Federal healthcare organizations, such as CMS, have spent billions of dollars over the years trying to bridge the gap between medical data and quality patient care with interoperability requirements and data integration, the mesh used to try and bridge the gap. Many government rules have been written to address the type of mesh needed and many EHR companies have claimed to meet these government requirements and claim the throne of the ultimate mesh maker.
However, hospitals and clinics found the mesh contained many holes, such as enabling hospitals to customize EHRs, but only if the EHR customers purchased the EHR systems for the manufacturers for millions of dollars that hospitals could ill afford. Also issues such as proprietary connectivity to their own brands that left the hospitals’ other EHR systems to serve as dead-end data silos. Rules and solutions came and went, but few had any teeth until now.
Anyone for A Slice Of PI?
To end the lack of interoperability morass and data duplication, the Department of Health and Human Services (HHS) issued 1,883 pages of proposed changes to Medicare and Medicaid. The changes rename the Merit-Based Incentive Payment System (MIPS) Advancing Care Information performance category to Promoting Interoperability (PI).
CMS announced the change as part of a proposed rule that will transform the EHR Incentive Programs commonly known as meaningful use under the Inpatient Prospective Payment System (IPPS) and the Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). The proposed policies are part of the MyHealthEData initiative, which prioritizes patient health data access and interoperability improvements.
But this time the name change wasn’t just that. For the first time a new CMS rule specifically requires providers to share data to participate in the life blood of hospital reimbursement—Medicare and Medicaid. The rule also floats the idea of revising Medicare and Medicaid co-pays to require hospitals to share patient records electronically with other hospitals, community providers and patients — a clear-cut demand for interoperability.
PI also reduces hospital interoperability requirements from 16 to six, revamping the program to a points-based scoring system and is requiring that hospitals make patients’ EHRs available to them on the day they leave the hospital beginning in 2019.
Does Your EHR Have the Right Stuff?
While this news from CMS appears to be a step in the right direction to solve a problem that has plagued the healthcare industry for many years, it must first be made a reality by those ultimately responsible for its implementation—hospital HIT organizations. The days of data obstruction and silo logic must end with a focus on new EHR markets built on interoperability.
Interoperability requires multiple layers to demonstrate an EHR system can be accessed. Meanwhile, every EHR system claims to support some form of interoperability, ranging from web interfaces to API protocols or to the lowest and highest cost HL7. However, healthcare systems will have to demonstrate their operability to CMS to abide by PI and therefore allow access of their EHR systems. Hospitals and clinics can encounter many challenges with this, such as HIPAA compliance and support for their infrastructure for open secure access, requiring an HIE and the funds to support data synchronization and IT support.
There is a growing interest among healthcare organizations to leverage actionable analytics solutions to derive valuable insights from data. Advanced, AI-driven predictive modeling is working to build healthier populations that meet the demands of value-based care, and new digital experiences are reaching providers and patients through a diverse array of touchpoints. Digital health solutions, driven by new and emerging data sources, are creating a unique combination of high-touch care management complemented by automated, virtual care.
This digital transformation in healthcare is being driven by the changing nature of the healthcare landscape, as well as the demands from consumers for more say in their care. The healthcare industry is making significant investments in IT to engage and empower patients, enable caregivers and improve operating efficiencies. However, the industry is also facing pushback from the caregiver community, with many physicians feeling that interacting with an EMR reduces their productivity. Physician burnout and unrealized expectations from technology investments have created a mood of caution in digital investments.
However, the digital transformation wave is still coming, since the proven patient health benefits, as well as industry improvements, are simply too great to ignore. Given the abundance of software-driven tools, technology professionals face the crucial task of integrating applications and data among the various players in the healthcare ecosystem including doctors, hospitals, government, device makers, insurers, employers, pharmaceutical companies and patients. Seamless transitions of care between these constituencies, however, are still a major hurdle, and positive patient experience is decided by the totality of patient care carried out by all those — both within and outside — of a health system. Shared processes between clinical entities are only possible if the data can journey smoothly from one system to another.
The problem today is that there is over-engineering in healthcare with overlapping and rich data standards and formats, and implementations that stay locked tightly in proprietary strongholds.
