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HIT Think

Why we need to expand the interoperability playing field

This morning, the healthcare IT research firm KLAS released its report “Interoperability 2016: From a Clinician View–Frustrating Reality or Hopeful Future?” In this, their second annual report, KLAS takes an in-depth look at information exchange among EHR vendors in the U.S.

The study complements the recent KLAS Cornerstone Summit, which I attended along with industry leaders and influencers committed to delivering meaningful interoperability within healthcare. The study provides a good snapshot of the current state of healthcare interoperability within the U.S., while the summit made excellent progress towards defining and improving the interoperability benchmarks used to assess performance.

The KLAS report specifically focuses on clinical information sharing among providers and hospitals that are using the same or different EHR platforms and how it improves or impedes care delivery. Many of the findings are presented from the perspective of the clinicians who make, or would like to make, use of shared health data. This approach is commendable: if health information is not made available or presented to clinicians in a way that meets their specific and varied needs, then the industry’s efforts towards interoperability will ultimately fade away.

The interoperability report meets its stated objectives—it provides both an overview as well as details on how information is shared between EHR systems and vendors. However, in my opinion and the opinion of others at the Cornerstone Summit, the narrow definition of interoperability as EHR-to-EHR document sharing does not go far enough. We need to start looking at interoperability from a wider perspective. Hopefully, this will be addressed in the future versions of the report.

KLAS explains its rankings with a baseball metaphor, using singles, doubles, triples and home runs to describe specific levels of achievement. If shared information is consistently (or almost consistently) available within the workflow, is easily accessible, and provides an overall benefit to the individual care of patients, then the interoperability rating is considered a “home run.”

As it did last year, KLAS’ analysis includes all the leading U.S. EHR providers. However, interoperability and “home run” information sharing go far beyond the EHR. While initiating the conversation with major EHR vendors is a good starting point, we must take the conversation further. There is a host of care teams, healthcare entities, and other health IT suppliers, including HIE and integration technology vendors, that also play a critical role in the effective exchange of healthcare information.

Stated in baseball terms, defining interoperability as EHR-to-EHR document sharing would be similar to playing a game using only the infield and infield position players. Most of the playing area, and a lot of the action, in a real baseball game takes place within the outfield. We see the same thing when we look at our own personal interactions with the healthcare system. While our encounters with our primary care providers and local hospitals are extremely important, we spend most of our lives outside of these specific settings.

This is even truer for those of us trying to manage a long-term or chronic condition for ourselves or someone close to us. In these cases, there is often a virtual team of people and organizations that we work closely with—home nurses, physical therapists, care coordinators, counselors, our family members, and so on—many of whom have no EHR or access to an EHR. If we want to truly coordinate care for the patient’s benefit, then all of these parties should be equally involved in the health information sharing conversation.

So what are some of the greatest barriers keeping us from moving health records across these stakeholders? Many of KLAS’ findings point directly to business constraints. The majority of providers are still reluctant to share their patients’ health information with outside organizations, while regulations like HIPAA and infrastructure hurdles are also still proving to be a major roadblock. To complicate matters further, even when the information is shared among healthcare entities, the most pertinent and actionable data is often buried in reams of irrelevant information, rendering it practically unusable.

The KLAS interoperability report gives us two contradictory takeaways: (1) the conversation needs to be expanded to include to other players across the healthcare continuum, and (2) there are still significant hurdles in how and with whom the information should be shared. So how do we move ahead?

Here are my three recommendations to all constituents who have a stake in winning the interoperability game:

1. Focus on the population, not just the patient.
While caring for patients at the individual level is obviously a huge priority, the crux of information sharing is about improving care coordination and outcomes for an entire population. By sharing, aggregating, and analyzing patient health information from a variety of entities, providers will be able to enhance coordination, close gaps in care, and reduce both financial and clinical costs.

2. Leave no one out.
The healthcare industry must collaborate with all stakeholders across the entire care continuum if we want to make interoperability a reality. While the initial involvement of care organizations outside of a patient’s network may be a challenge, it is critical if we want to attain a clear picture of the patient population.

3. Learn today for improved care tomorrow.
The concept of health information sharing is still in its infancy. As an industry, we need to create a “learning” health system, or what some might call a “clinical trial” of interoperability. By testing the waters with new information exchange initiatives, we will be able to leverage that experience today to deliver better patient care tomorrow. To stick with the baseball theme, practice may, in fact, make perfect.

The KLAS interoperability report underscores that we have made significant strides with interoperability, but we still have a long way to go before the game is won. I look forward to seeing new players enter the game and to work as a team to win in the game of successful health information sharing.

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