By Gevik Nalbandian, vice president of software engineering, Lyniate.
As healthcare providers manage market shifts such as value-based care, increased consumer expectations, staffing shortages, changing reimbursement models, and competition from non-traditional healthcare players including Alphabet, Amazon, Apple, and Microsoft — what will it take to compete?
Providers must strengthen the internal IT infrastructure systems to better manage patient relationships. This all begins with easy access to accurate patient data. But with the explosion of data in the healthcare ecosystem, this is no small feat.
Interoperability doesn’t end with integration
Reducing friction in health data exchange requires seamless interoperability among different systems. Interoperability is often viewed as accessing and exchanging data, typically through an integration engine for extracting, composing, standardizing, and passing data between disparate systems. This is a necessary component, but it is not sufficient to achieve a full and accurate picture of your patients and patient populations.
A second component is patient identity management. An identity layer, managed through an enterprise master person index (EMPI), is critical to knowing which patients the data is tied to. In an April 2022 report, Gartner describes EMPIs as “crucial tools for reconciling patient identity and addressing medical record matching challenges needed for high-quality healthcare delivery and health information exchange.”
Accurate patient identification ensures every interaction in which data about an individual is captured — regardless of system or location — is linked correctly for a single, up-to-date view of one’s care. This includes diagnosed medical conditions, lab work, imaging, diagnostic tests, medications, allergies, and family medical history. When a patient’s data is trapped in various systems across the continuum, it can have potentially disastrous downstream clinical, operational, and financial effects.
Gaps or errors in the patient identity management process can have serious consequences for patients. According to a recent survey, nearly 40% of U.S. healthcare providers have incurred an adverse event in last two years as the result of a patient matching issue.
While interoperability has always been one of healthcare’s greatest pain points, the last year or so has emphasized these challenges with the rising demand for data integration and information sharing. The pandemic has required high volumes of data integration, and it’s been difficult for organizations to adapt and respond in an effective and efficient way.
These challenges were further compounded this year with the impending ONC/CMS information blocking rules. With the previous administration’s focus on improving interoperability coinciding with a global health emergency, healthcare organizations had more on their plate than ever. As we look to the future of healthcare in a post-COVID environment, and to the new administration and its healthcare goals, what can healthcare organizations expect?
Healthcare organizations must remain flexible and optimize the organization to be as adaptable as possible. In our interview with Ivan, we explore what healthcare organizations should know about the information blocking rules and the new administration, what is really at the root of the healthcare interoperability problem, and best practices healthcare leaders can employ to set their organizations up for success now and in the future.
How would you define the healthcare interoperability problem?
Interoperability is an evergreen problem across the healthcare industry. As we continue to innovate new capabilities and concepts, we are also constantly expanding our interoperability needs. In a way, interoperability isn’t a problem to be solved. It’s an ongoing practice that has to evolve alongside our other capabilities. For example, there was a time not long ago when social determinants of health (SDoH) were not on anyone’s radar, but as SDoH became more important to healthcare practitioners, it was clear we needed not only to track and store SDoH-related data but also exchange that data across different software systems and organizations. The goal of HL7’s Gravity Project is to build out the standards for exchanging SDOH data using FHIR.
2020 was a tough year in healthcare. The demand for data integration was up, exposing the dire need for better data integration across the healthcare ecosystem. In a world where interoperability wasn’t an issue, how could the pandemic have looked different?
The bad news is that we live in a world where the most reliable COVID vaccination records are stored on paper cards and interoperability is achieved by the patient themselves carrying the card from place to place. In an ideal world, the vaccination would come with an electronic record that the patient could capture on their mobile device and upload to their doctor’s EHR system, their employer’s HR system, and any other third party that needed to see proof of vaccination.
Although we’ve fallen far short of the ideal state, there are some interoperability bright spots to be happy about. For example, we’ve been able to onboard many new sources of lab result data and integrate that into public health departments. This has not always been easy, but because of the ONC’s prior work on the Promoting Interoperability program, we already had agreed-upon standards and an infrastructure in place to move the data from location to location.
When the COVID-19 pandemic first began affecting the United States, the entire healthcare industry moved swiftly to leverage existing technology and practices to meet the intensive demands of the global health crisis. Amid this incredibly tumultuous year, however, the healthcare community has also been able to actively develop new solutions and approaches to address some of the biggest problems we face, both related to the pandemic and beyond.
