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Breaking the Code to Interoperability
Clearing the path to a true healthcare system
Executive Summary:
To say that world-class healthcare and state-of-the-art technology don’t automatically combine to create a strong healthcare system would be an understatement. Interoperability — or, more specifically, the lack of it — is a hot button issue in healthcare today. At the heart of the problem is healthcare itself, as well as its technology, remains fragmented with disparate systems lacking true integration, causing information to exist in silos. The inability to access and share information leads to a host of issues. According to leaders with the Center for Medical Interoperability, “The lack of plug-and-play interoperability can compromise patient safety, impact care quality and outcomes, contribute to clinician fatigue and waste billions of dollars each year.” With that in mind, they go on to say that the industry has “an ethical obligation” to push for improved tools.1
The issues recently took center stage in Congress where leaders heard testimony on the questionable results of health information exchange despite the federal government’s $28 billion investment. The key takeaway is that while the technology certainly exists to enable data sharing, significant barriers clearly remain: the inability for different systems, electronic health records (EHRs) in particular, to talk to one another; the lack of progress by EHR vendors to make integration easier; provider concerns about competition; the cost and effort needed to build interfaces; and the lack of well-accepted standards.
As a result, lawmakers demanded the Office of the National Coordinator for Health Information Technology (ONC) take steps to address these challenges, including what some believe to be intentional barriers to interoperability, stating, “The ONC should use its authority to certify only those products that clearly meet current meaningful use program standards and that do not block health information exchange. The ONC should take steps to decertify products that proactively block the sharing of information because those practices frustrate congressional intent, devalue taxpayer investments in certified electronic health record technology (CEHRT), and make CEHRT less valuable and more burdensome for eligible hospitals and eligible providers to use.”2 Health systems and providers need forward progress now as they struggle to respond to shifting payment models, increasing needs for coordination and connectivity across institutional barriers, and consumer demand for convenience, quality and transparency.
The promise of true interoperability paints an appealing picture. ONC defines it this way: “An interoperable health IT ecosystem makes the right data available to the right people at the right time across products and organizations in a way that can be relied upon and meaningfully used by recipients.”3
The benefits to patients, care providers, payers and other entities are enormous. From a clinical standpoint, healthcare providers improve patient safety and satisfaction, receive real-time information at the point of care, improve care coordination, reduce readmissions and support population health. On the financial side, organizations align with new delivery and payment models, meet Meaningful
Use and other regulatory requirements (and avoid CMS penalties), reduce inefficiencies and associated costs, improve patient satisfaction and hospital consumer assessment of health providers and services (HCAHPS) scores, and increase patient retention. And operationally, hospitals and care providers are positioned to provide more effective, faster care with less effort, resulting in significant workflow efficiencies both clinically and administratively.
While the full promise of interoperability is not yet fulfilled, health systems do employ a variety of approaches to gain at least some of these benefits.
Through a combination of government regulations, advances in technology and efforts of healthcare organizations, such as accountable care organizations (ACOs), larger health systems and physician hospital working to better facilitate information sharing across providers and settings though progressive mindsets and technology investments, interoperability exists with varying degrees of success. The three key approaches are state and regional information exchanges, electronic medical records and secure messaging. Each approach offers value, yet limitations still hamper true health information exchange across communities and care entities.
Interoperability:
A promise yet to be fulfilled
Typical approaches
and their limitations
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state & regional
information exchanges medical recordselectronic messagingsecure
State Health Information Exchanges (HIE) and Regional Health Information Organizations (RHIO) have launched across the country to facilitate information sharing within states or regional geographic areas. Their goals are to better track and securely share patients’ medical histories, facilitate coordinated patient care, support public health, reduce duplicative treatments and avoid costly mistakes.
Yet even with strong collaboration and support from public funds, these organizations continue to struggle. Government agencies as well as healthcare industry publications have analyzed the successes and challenges. In its annual survey tracking the progress of various health data exchange efforts across the U.S., eHealth Initiative found that HIEs nationwide face three key challenges4:
1 ] Interoperability: Connecting disparate systems in any meaningful and practical way, typically through interfaces, is tremendously difficult andcostly. The sheer numbers are staggering: “Of the survey’s 199 respondents, 68 organizations have the challenging task of connecting to more than 10 different EHR systems, and 32 have to connect with morethan 25 differ-ent systems.” Responddiffer-ents wdiffer-ent on to indicate that more standardized pricing and integration solutions from ven-dors, more technology platforms capable of “plugand play” functionality and more consensus among providers around standards would further progress, including specific standards such as HL7, IHE and ISO, and broader standards around security and clinical messaging.
Information Exchanges:
HIEs and RHIOs
2 ] Financial Stability: Many of these organizations were launched with public funds with the intent that funding would transition to participating organizations over time. The eHealth Initiative survey indicates that many HIEs have become more financially stable over the past two years. About a quarter of the responding organizations currently bring in enough revenue to cover expenses. However, another quarter still depends on public funds, which will start tapering off, for more than half of their funding. Many HIEs view more advanced services as a means to increase revenue. Nearly half of the HIEs are offering or plan to offer services in support of value-based care arrangements, such as provider alerts, patient access to records, and analytics.
