Interoperability critical to value-based care, but solutions fall short
While healthcare organizations universally agree that health IT interoperability is critical to successfully transition to value-based care, the vast majority of organizations say current interoperability solutions in the market are not meeting their needs as the industry moves away from fee-for-service approaches.
Those are among the findings of a new survey of 125 respondents—75 percent of whom were executive IT or clinical leaders—conducted by the eHealth Initiative. The results were presented during a December 20 webinar, providing a snapshot of the state of interoperability in healthcare.
Although 95 percent of those surveyed agree that strong interoperability capabilities are a key IT requirement for a successful transition to value-based care, 85 percent also agree that current interoperability solutions in the market are not meeting their needs.
Jennifer Covich, eHealth Initiative’s chief executive officer, said overall dissatisfaction with available vendors’ interoperability solutions is “clearly a sign of opportunity,” as organizations “aren’t necessarily seeing the return on investment in their systems.”
“It’s a sober reflection of the dynamic environment,” says Jon Zimmerman, vice president and general manager of clinical business solutions at GE Healthcare Digital. “We’ve got to go do some more work together to figure out what will fit and what will make a difference.”
Christopher Ross, chief information officer of the Mayo Clinic, says “there are no excuses” and “we should all get at it.” But, at the same time, he emphasized that the challenges of interoperability require a lot of focus and coordination on the part of healthcare stakeholders.
“I think we should be cognizant of the difficulty of what’s involved in providing technology to support value-based care,” added Ross. “It’s a big job.”
Data sharing is seen as critical to quality improvement and care coordination. Organizations not only need a strong IT infrastructure but the ability to exchange health data across the healthcare continuum. According to Covich, survey respondents indicated that the value of interoperability for them is dependent on the type of information that is exchanged between organizations. In fact, if they could have access to lab results, orders and tests that are readily available, easy to locate, integrated into clinician workflow and also drive significant practice outcomes, 49 percent of those surveyed said they would be willing to pay a premium for this capability.
When it comes to connectivity, Covich said the area that was most important to respondents was interoperability across providers—the exchange of information that gathers data from electronic health records from different provider organizations to support a holistic view of the patient and accountable care collaboration.
“It’s clear that access to lab tests and results are really important and that providers and respondents expect it to be included in core platforms, as well as connectivity across provider organizations,” she added. At the same time, Covich added that “being able to exchange data for regulatory reporting and research purposes is just not a priority for organizations right now.”
The good news, based on the survey results, is that when those surveyed were asked to rate their current interoperability solutions’ ability to drive value-based care outcomes, nearly 64 percent indicated that there was some value-add and that interoperability is driving some benefits. Yet, almost 21 percent said they “have the basics” but that “interoperability is not driving outcomes.”
Still, 75 percent of respondents agree that since 2008, technology has helped increase healthcare quality, and 68 percent agree that technology has helped promote team-based care concepts. However, 42 percent disagree with the statement that since 2008 technology has helped decrease healthcare costs.
Responding to the fact that the majority of those surveyed did not feel interoperability was decreasing costs for their organizations, Ross noted that “generally speaking, it’s been hard to find cost reduction trends in healthcare in the last eight years.” Nonetheless, he said that, “to some degree, interoperability or technology specifically probably has decreased healthcare costs, but we just haven’t seen that much—at least not the kind of reportability that we’re all aspiring to in the Triple Aim.”
In addition, many of those surveyed expect their IT budgets to increase in the coming years. Some 41 percent expect to spend more than $100,000 over the year or two on interoperability, while 22 percent are looking to pay $500,000 over next three years on interoperability.
As for the regulatory environment, 60 percent of respondents do not believe current federal policies, committees and regulations are sufficient to help the nation attain interoperability by 2020. At the same time, 69 percent agree that additional federal incentives need to be created or redesigned to enable delivery system transformation.
For his part, Ross believes it is a fair critique of the Meaningful Use program to conclude that these policies were not sufficient to achieve true interoperability. “I was part of the Health IT Standards Committee, and so I bear some of the blame and whatever credit there is,” he said. “I don’t think we finished the job. I think there’s a lot more to be done to improve the policies and regulations to get there.”
Further, according to the survey results, 60 percent of those surveyed do not believe providers clearly understand which clinical information can be legally shared with other providers and payers. “This is just another point to the fact that there is still a lot of confusion about HIPAA and what can be shared and what shouldn’t be shared,” concluded Covich.