Despite vastly improved technology, interoperability in the healthcare industry remains a challenge. The electronic exchange of health data has faced hurdles since the introduction of electronic health records (EHR) decades ago. A data brief from the Office of the National Coordinator from 2019 shows that interoperability was stagnant between 2015 and 2017. Meanwhile, a survey from the Center for Connected Medicine revealed that one-third of surveyed hospitals and health systems reported that their interoperability efforts were insufficient.
However, technology such as application programming interfaces (APIs), artificial intelligence and blockchain has helped augment the medical record retrieval process, making it easier for physicians to access patient EHRs and potentially paving the way for meaningful interoperability.
To truly understand interoperability and its importance in the healthcare industry, let’s take a walk down memory lane. The introduction of electronic health records was a transformative shift for the healthcare industry, helping to shape the way health information would be stored and shared for decades to come. But disparate vendors and a lack of interoperability between systems did little to improve patient outcomes and at times seemed only to add to providers’ frustrations. To address this lack of synchronization, in 2004, former President George W. Bush established the Office of the National Coordinator for Health Information Technology and tasked the new division within the U.S. Department of Health and Human Services with facilitating improved data exchange.
In 2009, as part of the American Recovery and Reinvestment Act, the Health Information Technology for Economic and Clinical Health (HITECH) Act was passed, which served to promote the adoption and meaningful use of health information technology, requiring healthcare providers to convert from paper to electronic health records. The HITECH Act then authorized CMS to establish the Medicare and Medicaid EHR Incentive Programs (now known as the Promoting Interoperability Programs).
When data blocking – the practice of interfering with or preventing the exchange of electronic health information – and siloed data exchanges continued to be barriers to providing higher quality patient care, Congress tasked CMS with creating a solution that addressed these issues; the result was a digital system that allowed EHR systems to seamlessly exchange data with each other, otherwise known as interoperability. While not a perfect system, it’s a system far superior to paper charts and a total lack of data exchange.
Today, there are multiple stakeholders that contribute to the healthcare interoperability ecosystem. Patients, payers, providers, hospitals and health systems all make it possible for multiple health information systems to work together across organizational boundaries to improve patient care and experience.
While interoperability is often discussed in a broad sense, there are many components that make up this diverse technology. A report released by the Healthcare Information and Management Systems Society (HIMSS) discusses the three levels and uses of Health Information Technology (HIT) in the healthcare industry:
The employment of interoperability and the resulting real-time exchange of healthcare information has become a critical component to how physicians provide patient care, improving not only the quality of care that is provided, but also the efficiency with which it is delivered.
The implementation of interoperability doesn’t just improve patient care; it also saves lives. A 2016 study conducted by John Hopkins found that 44 percent of deaths caused by medical errors were preventable. With access to advanced interoperability systems, providers can capture and interpret data across EHR systems, reducing errors that are a result of incomplete patient data and misdiagnosis.
While the implementation of interoperability has helped payers, providers and healthcare organizations improve patient care, decrease the cost of care, and reduce provider error, there are still improvements that need to be made to ensure that the best and most complete data is being shared between systems. As the healthcare industry shifts to a more holistic approach to medicine with the goal of creating a better patient experience and improving care, it is imperative that the push for a more technologically advanced industry does not lose momentum.
Helping to facilitate the exchange of healthcare information is Fast Healthcare Interoperability Resources (FHIR®), an open-source HL7® that seeks to advance interoperability in healthcare. As one of the fastest growing capabilities to standardize healthcare data exchange, there is growing consensus that FHIR® is providing greater opportunities for data sharing across the care continuum and enabling organizations to leverage their existing systems to improve care delivery and patient outcomes. Combining the best features of previous standards and placing them into a common specification, FHIR® provides a platform for payers, providers and organizations to share and represent patient data in a standard way, regardless of the origin of the data or the method used to store it. With a heavy focus on implementation, FHIR® leverages new technology to expedite the adoption of interoperability in the healthcare community.
While talks of CMS transitioning to a FHIR-based quality measurement are still in the infancy stage, it is safe to say that payers, providers and other key industry stakeholders should expect to adopt the FHIR® standard of interoperability data exchange soon. Moving forward, healthcare organizations seeking to leverage FHIR® models will need to address a range of strategic and technical considerations to ensure the development of innovative, foundational internal infrastructures that will help them achieve true interoperability and integration within – and across – the healthcare ecosystem. Interoperability in the healthcare community will continue to evolve and improve as new technological advancements are made. Organizations that keep pace with the advancements will find it easier to succeed in the new interoperability driven, patient-centered world of healthcare.