How to Make Interoperability Work
It is imperative that digital transformation initiatives focus on interoperability and integrations through well-defined application programming interfaces (APIs). APIs are designed so that systems with validated credentials can query and access systems widely available on the internet. Systems are then designed to respond to queries from programs with data that is machine-readable.
APIs deliver the ability to securely and efficiently access repositories of big data from wearable devices, social media, curated public datasets, research, and episodic care. They are the key to better understanding patients’ financial, social and behavioral context, and through predictive and prescriptive analytics can reveal trends across populations and micro-populations. With the explosion of disparate technologies, it will be about connecting them all quickly and efficiently to gain a competitive edge in healthcare.
Big data has arrived, and in healthcare, it has landed on our desks with a resounding thud. The challenge ahead lies in discerning how to analyze information and use it to effectively improve patient outcomes, costs and efficiencies.
Many of us are already influenced by machine learning and artificial intelligence (AI). For example, if buying hiking boots online, items of a similar nature also appear as suggested purchases, like bug spray or sunscreen. The data analytics behind those recommendations includes a wealth of information about the user, including demographics, such as age, gender, education and income level, as well as location and other factors that influence buying decisions. It will only be a matter of time until we are able to apply the same principles to healthcare data.
Imagine a doctor who can review operational and clinical data in real time for a patient who had knee replacement surgery. After the patient goes home, she is given a Fitbit to monitor her step count. If her steps trend downward, it is probably time for someone to intervene because she is potentially in pain or not ambulating correctly. That same physician could also see where she has received care, the cost of the care, and who performed the surgery. Then, the physician could compare her progress against others with similar demographic and health backgrounds by using machine learning and streaming analytics that not only gather relevant data across the entire care continuum—from hospital to rehab facility to home—but draw inferences from that information in real time to truly influence cost and care outcomes. In addition, if the patient had three MRIs that cost $2,000 each and someone with similar demographics and health conditions had one MRI that cost $500—caregivers can explore why that happened and work toward more uniformity.
This idea is inspiring, but a more practical look can be taken for how AI can support the business operations of healthcare as an achievable first step, along with connecting that operational data with remote care, device data and patient EHRs. Here are next steps for creating efficiencies with the power of AI and interoperability:
Step 1: Unlock Human Potential
As a recent Advisory Board report states, “AI works best when paired with humans.” The goal is to use this technology to create efficiencies across the care continuum that not only help staff in their roles, but that free clinicians, caregivers and office staff to focus on more valued activities. AI can help augment and automate human tasks and functions where appropriate, and sooner rather than later it may be able to offer advice, ultimately allowing caregivers to focus entirely on patient care.
Step 2: Optimize the Supply Chain
AI can quickly answer employee queries, buy supply, such as bandages from a certain supplier, and can also track unused supplies to minimize excess inventory. In addition, AI can help alleviate the amount of time—and frustration—nursing and clinical staff spend searching for supplies by not only providing location, but automating future order and delivery.
Step 3: Enhance and Expand Employee Self-Service
For those healthcare employees without regular access to a computer, such as lab technicians, AI can quickly and accurately empower cross-functional self-service. All employees need to do is ask for answers about anything, from paid time off (PTO) balances to company holidays.
Step 3: Automate Financial Processes
AI can augment the payment process, detecting payment, vendor and invoice patterns, and suggesting automating payments for a specific invoice that is approved 99 percent of the time.
By Donald Voltz,MD, Aultman Hospital, department of anesthesiology, medical director of the main operating room, assistant professor of anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
In his HIMSS keynote address, Alphabet’s former executive chairman and now current technical advisor Eric Schmidt warned attendees that the “future of healthcare lies in the need for killer apps.” But he also cautioned that the transition to a better digitally connected health future isn’t just one killer app, but a system of apps working together in the cloud. He also advocated transforming the massive amount of data held in EHRs into information and knowledge.
Schmidt is correct in his assessments. There is a need for interoperable “killer apps” for new health IT priorities and procedures. The apps need to deliver better patient outcomes by integrating and optimizing patient data while driving healthcare facility financial incentives such identifying cost savings and streamlining insurer payments. These types of needs are accelerating convergence in the health care sector for interoperability across clinical, financial, and operational systems, not simply EHR connectivity.