3 ] Competitive Concerns: Although the ideal is open sharing of patient information needed to coordinate care, it puts compet-ing organizations in a touchy position. Accordcompet-ing to the survey, prioritizing competition over information exchange has affect-ed HIE behavior. “Of those surveyaffect-ed, 33 HIEs are restrictaffect-ed to entities within a health delivery network, and 58 HIEs have not connected with any other network, such as a regional HIE, a state-designated network or the federal eHealth Exchange.” Information Exchanges: HIEs and RHIOs ~ continued
With Meaningful Use incentives the adoption of EHR systems has steadily increased, but part of the challenge remains in sharing and receiving critical patient data at the right time. In fact, recent government figures indicate that 48 percent of physicians and 59 percent of hospitals have such systems in place. Within a health system with a well-integrated enterprise EHR, the benefits of easy data exchange can be apparent in patient care and financial processes.
The challenges grow when organizations with different EHRs need to exchange information, which is often the case when provider organizations affiliate or merge. The issues with EHR interoperability are well documented, as summarized in a recent CIO Magazine5 article.
Electronic
Health Records
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Interoperability
EHRs face the same challenges as HIEs in terms of the cost and effort required to build and manage multiple interfaces.
Standards
It’s not just technology that is at issue. “An agreed-upon set of standards, implemented in a consistent way, would undoubtedly facilitate interoperability... yet, EHR vendors do not have a business case for seamless, af-fordable interoperability across vendor platforms, and provider organizations find it an expense that they often can’t justify.”
Data Overload
From the provider perspective, the amount of data collected in EHRs to meet clinical, billing and regulatory requirements — data often not directly relevant to patient care — is compro-mising the quality of the data in the EHR. “If the data isn’t good, simply having it be electronic isn’t going to get us anywhere.”
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Many healthcare organizations and providers have embraced the use of messaging —employing inexpensive solutions facilitated by the DIRECT Project protocols — to exchange information. These standards make it easy and cost-effective to securely send and receive messages and are typically used by participants in an HIE.6
On one hand, secure messaging replaces less efficient, less secure ways of sending information, including phone, fax and standard
email. This can help address Meaningful Use objectives, such as the transitions of care objective. However, its capabilities are specific to exchanging information between parties, without integrating that data into a longitudinal patient record. For those reasons, many organizations view secure messaging as one part of a broader interoperability approach.
It takes more than technology to achieve interoperability. While HIEs and EHRs make some interoperability possible, in order to realize the vision of a true healthcare system, many entities will need to be able to connect, collaborate and cooperate across devices, IT systems and institutional borders. To do this requires a neutral technology platform that can be leveraged and adopted for the broadest spectrum of users.
A neutral technology platform is characterized by being open, easy for networks to attach to, and complementary to other systems and networks to deliver on the intent of true interoperability. To see the power of a neutral platform in action, consider that to-day, each time a patient picks up a prescription, gets blood work
done or visits an ER, their health information is stored in different places, requiring separate technologies and communications systems to access it. However, despite these silos, a neutral technology platform and network overcome the barriers and connect key healthcare players and entities with the right information at the most pertinent time, leading to a myriad of benefits for patient and healthcare organization alike.
The industry currently focused on pursuing technology adoption, so it’s possible now for healthcare organizations to tap into platforms that enable optimization to bring the promise of true interopera-bility to fruition. Reducing errors, improving quality and efficiency, increasing patient safety and saving money are just the beginning of the benefits tomorrow’s healthcare system will bring.
Clinical Messaging
and
Direct Secure Messaging
A proven platform for
true interoperability
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collaborate
cooperate
It’s evident from the current status of interoperability within the U.S. healthcare industry that state-of-the-art technology and world-class healthcare don’t automatically combine to create a strong healthcare system. Yet, true interoperability is in sight when health-care organizations and providers partner with a vendor who can enable critical data connections, integrations and deep exchange, not only within the four walls of an organization, but also well beyond, reaching all stakeholders in the care continuum nationwide. With the push forward in a value-based care environment, this type of vendor-neutral technology platform can break down the barri-ers to interoperability, while also extracting and sharing new patient data at the right time across the myriad of existing technologies for optimized clinical success, improved operational efficiencies and enhanced financial performance. As a result, the vision of a truly
1 Bowman, Dan. “Why Healthcare’s Lack of Interoperability is Unethical.” FierceHealthIT. July 15, 2015.
Online. www.fiercehealthit.com/story/why-healthcares-lack-interoperability-unethical/2015-07-15.
2 Bresnick, Jenifer. “Are Vendors, Providers Blocking Health Data Interoperability?” HealthIT Analytics. April 10, 2015.
Online. www.healthitanalytics.com/news/are-vendors-providers-blocking-health-data-interoperability.
3 “Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure,”
report by The Office of the National Coordinator for Health Information Technology, 2015.
4 Gregg, Helen. “The 3 Biggest HIE Challenges.” Becker’s Health IT & CIO Review. November 18, 2013.
Online. www.beckershospitalreview.com/healthcare-information-technology/the-3-biggest-hie-challenges.html.
5 Corbin, Kenneth. “EHR Adoptions Up, Challenges in Interoperability and Meaningful Use Remain.” CIO Magazine. March 19, 2015.
Online. www.cio.com/article/2899140/healthcare/ehr-adoption-up-challenges-in-interoperability-and-meaningful-use-remain.html.
References
Surescripts partners with hospitals and care providers to provide the most connected, technology-enabled network in healthcare. More than 900,000 healthcare professionals nationwide rely on Surescripts to secure critical patient information and data across institutional borders every day to better care for 230 million insured lives each year. The vision of connecting, exchanging and integrating today’s healthcare environment to tomorrow’s healthcare system is what drives Surescripts:
• 700+ electronic health record application connections • Unrivaled access to pharmacy data
• 6.5 billion secure and private health data transactions • 1.2 billion prescriptions
• 764 million medication histories • 9.6 million clinical messages • 7 million immunization reports
