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Emerging pressures on healthcare fuel need for true interoperability

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A variety of pressures have caused the health information technology industry to settle for easy information exchange that mucks up workflow and doesn’t improve care coordination. It’s time to aim higher.

The healthcare IT industry is quick to latch onto buzz words, and after a while, we glibly use them in conversation with little regard for nuances in meaning. Interoperable is definitely one of those words. It speaks of the ability for a provider to use an information system to seamlessly share data with other providers’ information systems.

There used to be a more discrete line in the sand between interoperability and information exchange. Both have been a challenge to achieve, anyway, so what’s the difference if we play a little fast and loose with those definitions?

A lot, some healthcare IT executives believe.

In the minds of many, we’re settling for clunky information exchange when we desperately need to be aiming higher, for true interoperability. At this point in time, it’s crucial for the healthcare industry, and country, to really understand the terms, believes Chuck Christian, who’s dedicated years of service to HIT as a CIO, leader in professional associations, and now as vice president of technology and engagement at the Indiana Health Information Exchange.

For Christian and other HIT executives, the nuances separating interoperability from information exchange make a difference, because providers will face new data requirements for accountable care organizations and population health management. Those new reimbursement models require a more global view of the member populations, quickly and completely sharing where members received care, what care they received, and more. That information needs to be easily integrated into providers’ workflows, so they have access to important information when and where they need it.

That level of interoperability is not widely achievable today. The Meaningful Use program helped push providers to implement electronic health records systems that technically can exchange information, but it also fostered a “check the box” mentality that allows MU-stressed providers to settle for limited approaches for information exchange, which concerns Christian and others in the industry. These now almost serve as barriers to a more functional environment of data interoperation.

Right now, current approaches for information exchange use a “look up” system for finding patient information across providers. To help me understand this, Christian used this overly simplified example to explain it: A vendor system (or systems of vendors that belong to a collaborative) looks in a virtual “phone book” to see if a patient has received services in any of the facilities that are listed within that book. If the patient has received services and the clinicians get a hit, they see a link enabling them to pull a record in the Consolidated Clinical Document Architecture (CCDA) standard from the other facility. If the patient has received treatment at multiple locations, clinicians will be presented with multiple links and will have to look at each CCDA record separately. After the review, it’s up to clinicians as to whether to include the information from each link into the current electronic record.

Unfortunately, the information that can be included from that CCDA is small, limited to only problems, allergies, medications and immunizations. Other sections of the CCDA can’t be included.

While providing clinicians with more information than they otherwise would have had, the issue is that the process takes them out of their normal workflow and adds to the work they have to do. Due to the hectic pace of care delivery today, many clinicians opt not to search out or include CCDA information in the EHR they’re working on.

The true interoperability that’s needed is the use of technology that can pull data from multiple locations, combine it in a normalized fashion and then have it be usable by clinicians without a great deal of effort or thought.

Interoperability claims abound, but the industry has a ways to go to achieve true interoperability.

Interoperability claims abound, but the industry has a ways to go to achieve true interoperability. Vendors say their systems allow information to be exchanged with providers using the same systems, but that doesn’t facilitate exchange between different vendor systems. There are frameworks, like eHealth Exchange and Carequality, which are not really technologies, but are legal agreements on how data will be moved or shared. Then, there are community, regional or state information exchange organizations, which each have their own “flavor” – they don’t all do the same thing, work the same way or serve similar service areas.

HL7’s FHIR standard will help a bit, but current development is limited to improving the ability to access information; it won’t help in determining where a patient has received care unless it’s paired with some kind of locator service that can be queried. Other questions still remain for FHIR, such as how long searches could take using FHIR, and how data will be presented and normalized.

Interoperability is a moonshot challenge for the country, which must not settle for a “lowest common denominator” approach that will only provide minimal information exchange capabilities.

Draft legislation released last week by the Senate Committee on Health, Education, Labor & Pensions (HELP) appears to be taking this challenge on. The panel is seeking feedback on a staff discussion draft to improve health information technology, including EHRs. Tucked away in the bipartisan legislation is an effort to identify one trusted framework for data exchange and interoperability.

Christian’s hope is that this is not just an exercise in creating yet another framework, but a call for the industry to “pick one that will work the best and then christen it as the platform of choice. I’m thinking that this will be one of the best approaches that I’ve heard of.”

There’s often a quick reaction against the notion of having standards imposed on the healthcare industry, but if providers are going to have the infrastructure in place to cope with value-based care—especially as it comes upon them rapidly and from all payers—it’s time to dream big and aim high, at true interoperability. Settling for less just won’t help providers cope with the new incentives of value-based care.

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