One of the cloud “killer apps” that is a strategic component of convergence and hospital growth are Annual Wellness Visits (AWVs). First introduced by private insurers and then by CMS in 2011 as part of its preventative care initiative under the Affordable Care Act (ACA), AWV’s are designed specifically to address health risks and encourage evidence-based preventive care in aging adults.
The typical visit requires a doctor or other clinician to run through a list of tasks like screening for dementia and depression, discussing care preferences at the end of life, asking patients if they can cook and clean independently and are otherwise safe at home. Little is required in the way of a physical exam beyond checking vision, weight, and blood pressure.
On its own merit, some could argue that while this app can greatly contribute to better patient care, it does not significantly impact hospital and clinic growth, but when integrated with other apps, it becomes a key healthcare growth catalyst with its treasure trove of patient data. That data, when streamlined, can enable expedited payments to government and private insurers, help lay the foundation for AI and other knowledge initiatives as cited by Schmidt.
Chronic Care Continuum App
Another “killer app” is the care continuum integration of treatment for chronic diseases ranging from diabetes to dementia and behavioral and mental health issues such as the U.S. opioid epidemic, heroin addiction, alcoholism and suicide. The ECRI Institute released its “Top 10 Patient Safety Concerns for Healthcare Organizations” in March 2018 and cited the management of behavioral health needs in acute care settings as the 6th highest ranked safety concern.
“Organizations should consider working with other partners, such as psychiatrists, behavioral health treatment programs, clinics, medical schools and teaching programs, and law enforcement,” says Nancy Napolitano, patient safety analyst and consultant, ECRI Institute. “Being able to communicate remotely and seamlessly, assessing risk and complexity, as well as delivering high-quality connected care are critical. Relationships and partnerships are what get you what you need.”
Guest post by Fizzah Iqbal, content writer, Incubasys.
After a number of initial coin offerings being launched in the cryptocurrency market, blockchain development companies plan to introduce blockchain technology to the health records (EHR) industry. The Electronic Health Record (EHR) is a digitised version of patient’s medical history maintained by their doctors over a period of time. It includes information on demographics, diagnosis, vital signs, past medical history, progress over time, lab tests and more.
Owing to the de-centralised nature of blockchain system, it securely stores health records and maintains a single version of the truth that cannot be tampered with. This is of significant importance to different medical organisations and individuals like doctors, hospitals, labs, and insurers who can request permission to access a certain patient’s record from the blockchain without involving an intermediary. It offers two-way benefits; first, doctors and medical organisations get access to patients’ details and history without losing any precious time waiting for approvals from any intermediary and provide better patient care based on more accurate data, second, patients have more control over who sees their data.
The biggest challenge faced by healthcare systems throughout the world is how to share medical data with known and unknown parties for different reasons without violating patients’ rights and ensuring data security. Creating a trusted environment for decision-making regarding EHRs is challenging for medical community since each EHR stores data using different workflows which makes tracking data recording rather ambiguous. The growing focus on care coordination and EHR access across the care continuum has raised questions about ways to ensure that multiple providers can view, edit and share patient’s data without violating their rights and privacy in any way.
It’s not only about the problem of data sharing logistics in HER instead every solution that requires serious contemplation in a national healthcare system needs to put patient’s privacy and rights first in their list of priorities. And although laws have made health care data more accessible, vast majority of hospitals and doctors still cannot share data safely and securely. The time has arrived where solutions are needed in which patients themselves control whom to share their data with and where to remain pseudonymous.
Healthcare data is inherently sensitive in nature. Besides that the constant challenges of interoperability, patient record matching, and health information exchange have created opportunities for blockchain development companies to come up with a blockchain-based solution.
Once a blockchain solution is deployed to manage EHRs, it becomes a unified and common backbone for digital health. The biggest advantage of using this backbone is that each hospital or care provider no longer needs a specific version of databases or software to access patient data. Any information presented by EHR on the distributed ledger of a permissioned blockchain would be perfectly reconciled community-wide with the assured integrity throughout without any human intervention.
The use of blockchain technology to manage EHRs reduces the time it takes any medical representative to access patient’s information, enhance system interoperability and improve data quality. It also enables a reduction in overhead costs especially for development and maintenance of legacy health record systems. What blockchain does for everyone in healthcare system is that instead of relying on a designated intermediary for information exchange the de-centralised nature of blockchain allows any approved party to join in and either access information, share or exchange without the need to build data exchange channels between certain organisations.
