In recent weeks, participation in interoperability initiatives has been growing from different constituencies within the healthcare industry. Most striking has been an influx of interest from groups that have not been at the table before, such as professional groups and the pharmaceutical industry.
Input and assistance by provider organizations gives added impetus to ongoing efforts of standards groups, hospital information system vendors and a few select provider organizations that have taken on interoperability as a mission.
These new participants in the interoperability movement say changes in reimbursement approaches are driving the new interest. Value-based care is a key component of the Department of Health and Human Services to rein in healthcare costs. HHS has set a goal of tying 30 percent of traditional, or fee-for-service, Medicare payments to quality or value through alternative payment models, such as Accountable Care Organizations (ACOs) or bundled payment arrangements by the end of 2016, and tying 50 percent of payments to these models by the end of 2018.
These new models will put new pressure on providers to coordinate care, and with the increasing use of electronic health records systems, the need for these systems to share information easily and without human intervention will grow significantly.
The continuing pressure of the Meaningful Use program also is compelling provider participation, says Stephen Hasley, MD, who is assuming the role of CMIO at the American College of Obstetrics and Gynecology (ACOG), and recently attended an interoperability strategy meeting convened by Health Level Seven.
“There’s a huge clinical need right now,” Hasley says. “Providers need to merge Meaningful Use Stage 3, as it’s designed, with the new pay for quality and [accountable care] models of healthcare delivery. It will require some significant restructuring of how healthcare is delivered, and that is going to be based on data. To get that data, both in the aggregate for analysis and at the point of care for the physician, we need interoperability.”
The HL7 meeting in Chicago included participation and support from the American Medical Association and representatives from several medical societies, including Hasley. “The leadership of professional societies is recognizing that, to have their constituents be successful in these new models, they need to have a seat at the table when these EHR architectural decisions get made,” he said. “We’ve woken up to see that this is how we’re going to take care of patients.”
Professional organizations also are making commitments to improve quality, and that will require vastly improved interoperability. For example, ACOG plans to create a national registry for maternal quality, and information derived from analysis of the registry can help smaller providers improve the quality of care they provide.
“One of the promises of EHRs is their ability to exchange data fluidly,” says Janet Campbell, vice president of patient engagement for Epic.”The AMA and [American Hospital Association] are looking forward to an ecosystem that makes that happen. Installing an EHR is the first step toward interoperability, but it’s not the last piece. They can see where they can start to accelerate that process by their involvement.”
Support of medical organizations will be crucial to continuing the push for interoperability, says Andrew Truscott, managing director of clinical services for Accenture, a consulting company. “You’re more successful in these efforts when you have the medical societies behind you,” he says.
The strategy meeting in Chicago provided some clear guidance for HL7 on what it can do to move interoperability forward, Truscott says. For example, it highlighted the need for the Ann Arbor, Mich.-based standards organization to develop implementation guides and use cases to guide the use of FHIR, its emerging standard for information exchange.
Truscott noted that many leading vendors in the industry provide support to HL7 and the interoperability effort to move it forward. “They’re all competitive, but we all come together to work on this, because we do realize that it’s important.”
“If everybody takes a step back and thinks about themselves as patients, or a being a family member of a patient, you realize what’s needed with this,” says Andrew Wiesenthal, a director for Deloitte Consulting, who also was at the HL7 meeting. “You want to feel confident about EHR systems and feel the support of a system to do things safely and correctly. The public understands that if they have that expectation, there shouldn’t be any technical barriers to this, and they’re starting to push this on their doctors; that will turn the tide [for interoperability].”
There's also Interest growing from pharmaceutical industry leaders in interoperability. HL7 recently held an informal meeting with some pharmaceutical industry leaders to discuss the potential for interoperability within that sector. Capabilities provided by FHIR have the potential to change how clinical trials are conducted, HL7 says.
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