Interoperability consensus – the pipes are built; data CAN flow.  

Easier data exchange can help solve major pain points for healthcare organizations, and that will sustain momentum, say presenters at the HDM KLASroom.

Interoperability has always seemed like a long distant goal, but the reality appears now that all the technology pieces are in place to make it a reality. 

Two major hurdles remain – bringing those pieces together into a finely integrated picture, and having clinicians find ways to utilize it to solve their day-to-day data access problems. 

Facilitating the exchange of clinical information was the theme of this week’s HDM KLASroom, which focused on using data to strengthen the clinician-patient relationship. In addition to improving care, interoperability-aided data access has the potential to lighten clinicians’ burdens and give them the tools to improve the care they provide, presenters said on Wednesday. 

The pipes are in place 

Interoperability has come a long way in the past 15 years, noted Steven Lane, MD, clinical informatics director for privacy, security and interoperability at Sutter Health. Early efforts used standards to move data between partners, but now standards such as the Fast Healthcare Interoperability Resource (FHIR) and APIs can support exchange between providers, payers and patients. 

Dr Steven Lane, of Sutter Health with Coray Tate (KLAS Research and Mitchell Josephson (HDM)

The recently finalized Trusted Exchange Framework and Common Agreement (TEFCA) is the latest impetus to advance interoperability in healthcare, Lane noted. “TEFCA is meant to bring all of that together. There’s a long way to go because there’s a diversity of solutions. TEFCA is trying to bring it into a more logical and coordinated framework.” 

Electronic health records systems have boatloads of patient data and have the capacity to share it when and where needed, but clinicians have not yet adapted to this expanded access, said Corey Tate, vice president for core solutions and interoperability at KLAS Research. “A lot of organizations are living below their privilege,” he contended. “Data is not perfect yet, and it’s not as consumable as it needs to be. The money question is does it have an impact.” 

The problem is complex, hinging on the usability of the data, Lane suggested. “The real problem is bringing the data into workflow. You don’t want to think about it as being local data versus outside data; that’s an artificial barrier. The challenge is to bring all the data together with standards and mapping.” 

The ability to bring the data together also is important so that it can be analyzed, both for patients and populations, Lane contends. Better information exchange can get at the root of problems that have vexed healthcare for years, particularly ensuring continuity of care as patients move from one care site to another. “The real brass ring is being able to achieve ongoing care coordination,” he added. 

Coray Tate of KLAS Research with Dr Stephen Lane (Sutter Health) and Mitchell Josephson (HDM)

The decade of interoperability 

Presenters at the HDM KLASroom acknowledged the challenges that achieving interoperability poses, but note that IT leaders can fall back to a tried-and-true formula for building momentum – get clinicians excited. 

Chris Emper of NextGen Healthcare with Muhammad Chebli (NextGen Healthcare) and Mitchell Josephson (HDM)

One key to success is simply starting the process, said Tate of KLAS. “The thing that jumps out at me (from research) is that the most important thing is to start. There’s a definite learning curve.” 

Lane urged leaders to “look inward – what are your pain points? Where is your system wasting money? Is it prior authorization, documentation, getting imaging files. The easiest things to implement is in areas where you’re solving somebody’s problems. That’s where you get your champions.” And he emphasized that taking full advantage of interoperability involves enlisting champions from the clinical, administrative and technology teams. 

“There is real value in crossing this river and getting to the other side,” he added. Early on, healthcare organizations had to investing in computerized billing systems; then, they were incentivized to digitize clinical systems, which has largely occurred over the last decade. “This is the decade to invest in interoperability,” Lane concluded. 

TEFCA and other recent federal rules show that the federal government is serious about getting electronic data flowing among providers, payers and consumers, said Chris Emper, government affairs advisor for NextGen Healthcare. 

The 21st Century Cures Act is intended to prod the industry to make progress on interoperability, Emper noted. Information blocking provisions set requirements for not impeding access to clinical information; API-enabled apps intend to facilitate patients’ access to their information; and TEFCA provides a common approach for getting the nation’s health information networks to connect and channel data. 

Participation in TEFCA is voluntary now, and aimed at larger health information exchange organizations, and as such does not directly affect provider organizations, said Muhammad Chebli, vice president of solutions for NextGen Healthcare. “But TEFCA is an easier on-ramp – it offers a single pipe to give access to a broader set of providers. It promises a simplified interoperability process that will shift more of the connectivity burden to (Qualified Health Information Networks).” 

Mohammad Chebli of NextGen Healthcare with Chris Emper (NextGen Healthcare) and Mitchell Josephson (HDM)

Making it work 

Improving information exchange for clinicians is challenging because programs that incentivized implementation of EHRs didn’t emphasize interoperability, said Lisa Bari, CEO of Civitas Networks for Health, a nationwide organization that represents health information exchanges. 

“Now, we’re retrofitting systems with FHIR to enable standards-based exchange of data,” she said. 

But examples of the promise of information exchange are growing, said David Kendrick, MD, CEO of MyHealth Access Network, an Oklahoma-based network that links more than 4,000 providers and their patients in a community-wide health information system. 

Kendrick’s organization is promoting the notion of a patient-centered data home, which “is not too dissimilar from the patient-centered medical home (PCMH),” he said. With a PCMH, one organization bears the responsibility for knowing the totality of a patient’s care. With a patient-centered data home, there would be one centralized repository for a patient’s information, no matter where care was provided or where that patient was in the U.S. 

Dr David Kendrick of MyHealth Access Network with Lisa Bari (Civitas Networks for Health)

Such an approach would be “governance respecting and privacy respecting,” Bari added. Civitas is working now to conceptualize the idea and modernize networks to accomplish it. “The effort is underway right now, we want to bring the patient-centered data home into this current decade and make it more useful for providers.” 

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