In just a few short years, we’ve witnessed the smartphone’s rise from bleeding-edge innovation to household fixture. We’ve watched it permeate every industry, establishing itself as essential to how we interact and operate, to the point where we’ve come to define our times by it—this is the smartphone age.
But mobile technology’s diffusion into the mainstream hasn’t been uniform. Some industries have greeted the mobile revolution with open arms, while others have resisted this paradigm shift (to varying degrees of success).
The healthcare sector falls somewhere in between, and that’s a cause for serious concern. After all, the purpose of technology is to improve the quality of our lives, our society, and our human experience, and it’s alarming that health care—arguably the most direct way to do just that—isn’t leveraging mobile tech to its full potential.
Hospitals, clinics, and other care facilities are facing challenges when it comes to successful mobile health (or mHealth) solutions. And as a mobile app development company with an extensive background in the medical sector, Codal has a few ideas about how to cure this smartphone affliction.
Is There A Doctor In The House?
Just like a doctor diagnosing a patient, let’s start by ruling out what isn’t the issue.
This year, popular medical publication Physicians Practicesurveyed 187 doctors, nurses, and other healthcare workers to find that a massive 75.9 percent of them said their facility used some form of mHealth on weekly basis. Safe to say, adoption isn’t the problem here.
But the same survey found that the majority of those care facilities were using those solutions between just 0 and 5 hours a week. They might have access to mHealth solutions, but they certainly aren’t using them in their day-to-day practices. The question is why.
The brass of these hospitals certainly doesn’t need to be convinced— not if over 75 percent of them are willing to invest in mHealth solutions. But perhaps we need to dig deeper. Perhaps it’s the physicians themselves who aren’t willing to implement these smartphone tools in their workflows.
But another recent study, this one conducted by the American Medical Association, found that 85 percent of 1300 physicians surveyed believed that digital health solutions gave them an advantage in their ability to care for their patients. The figure attached illustrates a more in-depth breakdown of these findings.
The AMA’s study went even further, attempting to identify exactly what attracted these physicians to digital tools like mHealth. The primary reasons cited were improving work efficiency, enhancing diagnostic ability, and most importantly, increasing patient safety. And these were just the most popular factors—the full responses are a laundry list of the benefits mHealth solutions offer.
Another notable conclusion was the high amount of younger physicians that were especially optimistic about the impact digital tools could have. This finding suggests that these solutions are indeed the future of medical practice in the healthcare sector.
So if everything is pointing towards mHealth dominating hospitals and clinics across the country, why isn’t it? If it’s not the higher-ups or the users themselves, what’s left? The quality of the mHealth solutions themselves.
By Mark Weber, SVP of healthcare development, Infor.
With payer models changing, it is time to start thinking of patients as both clients and customers. Are they as satisfied with the cost of service as they are their experience and outcomes? Will they keep coming back?
With high deductible and health savings plans shifting more of the patient cost burden to their own pocketbooks, healthcare consumers are motivated to make more informed care choices. The good news, for them, is that they have a lot more options, as nontraditional players such as retail clinics, online diagnosis sites and others have entered the market. There is more information about those choices available to them, whenever and wherever they need it.
However, all of that creates more competitive pressure among providers. Patients can be an organization’s biggest cheerleaders—or biggest detractors. That means like any brand, healthcare providers must work hard to maintain loyalty to remaining successful—or even sustainable—in the industry. And technology is helping lead the transformation.
The Era of Consumerism Is Here
According to Shafiq Rab, CIO of Rush University Medical Center, “It is all coming together as the ‘day of the patient.’ We call it care where you are. Where you want it. How you want it.”
He then went on to say that while technology continues to support the era of big data, digital innovations and advances also provide healthcare’s biggest opportunity to streamline the care experience across the continuum.
EHR Is Just a Start
One of the biggest evolutions is the implementation and proliferation of the electronic health record (EHR). It has been a catalyst for more efficient, personalized care and is integral to a better patient experience.
However, if the EHR is unable to connect to disparate systems, or across facilities (especially in this era of increasing mergers and acquisitions), or between non-affiliated organizations, its value decreases as the potential for real interoperability is lost.
