Electronic Health Reporter

Guest post by Abhinav Shashank, CEO and co-founder, Innovaccer.

P.J. Carter in a blog explained how the lack of interoperability resulted in extreme physical pain to his father who had to go into an eye surgery for the repair of a detached retina. His father was told by his eye specialist that and an urgent operation had to carried out. The operation began, but doctors could not access the past medical record of his father. Since doctors were unaware of the medical history, they had to carry out a painful operation of the eye without anesthesia! His father was awake the whole time and had to endure the pain.

Healthcare industry is lagging the most when it comes to advancements. There have been innovations, but equal implementation has been lacking. The cost of care has risen to over $10,000 per person in the US because there is huge expenditure on various digital infrastructures, but not for the meaningful use of them.

Interoperability and Its Types

Interoperability is a term that has no single definition. In broad terms, interoperability is the ability of systems and devices to exchange vital information and interpret it. For healthcare, interoperability is the ability of computer systems in hospitals to communicate, share critical information and put it to use to achieve quality health services delivery.

There are three levels of health information technology interoperability:

1) Foundational: This is the most basic level of interoperability. In this tier, the health information systems are equipped to transmit and receive data, but the HIT system on the receiving end may not be decked up to interpret that information.

2) Structural: The middle level, structural interoperability defines how the data exchange will take place. Structural interoperability is all about how data should be presented in pre-described message standards. This tier is critical to interoperability as it allows a uniform movement of health information from one system to another, avoiding the alteration and promoting the security of data.

3) Semantic: Semantic interoperability is the third tier, and at the top of the communications pyramid. The highest level of interoperability, it provides the systems the ability to exchange data and make use of the information. The message is received in an encoded format and which is later normalized. This normalization of data pushes health IT systems to close in on the technology gaps and create a common platform for secure, uninterrupted machine-to-machine communication.

Scope of Interoperability

There has been a dramatic increase in population, and with that came the need to manage population health. The amount of information increased exponentially with the use of EMRs. They helped in storing the increasing information, but sharing was still doubtful.

In 2005, only about 30 percent of the entire group of office-based physicians and hospitals used basic EHRs which increased to 75 percent for hospitals by the end of 2011. The state of Indiana now connects more than 10 million patients across 80 hospitals, and about 18,000 physicians use this data.

How long until 100 percent interoperability?

It has been accepted that health care, as a single entity, faces challenges in the exchange of information. Even the pioneer EHR vendors admit that although they have some complex connections established, not all of them were successful. According to a report, less than half the providers were satisfied with the way their information exchange was taking place. Stakeholders involved have always been concerned that EHRs, even the ones for Meaningful Use 2, are unable to share data effectively.

In the latest ONC report, it was mentioned that if all the providers were to come down to a common consensus, there happen to be two barriers on the road to complete interoperability. One, discord on how data should be transmitted. Second, a lack of proper infrastructure which is equipped enough to transmit data nationwide. It is very critical that the technology being used is updated and standardized to ease the flow of patients’ vital information to avoid any probable mishap.

Persisting Problems in the Path of Interoperability

1) Inadequate Standards

More often than not even after collecting patients’ data, it cannot be passed on to the members of the healthcare community because of lack of the appropriate standards. Most of the times it happens that two systems trying to exchange data are using a different version of standards. This is because there are varying standards and numerous version for which providers aren’t equipped.

2) Varying State Privacy Rules

The law that allows sharing of patient data varies from state to state, which creates a problem while sharing data across the state lines. Furthermore, the consent from patients for sharing their information is also an issue, as consent from many cannot be obtained.

3) High Data Exchange Fees

Ideally, there should be no cost for sharing of the data as it is for the greater good of patients. However, some vendors charge money for the sharing of data and this price for setting up the connection could be as high as $50,000.

4) Resistance from Some Vendors

This is a problem which providers are facing even though the law prohibits it. “Information blocking” for vested motives is somehow in practice. For instance, keeping the information blocked for a period of time and later asking for fees to exchange the needful data is an unfortunate but common problem.

5) Lack of Incentives

Members in the healthcare community would implement costly solutions only when they are assured that their investment is worth it. No one wants to operate at a loss, and thus, there is a need to incentivize the providers who successfully implement interoperability. According to this study, lack of such incentivization is reason for the lag in the development.

The Need of the Hour

System interoperability is all about multiple devices and systems exchanging their information and spelling them out meaningfully to simplify the process of information sharing, and this is what makes it the Holy Grail of the healthcare industry. In 2014, ONC released a 10-year roadmap to interoperability and here are some key milestones to be achieved in that roadmap in the coming years:

• 2017: providers and patients can send, receive and make use of a basic set of vital health information
• 2020: Access to granular information and expanding the uses gradually
• 2024: Self-learning healthcare systems

A survey interviewed 220 providers, and almost 82 percent of them felt at least moderately successful when it came to achieving interoperability. Though only 6 percent of the providers could access information from exchange partners on a different EHR system effectively enough to improve patient care and which shows that we are only at the tip of the iceberg.

The Road Ahead

The ONC has realized that in this phase of transition from volume to value-based care, interoperability is a must and has taken a few steps to accelerate this development:

ONC has created the Interoperability Standards Advisory (ISA), which is a set of standards and implementation guidelines to facilitate fulfilling a set list of interoperability needs. ONC is also promoting the widespread use of Fast Healthcare Interoperability Resources (FHIR) – a plug-and-play service allowing healthcare apps to work together and interact. Increasing focus towards value-based care models, where interoperability is a must-have to meet quality standards.

Even under MACRA, health IT interoperability plays a crucial role as health systems equipped with interoperability would benefit physicians planning to participate in an advanced alternative payment model. Moreover, the health systems eligible for MIPS need to meet specific health data exchange requirements that depend hugely on interoperable systems. With a new administration, we can be assured that all the initiatives associated with interoperability will not only be backed, but grow exponentially.

Not a long time ago, using health information exchange, a value-focused organization was successful in reducing total office visits by 26.2 percent and increasing the number of scheduled telephone visits to the hospital by eight times!

As the healthcare industry moves from fee-for-services to fee-for-value, much needs to be done to sustain the change and evolve with it. New measures need to adopted: right value, right care, and right living; and with these new measures, new pathways have to be developed to reach the point where every citizen can afford quality healthcare. But more than anything, the entire healthcare industry should strive towards attaining health IT interoperability — a high priority, but only partially realized.