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Achieving interoperability in healthcare: Are we there yet?

Henry Archibong, Associate Vice President, Innovation Solutions

Despite vastly improved technology, for many professionals across healthcare, understanding how to achieve interoperability in healthcare 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 healthcare 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.

What do we mean by interoperability in healthcare?

To truly understand the concept of interoperability and how to achieve interoperability in healthcare, 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 connections 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; a step forward in achieving EHR interoperability.

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 support patient care and deliver better experiences – and improve healthcare interoperability.

The many levels of interoperability

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:

  1. Foundational Interoperability: Foundational interoperability allows data from one information technology system to be received by another. The uniqueness of foundational interoperability lies in the receiving system’s ability to receive HIT from another system without the need for it to interpret the data. This allows for data exchanges between HIT systems to be interpreted at the data-field level.
  2. Structural Interoperability: Structural interoperability is also known as syntactic or technical interoperability and is an intermediate level of interoperability that defines the structure or format of data exchanges, enabling the unaltered exchange of data from one HIT system to another. The focal point of structural interoperability is to define the syntax of the data exchange, ensuring that the data being exchanged adheres to Health Level 7 (HL7®), the organization responsible for setting international standards for transfer of electronic health data, standards and guidelines.
  3. Semantic Interoperability: Semantic interoperability is the “highest” level of interoperability that can be achieved between HIT systems. The software enables two or more HIT systems or elements to use data that has been shared while simultaneously exchanging new information. Disparate EHR systems, health and business systems, and medical and mobile technologies make the semantic exchange of information possible. Organizations across the healthcare industry are using semantic interoperability as the foundation for their complex clinical data extraction solutions to help facilitate the two-way exchange of clinical data in an effective, efficient, and scalable fashion while minimizing provider practice disruption.

Why is interoperability in healthcare important?

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.

How to achieve interoperability in healthcare

While interoperability as a concept has gained interest, and there are appointed organizations such as those mentioned above who aim to pave the way toward the future of interoperability in healthcare, there are a few strategies leaders across healthcare can adopt to improve interoperability for their teams.

  1. Providers can connect eligibility, billing, and EHR systems to ease some of the stress of revenue cycle management through better connected systems that inform various parts of the patient journey. Rather than having one system for patient admissions, another for billing, another for clinical documentation, and so on, providers can instead invest in interoperability to improve their workflows – and the patient experience. This could even be as simple as asking their current RCM vendors what else they can offer in one application, or inquiring if their EHR has any established partnerships in which the work of connecting systems has already been done for the provider.
  2. For pharmacists, achieving interoperability may look like improving data connections and communications with providers, to better receive referrals, document patient demographics and prescriptions, and monitor patient adherence. Interoperability can increase speed to fill and help improve the patient experience, which can lead to better retention and more future fills – but this all begins with better data connections made possible by healthcare interoperability.
  3. Across EHR systems, coding systems, and even patient billing systems, developers in the healthcare space should consider what interoperability in healthcare means for their organization. Is there an opportunity to expand their system’s capabilities by connecting with another vendor? Is there market share up for grabs by investing in developing connection capabilities?

The above are just a few ways various players across the healthcare space can achieve interoperability in their own ways, from how to improve EHR interoperability to how to better inform patient interactions powered by interoperability. This is not an exhaustive list, however, and it’s worth considering what interoperability can do for your organization.

Exploring the future of interoperability

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.

Don’t miss our session at RISE Nashville 2020, as Blue Shield of California and the CommonWell Health Alliance join Eric Sullivan, SVP of Innovation and Data Strategies at Inovalon, explore how healthcare electronic exchange standards are transforming the interoperability landscape to solve today’s common challenges around provider connectivity and patient engagement, care gap closure, and the ability to leverage advanced, intelligent clinical decision support.
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