What healthcare organizations really need is an engine that pulls together the EHR and other systems. To have a single patient data source, organizations need to streamline the exchange and aggregation of clinical data within an organization, and between its facilities and partners. Do not forget that such an engine needs to be built with standards such as FHIR as a top consideration and can create apps that allow patients to schedule appointments via laptop, tablet and phone.
Even efficiencies a patient cannot see are key to patient satisfaction and a positive consumer experience. Such efficiencies include the processes that power everything from claims processing to supply chain to equipment maintenance. If supplies are missing or need to be tracked down, patient care and experience are compromised. Or imagine arriving at your appointment and finding the MRI machine is down. A truly integrated system will provide real-time, role-based insight to minimize risks, issues and service disruption.
As savvy consumers demand more cost transparency, revenue generation must be balanced with the constant need for cost efficiencies. As a healthcare organization, a wise endeavor is to bring accounting and cost analysis to a new level by allocating patient and department expenses, such as procedural and lab test costs. From there, you need to break down expenses by patient cohort, surgeon, procedure or provider. Imagine getting a bill from the hospital that clearly outlines charges in a manner that you, as a consumer, can easily understand. Not only does that help achieve a higher level of consumer satisfaction, but it helps the healthcare organization understand the true cost of patient care.
By Donald Voltz,MD, Aultman Hospital, Department of Anesthesiology, Medical Director of the Main Operating Room, Assistant Professor of Anesthesiology, Case Western Reserve University and Northeast Ohio Medical University.
Healthcare is evolving quickly and HIMSS 18 offers a broad range of healthcare issues to explore. New requirements for implementing HIT systems have changed dramatically in the last few years as new health IT priorities and procedures have emerged. Convergence in the health care sector has accelerated the need for interoperability, not just for EHRs, but also across clinical, financial, and operational systems. This need is also challenging and changing one of the biggest traditions in healthcare—the doctor patient medical visit.
In the past, patients would simply make appointments to visit their physicians. Now, we have the popularity of Annual Wellness Visits (AWVs) and the growing need for chronic care treatments caused by the opioid epidemic and other behavioral health issues. This trend is causing physicians to be the ones actively pursuing patients, but with both sides reaping the benefits of this new arrangement. The new approach to the traditional doctor-patient relationship enables patients to receive better care while clinics and hospitals build up a roster of new and potentially long care patients.
Disrupting this office visit tradition are also larger, long-term HIT trends, such as the widespread implementation of electronic health records (EHR) and other healthcare practices. However, these trends spurred many challenges, but also a great deal of opportunities, many of which have yet to be fully capitalized upon. To understand these changes, we need to be cognizant of the increasing opportunities patients and physicians have in accessing and interfacing with the healthcare system.
Patients have a great deal more choices and entry points to the complex and dynamic healthcare system than they had even 10 years ago. When Medicare, Medicaid, organ transplantation and synthetic insulin were coming in vogue 50 years ago, patients had relatively limited access to healthcare. Those that did often choose to enter the system through a single physician who they had built a long-term relationship with and who served as the conductor of any labs, studies or further consultation from specialists. With the implementation of governmental and private healthcare insurance options, patients had improved access to care. Commensurate with this increased access to care, an increased national health expenditure followed.
With increased costs, healthcare responded by changing the way patients interacted with the system. Beginning in the ‘70s and continuing into the ‘80s, the rise of HMOs and capitation attempted to improve national healthcare, but this led to limitations in patients’ choice and began the concept of bundling services, cost sharing, and expansion of preventative care. Other managed care plans and a focus on utilization of care continued to decrease the cost of care.
Although many aspects of these managed care structures benefited patients, such as preventive services and prescription coverage, access to services and specific physicians were constrained as “in” and “out” of network coverage, limiting patient choices. The implementation of EHRs has established the foundation upon which opportunities are and will be found to improve healthcare quality by improving the decisions being made.
Enhanced access of patient data by authorized patients, professionals and algorithms focusing on analytics or artificial intelligence is now a requirement for enhanced patient engagement, improving professionals’ delivery of care, enhancing clinical decision making and optimizing patient outcomes while maintaining choices that are consistent with best practices, patient values and prior empirical experiences.
