9 crucial steps for achieving and capitalizing on data exchange
Interoperability in healthcare will play a crucial role in improving delivery and achieving the benefits of healthcare reform, as well as enabling healthcare information technology to achieve a return on the billions of dollars that’s been invested by the federal government and providers. An interoperability discussion paper, written by a select group of HIT experts for the National Academy of Medicine, also will serve as a roadmap for the next administration, identifying future directions for healthcare IT policy.

The paper’s topic is one of 19 priority areas of focus covered in NAM’s series entitled “Vital Directions for Health and Health Care” initiative, intended to provide guidance to the next administration on how to achieve progress in healthcare delivery and improve the health of the nation. This feature describes the nine action points described in the discussion paper.
Thought leaders in HIT
A panel of healthcare information technology luminaries participated in the interoperability research, including:

Dixie Baker, security expert with Martin, Blanck and Associates
David J. Brailer, MD, president of Health Evolution Partners and the first national coordinator of the Office of the National Coordinator for Health Information Technology
Douglas Fridsma, MD, president of the American Medical Informatics Association
Mark Frisse, MD, Accenture Professor of Biomedical Informatics and Vice Chair of Business Development, Vanderbilt University
John Halamka, MD, CIO at Beth Israel Deaconess Medical Center
Jeffrey Levi, Professor of Health Management and Policy , The George Washington University
Kenneth Mandl, MD, Professor of Biomedical Informatics and Pediatrics, Harvard Medical School and Boston Children’s Hospital
Janet Marchibroda, director of the Health Innovation Initiative at Bipartisan Policy Center
Jonathan Perlin, MD, president of clinical services and chief medical officer, HCA
Richard Platt, MD, Professor and Chair of the Department of Population Medicine, Harvard Medical School
Paul Tang, MD, chief health transformation officer, IBM Watson Health
Setting data standards and achieving interoperability at scale
While efforts are underway in pursuit of interoperability, they need to be broadened dramatically, the paper notes. “Data standards are necessary but not sufficient for interoperability. Supporting infrastructure, policies, and incentives to share data are the rate-limiting elements,” it states. Meaningful Use policies have not done enough to push interoperability—“If future federal programs focus on enabling infrastructure, creating trust, and streamlining heterogeneous policies, barriers will be reduced and stakeholders will exchange data that support high-value use cases, such as transitions of care, outcomes measurement, and public-health reporting.”
Integrating interoperability with consumer health technology
Healthcare organizations have traditionally used IT to facilitate internal purposes. Now, as consumers increasingly use digital devices for health purposes, organizations will need to achieve interoperability to take in consumers’ data. “Initially, steps should be taken to ensure that devices at all levels of product maturity are given common data-transmission standards that address public concern about privacy and the market need for effective communication,” the paper says. “As new technical innovations and care models become more mature, they should adhere to interoperability standards adopted in hospitals and ambulatory care settings.”
Improving patient identification and matching to support interoperability
While there’s traditionally been opposition to a national system for patient identification, the development of a system to ensure foolproof matching of patients to records is critical, the writers say. “Increasing the level of information-sharing—supported by the interoperability of systems—requires substantially improved methods for accurately identifying patients and matching their records throughout the health care system,” it states. “The need for a national strategy for identification and matching has become more urgent in light of the increasingly digitized state of the US healthcare system and the substantial increase in demands and policies for accelerating electronic information-sharing.” Congress needs to step in and authorize the Department of Health and Human Services “to adopt and promulgate standards for patient identification and matching.”
Using service-oriented architectures and web-based services
Current EHR systems are dated—many were designed before the advent of the Internet, and had a purpose of maximizing reimbursement and meeting certification requirements. “Realizing a return on the substantial investment in EHRs means unlocking the point of care and opening it up to modern, Web-based software applications, local intranets, and mobile devices and fitting EHRs into a dynamic, state-of-the-art, rapidly evolving information infrastructure,” the paper contends.
Enfranchising vulnerable populations and improving care for chronic disease
“Applying society’s resources in the most effective and cost-effective ways requires a global, data-based view of personal and population health,” the paper’s authors wrote. “With the opening of federal data sources and the data available through the Internet of Things, the opportunity for learning and improvement is more a matter of making sense of the data than of their availability. The most potent lever for data sharing and use of data for supporting vulnerable populations and individuals is the alignment of incentives for this purpose… As the country orients toward alternative payment models, measuring individual health outcomes and disparities among vulnerable populations is crucial for driving innovation toward outcomes.”
Using interoperability to enable the use of health data in public health
“Critically important data on the health of a community are often held in the EHRs of health systems and are not accessible to public-health agencies,” the paper contends. “Public health is community-based, and legal barriers can prevent sharing across jurisdictional lines. New approaches to collaboration regarding data collection, sharing and analysis will be critical in advancing the general health of a community. That includes a much more profound ability to collect or analyze data than the current capacity of most health departments.

“Advances in surveillance and epidemiology functions and widespread use of de-identified EHR data for population surveillance would bring a deeper understanding of the health needs of communities and the nation and allow better targeting and alignment of healthcare and public health dollars to focus on prevention and response,” the writers conclude.
Accelerating the use of aggregated health information and research
“Routinely collected health information, including EHR and claims data, has great potential for secondary use to support observational and interventional research and to inform policy,” the writers say. “New policies are needed to encourage the voluntary participation of the public and data holders in national research programs. These include incentives to participate and protections against uses of data in ways that threaten individual privacy or that disadvantage data holders.” The paper suggests continuing progress in creating large-scale distributed data systems, as well as the development of advanced methods for analyzing distributed data.
Building an HIT workforce
“The workforce of our 21st century healthcare system—awash in data and fundamentally transformed by IT and ‘big data’ analytics—must develop a competence beyond the mechanics of HIT and health information management,” the paper says. “Clinicians and other healthcare workers themselves must become drivers of the ‘learning healthcare system.’ To realize fully the value of HIT and data-driven clinical decision-making, we need an educated workforce that understands how to collect and locate, analyze, and use information for health and healthcare.”
Creating a trust fabric for health services—privacy and security
Healthcare organizations have viewed information privacy and security as federal requirements and not “business imperatives for enabling high-quality care,” the paper notes. But that must change to ensure protection for data in a more interoperable system. “The shift reflects a growing awareness of the need to create a ‘trust fabric’ of trustworthy, defensible, and survivable health systems while enabling the sharing necessary for patient safety, high-quality care, population health and biomedical knowledge advancement,” writers say. And creating a more secure infrastructure will reduce the number of breaches and likely drive down the overall costs of mitigating incidents..
Main conclusions from the report
In sum, the report suggests three “vital directions” to achieve progress on interoperability:
1. Commit to end-to-end interoperabiliy extending from devices to EHR systems.
2. Aggressively address cyber-security vulnerability.
3. Develop a data strategy that supports a learning health system.
For more information
The discussion paper can be found here.