A quick Internet search will turn up a variety of national, state, public and private initiatives focused on setting data standards, streamlining data exchange, improving health care I.T. systems and a host of electronic best practices. Each of these efforts is laudable, very needed and offers a step in the right direction. Yet, until they seamlessly interconnect with one another or enable health care stakeholder system interoperability, true national health I.T. will remain elusive.
Interoperability requires creating and adopting a universal set of health I.T. business rules that allow for consistent, reliable data exchange among physicians, health plans, pharmacies, hospitals and other health care entities — regardless of technology. Or, to put it another way, it requires agreement. Building consensus among all of the stakeholders with an interest in such information transactions is no easy task. Industry collaboration is the key.
Collaboration Works
True collaboration and cooperative partnerships between private- and public-sector stakeholders is the fastest path to practical, win-win solutions for everyone involved in delivering or receiving quality care. As executive director of CAQH, a nonprofit alliance of health plans and trade associations, I’ve been fortunate to see first hand the mutual benefits that collaboration can bring.
CAQH has brought together more than 100 of the country’s largest heath plans, provider groups, associations, regional entities, standard-setting organizations, government agencies and technology companies to collaborate on developing a standard set of operating rules that dramatically improve administrative data exchange between providers and health plans. This initiative is called the Committee on Operating Rules for Information Exchange (CORE). By working together, CORE participants are creating an all-payer approach that enables provider access to consistent insurance information before or at the time of service using the electronic system of their choice.
Participants in a multi-stakeholder process, such as CORE, are more willing to implement standards that they have had a voice in shaping. They are also more likely to promote these standards to their trading partners, increasing the impact in the process.
For example, Aetna became certified on the CORE rules in early 2007. By the end of the year, the insurer began requiring all of its administrative data-exchange business partners to become CORE-certified, furthering the value of the rules to the industry. It is reasonable to assume that Aetna’s partners will now introduce their other trading partners to CORE, expanding the reach even further.
Driving Widespread Value
Collaboration by a broad, diverse group also increases the likelihood that CORE’s work will produce outcomes valuable to the entire industry. After reviewing the rules created during CORE’s first phase of work, the Healthcare Information Technology Standards Panel included the CORE eligibility data content section in its Consumer Empowerment specifications recommendation to the U. S. Department of Health and Human Services.
HITSP is working to achieve a widely accepted and useful set of standards specifically to enable and support widespread interoperability among health care software applications. HHS recognized the HITSP Consumer Empowerment specifications this past January.
By replacing the “if you build it they will come” mentality, with a “if you involve them, they will build it” philosophy, the industry can sustain this critical momentum. Interoperability, more efficient systems, streamlined administration, faster communication and the better quality of care that they make possible will be the reward for our collaboration.
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