Evolving Relationship Drives Healthcare Revenue
While the doctor-patient relationship has evolved, hospital systems and physicians must still derive revenue which is still at the core of that relationship. The healthcare industry is now looking at revenue which can be generated through the interoperability of annual wellness visits (AWVs), chronic care and service care transitions between physical and behavioral health services. Hospitals and healthcare clinics that can connect these services with technologies such as bi-directional information flow will benefit by creating new profit centers of revenue through reimbursements by CMS and private insurers.
“Programs such as revenue cycle management are important for any healthcare institution’s bottom line, but when carriers can actually drive revenue using cloud based, bi-directional interoperability technologies that enable doctors to spend more time with patients and therefore provide superior care, then flipping the traditional patient-doctor relationship is a winning trend for the healthcare industry,” said Doug Brown, managing partner, Black Book Research.
Driving this trend are new apps and innovations that address the payment gap caused by medical billing and collections processes with outdated EHR platforms and inoperable systems. New technologies from organizations, such as Core Care Medical and others, fueled by the growth of cloud computing in the healthcare industry are improving real-time communication and data exchange. Here are some examples of how this is working which you might not hear about at HIMSS.
Hospital CEO Drives Revenue with Doctor Patient Visit Apps
A healthcare colleague, David Conejo, CEO, Rehobath McKinley Christian Healthcare Services (RMCHS) is boosting revenue right now using this doctor/patient flipping model as a strategy to help in his effort to improve behavioral healthcare for Gallup, New Mexico’s large Indian Reservation community who suffer from addiction to alcoholism and opioids.
He integrates data from the hospitals’ three clinics using a cloud application that streamlines data from AWVs and integrates it with any EHR system without data duplication. The Zoeticx ProVizion app also allows for the management of support tracking for wellness visits, provides a physical assessments guide through preventative exams, and maps out the risk factors for potential diseases for patient follow-up visits. He can then enter the relevant data about the patient.
In addition, it includes everything else that Medicare would recommend apart from a checkup. The app also lets him identify integrated EHR solutions that could also meet CMS and private insurers billing requirements. RMCHS’ business is growing with full or near-full compliance. And with its ACO in startup mode, RMCHS is also receiving a bonus check for $80,000 from Medicare for containing costs, in addition to the new revenues being generated.
The fact that more patients can be seen is a bonus. When the doctor comes in, they already have the requisite information about meds, compliance and other important factors, but if a physician saves 10 minutes per patient, at 18 patients a day that’s an extra 180 minutes. More minutes, more patients.
It’s not exactly a sweater or tie that gets worn once and then relegated to the top of the closet, but it turns out that patient data may have something in common with unloved holiday gifts. Both, it appears, are shared and then seldom used.
At least that’s one takeaway from a recent Health Affairs study on interoperability and how far forward we’ve actually moved the ball. The authors used the most recent available data (2015) and the four interoperability standards established by the Office of the National Coordinator (ONC)—finding, sending, receiving, integrating—to conclude that progress on this measure is lagging, at best.
“… Progress toward interoperability has been slow, with fewer than 30 percent of hospitals engaging in all four domains of interoperability in 2015 and with an increase of only 5 percentage points from 2014,” the authors write.
The low percentage of hospitals using all four standards is particularly significant in that simply sending or receiving data does not guarantee its use. Of those hospitals that said they sometimes, rarely or never use outside patient data in care (55.8 percent), or didn’t know (11.2 percent) how often they used it, the most oft cited explanation was that “clinicians could not view the information in the EHR as part of their workflow.”
“Issues with integrating information into existing EHR systems and clinical workflows were the most commonly cited barriers for hospitals that were not routinely using external information for patient care, which further underscores the need to shift the policy focus from transmitting information to information usability.”
Ah, yes, usability … yet another technological imperative that ends in ‘ability.’ Health Affairs suggests that data usability has a lot to do with EHR sophistication.
But is it having an advanced EHR that improves data usability? Or is it perhaps having the same EHR as the facility you share data with? As Health Affairs points out, those hospitals that most frequently share patient data via HIE are those working with an EHR and HIE from the same source.
