be manipulated and sanitized before it can be imported into another system.
The adoption and use of health data standards form the basis for enabling interoperability across organizations and between electronic health record systems. According to the Office of the National Coordinator (ONC), “standards are agreed-upon methods for connecting systems together. Standards may pertain to security, data transport, data format or structure, or the meanings of codes or terms.” With standards, health information exchanges, predictive analytics systems, and other information exchange efforts can be established, at least foundationally.
Throughout healthcare, a number of different standards development organizations (SDOs) create, define, update and maintain health data standards through collaborative processes that involve health IT users, but there is no single standard. With billions having been spent on EHR implementation, a health system must find more efficient ways to connect fragmented patient data, an effort that is increasingly relevant as the U.S. moves from a fee-for-service to a value-based health care system focusing on outcomes and populations. There is no interoperability standard. This lack of a common standard for capturing, transmitting, receiving, storing and managing patient data causes delays and inaccuracies – a major hurdle to interoperability efforts.
As the saying goes, you can’t improve what you can’t measure. Therefore, it’s difficult to quantify costs, error rate and other issues that are created when healthcare systems do not speak to each other in meaningful ways. Without the ability to measure, or track outcomes, health systems and other healthcare organizations can’t improve its most important processes and no true interoperability can be achieved.
The challenge faced by providers, their vendor partners and payers is the lack of a standardized way to measure the impact of interoperability delays and failure. Once providers can measure issues across the entire healthcare chain then they can begin to analyze any problem areas and make changes or even monitor how those changes can improve the quality of care and patient outcomes.
But, more than talk is needed. Data analytics has quickly become one of the most difficult undertakings for healthcare. Providers who are still trying to come to terms with managing and operating their electronic health records and are being asked to pull insights from the clinical data within the technology. For those organizations that can successfully integrate data-driven insights and bring them into their clinical and operational processes, the rewards are plentiful: Potentially healthier patients, lower costs, visibility into performance, and higher staff and patient satisfaction, among others.
Shared data in healthcare or, better said, a lack of shared data in healthcare is a problem. A major impediment to the healthcare interoperability is the practice of information blocking — by some EHR vendors. In the event that information is shared, some of these technology companies then charge fees for transmitting data outside the system.
While this practice is deeply disruptive to the flow of healthcare data, many vendors continue the practice despite new efforts to bring it to a closure. For example, Joel White, executive director of Health IT Now, a coalition of healthcare and technology companies, is calling for the publication of any regulation on information blocking, as required by the 21st Century Cures Act legislation. In an op-ed published recently in STAT, White wrote, “More than 600 days after the enactment of the Cures Act, not a single regulation has been issued on information blocking.”
Publishing the regulation falls at the feet of the Office of the National Coordinator for Health IT (ONC), which is tasked with carrying out specific duties that are required under the 21st Century Cures Act, signed into law in December 2016.
Core components of the legislation include encouraging interoperability of electronic health records and patient access to health data while discouraging information blocking. The law is receiving a great deal of positive attention because of its potential ability to free the lanes for true data interoperability.
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Action by the government encouraging interoperability is a significant move for healthcare — health organizations, patients and eventually vendors — not all of whom are yet on board – will have to take this on. The good news is that there is a great deal of movement toward interoperability despite the present lack of analytics, a universal patient identifier, and EHR foot-dragging in regard to the information sharing needed to reach interoperability.
In the near term, we’ll likely see the convergence toward some common standards, reductions in fees, aggregation of patient information and the ability to analyze and make use of data collected. At the local level, healthcare organizations and providers should make their improvements to enhance healthcare, resolve problems and lower costs for everyone, if able. Interoperability, however, remains a problem throughout healthcare as disparate vendors, processes, and standards create tremendous barriers to delivering improved patient experiences and better patient care outcomes. With some effort, though, interoperability can and will be achieved, but like all things, a good deal of energy is required.
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