Interoperability, which allows disparate technology systems to communicate openly, could easily be called the secret sauce for successful value-based care models. But as we approach the era of value-based care, the industry needs to think beyond EHR interoperability. Interoperability for telehealth—a critical part of the care delivery system of the future—must be top of mind.
The healthcare industry is moving into an age where quality, efficiency and positive outcomes outpace volume in importance; being able to exchange data easily and securely is front and center. However, healthcare systems and stakeholders still use multiple technology systems that, by and large, don’t communicate well. This wastes a lot of resources, puts patient safety at risk and hinders the progress of medicine—especially for the many healthcare providers entering into shared-risk groups, such as Accountable Care Organizations.
The 21st Century Cures Act, signed into law in December 2016, emphasizes the urgency around open communication, calling for greater interoperability among EHRs, while discouraging information blocking.
Although a greater number of organizations are sharing information while using disparate EHRs, thanks to the emergence of standards like HL7, we have a long way to go before healthcare isn’t hindered by a lack of interoperability.
There is no greater example of this than with telehealth, which makes it possible for remote patients and skilled physicians to interact in a timely and convenient manner.
Because it facilitates efficient, cost-effective healthcare delivery, patient engagement and preventive medicine, telehealth is poised to be a game changer in value-based care. Unfortunately, the vast majority of EHRs, whether on-site systems or cloud-based solutions, operate separately from telehealth systems, with limited flexibility or opportunities for data sharing. This is true whether EHRs and telehealth technologies are being used by two health systems that exist in two separate states, or within a single hospital that uses multiple EHRs under the same roof.
As a result, healthcare organizations are engaging in a series of duplicative efforts, documenting consultations and sharing files in archaic ways. This not only goes against the essence of value-based care; it also spills over into patient safety. If a telehealth consultation isn’t properly documented, a hospital or clinic could be missing a key piece of information that would determine the best course of action for a patient.
The interoperability challenge is often exacerbated because telehealth is seen as a secondary, less-than-ideal substitute for a gold-star, in-person consultation. But nothing could be further from the truth for the patients and healthcare providers who rely on telehealth.
To understand the scope of this problem, consider documentation practices within leading healthcare organizations, whereupon the hospital campus serves the role of the “hub” and the ancillary locations or clinics as the organization’s “spokes.” Each facility may use the same EHR brand, but the “hub”—which may have spent years acquiring smaller hospitals and ambulatory clinics—may be using a different version than its subsidiaries. Thus, communication is already complicated before a telehealth visit is initiated.
For example, a hospital system may offer telestroke consultations at one or more of its locations. One day, a patient is seen by a neurologist via a live video interaction. All is well until the clinician in charge attempts to document the high-tech encounter and has to compensate for the lack of interoperability. Then, it becomes almost comical.
Instead of inputting data directly into the main hospital EHR, which could be integrated with the telestroke system but often is not because of current interoperability complexities, the clinician is forced to type a few notes about the visit in the telestroke system, download a Continuity of Care (CCD) Document, and then print it out. Next, she logs onto the main hospital EHR (separately, of course) so she can attach the downloaded CCD to the patient record, for which she must manually search.
This CCD—which may be several pages long—is most likely a PDF and will be the only record of the telehealth interaction. Unfortunately, critical information within it is already at risk of getting lost in the deluge of data that isn’t searchable through an EHR. Making matters worse, the clinician is likely to print out the CCD before manually faxing the printed document to the spoke hospital—using a transmission method fraught with security challenges.
Obviously, there are many opportunities for something to go wrong throughout this lengthy scenario, from the clinician using the wrong fax number to the physician not being able to open the PDF document containing visit information in a timely fashion. Ultimately, the patient may one day suffer as a result of a healthcare provider not having easy access to the patient’s complete health record.
To leverage telehealth in an impactful way, the industry needs to reduce wasteful documentation practices so that disparate technologies can easily record and communicate information. There must be tighter integration with EHRs.
This isn’t simply important for healthcare systems that are adopting telehealth; it is also important for the future of value-based care. When telehealth is treated as a separate, secondary aspect of care that is documented outside of an EHR, both patients and caregivers miss out on the key benefits of telehealth—convenience, efficiency and value.
An economy, and a society primarily are improved by improving productivity—and both telehealth and interoperability are key aspects of that. Moving forward, the industry must consider whether it is doing as much as it can to promote seamless communication within health systems, and whether the technology purchasing decisions we make are in-line with our broader goals.
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