“Without strong incentives that would have created market demand for robust interoperability from the start, we now must retrofit interoperability, rather than having it be a core attribute of our health IT ecosystem,” writes Julia Adler-Milstein, also an author of the Health Affairs study, in a recent NEJM Catalyst article. “And, if there had been stronger incentives from the start, we would not now need to address information blocking: the knowing and intentional interference with interoperability by vendors or providers.”
Adler-Milstein argues that policymakers dropped the ball more than any stakeholder group. The EHR vendors and providers, she says, are just working within the boundaries to retain or improve their respective positions.
“Of the stakeholders, only policymakers have a clear, strong interest in promoting interoperability,” she says. “Therefore, it is up to them to ensure that robust, cross-vendor interoperability is a stay-in-business issue for EHR vendors and providers.”
Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.
A personal health record of any patient, whether it is an aging parent, a spouse or a child with a chronic illness, contains a summary of medications, lab results, visit notes, billing information and more, and interoperability makes it easy to manage all these files and documents with just a few clicks.
Every form of health data makes an entry in an EHR today thanks to the shift towards a digitized healthcare in U.S. Although this has made data entry, storage, retrieval and exchange easier, it has brought with it certain challenges. Integrating and utilizing EHRs is the first baby step; however, if we are to overcome all the hurdles then achieving 100 percent EHR interoperability is the summit where we are yet to reach.
Physicians want to optimize the full potential and promise of EHRs for the simple reason that improved communication between systems will lead to a better and enhanced care. Once all the systems in use nationwide are connected and interacting with each other, patients will find it easier to seek a second opinion as their health information will reach the physician in a matter of seconds.
How interoperability exists today
Today, various interoperability standards have developed for the sake of continuous improvement in this realm. Health Level Seven (HL7) has produced the likes of HL7v2, HL7v3, and the latest FHIR as competent standards that exist in the industry for better streamlining of documentation and care coordination. With the help of FHIR, physicians can access health data on their mobile phones through various API (Application Programming Interface) functions that FHIR supports. This ease of access to complete and accurate patient data, in due course, helps in many ways. As providers and health coaches work together on improving the health of people, it also significant for them to be able to access accurate data from sources other than EHRs. Apart from EHRs, HIEs have popped up in various places that allow for the smooth flow of data across the health care network.
Ways in which interoperability facilitates healthcare
Physicians can easily access and share medical information with their patients and perform their tasks with greater efficiency. This could be done by increasing the efficiency of monitoring chronic diseases. Besides saving time and labor cost, physicians and patients with access to interoperable health information can benefit from higher-quality patient outcomes. Interoperable EHRs carry the potential of giving easy and ongoing access to patient’s health records to the physician. For a doctor to have an updated and detailed medical history of his patient cannot just be live-saving, it will mainly help those people who are always on the move. This will empower an individual to move across the continuum of care seamlessly with their clinical record.
Doing more with less
As value-based care and reimbursements stepped into healthcare, the US managed to turn the tide towards a more qualitative and equitable delivery of care. This has made physicians more responsible for better patient health outcomes than ever before. To manage hospital readmission and managed care plans, physicians need to have as much patient information as possible at hand at all times. This is where interoperability comes into play by aggregating and relaying data from disparate regions and bringing it onto a single platform.
For a secure data exchange to take place amongst healthcare organizations and patients, it’s important that both parties are willing and equally involved in the sharing process. This will inevitably lead to shared decision making apart from the fact that the physician will be able to make quick and informed decisions. The ultimate aim is to have a complete understanding of the health status of patients and helping them navigate effectively in their health journey for a better patient experience.
Patient-centric interoperability is the direction in which healthcare is slowly moving. There’s so much that we can do with the availability of data. Ongoing monitoring of patient data can better facilitate the ongoing management of that patient’s health and the physician can intervene where necessary. With this, patients too can track their progress and work towards improving their health hand-in-hand with the physicians.
Challenges that interoperability is yet to solve
One of the issues that interoperability is dealing with today is the vast and disjointed patient data that exists in regional HIEs and independent, transactional databases like EHRs. Along with this, patient privacy concerns and consent are other risk factors that need to be considered when diving through protected health information data. Lack of a common standard, state policy rules, workflow and policy difference and the need for incentives are some barriers in the way of achieving 100 percent interoperability.