We connected with some of the leading voices in health IT to find out what they considered to be the biggest innovations of the past year and how they expect the landscape will continue to evolve in 2021, from advances in patient experience to greater public health data connectivity and more widespread digitization.
We saw prolific adoption of artificial intelligence (AI) solutions throughout 2020, particularly in the wake of the COVID-19 pandemic. For example, provider organizations leveraged chatbots and other rudimentary virtual symptom screening tools to decrease infection spread and address patients’ care needs without placing even more burden on the workforce. As we continue living in a global health crisis, we will see more provider organizations leveling up AI-enabled capabilities to help manage patient volumes as they ebb and flow during COVID-19 surges. Specifically, we will see providers bringing mature, AI-driven diagnostic tools into the exam room to provide reliable “second opinions” on demand.
As providers work to address the pandemic, they will also adjust their practice of medicine to better meet the needs of their BIPOC patients. In 2020, COVID-19 and racial injustice has highlighted serious racial disparities and underscored how important it is for health leaders to improve diagnostic accuracy and outcomes for traditionally disadvantaged populations. In 2021, I predict we will see greater inclusion and representation of patients of color in our medical education curricula and resources, clinical trials, and pool of medical students and residents.
2020 will be remembered for many things but in terms of healthcare information technology (HIT), it was the year of telehealth. 2021 will be the year that patients, providers, and payers blow the doors off the idea that “virtual” equals “video doctor’s appointments.” Virtual HIT enabling doctors and nurses to do their rounds virtually from down the hospital hall or the other side of the world will grow in popularity. It’ll be the year that hospital bedside patient engagement technology demonstrates its tremendous value in enabling higher quality and satisfaction from a pandemic-safe distance. We’ll also begin to see an increase of terrific HIT solutions integrating with the data plumbing that is an EHR to finally give nurses new efficiency and satisfaction.
As we look forward to 2021, healthcare IT will see a continued focus on the COVID-19 pandemic response, including the highly anticipated roll out of a vaccine. Vaccine administration is a key component of an effective pandemic response plan at both a local and state level. Health information exchanges (HIEs) have the ability to ingest and leverage data, including demographic information, from individual access points of care across the health system and will play a critical role in matching the COVID-19 vaccine data to the correct patient. HIEs also have the potential to streamline the reporting of individual vaccination information to the state for analytics. Harnessing this technology to accurately track vaccine data in near real time will provide crucial insight around who has been immunized and who hasn’t; who has received which vaccine and any side effects in the event that multiple vaccines are available; the ability to target under serviced populations and support ongoing resource planning as we continue to navigate these unprecedented times.
By Scott Galbari, chief technology officer and CISO, Lyniate.
For as long as healthcare data has existed, so has the healthcare industry’s challenges with interoperability. The pursuit of healthcare data interoperability has been a longstanding industry challenge, and with the recently finalized interoperability rules from the ONC/CMS going into effect at the end of this month (though deadlines will be extended until mid-2021), interoperability yet again is at the center of many healthcare discussions.
The rules, which aim to provide patients with greater control over their health data and eliminate information blocking, has not been without its critics. Some argue this rule will put patients at risk by inadvertently exposing patient health data to security breaches. However, the spread of the coronavirus pandemic across the United States has underscored the dire need for seamless, bi-directional data exchange. The new rules’ focus on FHIR and APIs to enhance electronic health information sharing are proving to be exactly what we need in the current crisis.
The coronavirus has necessitated all kinds of changes — from rapidly escalating the use of telemedicine, to standing-up temporary testing sites and care centers, to meeting enhanced public health reporting requirements — all of which would have been much more easily addressed if the new rules’ requirements were already in place, and all of which have presented significant challenges amid the COVID-19 crisis.
Because of these unprecedented circumstances, healthcare stakeholders are being required to share health information and data at increasingly high volumes, emphasizing the importance of strengthening the internal infrastructures of these organizations to ensure they can properly send, receive, and analyze health information. However, because of the strain COVID-19 has put on healthcare organizations, the Department of Health and Human Services (HHS) has decided to push out the timeline for meeting the rules’ requirements. While the reasoning for this is understandable, in many ways it is unfortunate that these requirements were not already in place prior to the pandemic.
By Drew Ivan, chief product and strategy officer, Lyniate.
It is becoming increasingly popular to move healthcare outside of the clinic and into the community and the home with the use of telemedicine platforms, apps, and other digital means — and the coronavirus pandemic has dramatically accelerated that trend. Counterintuitively, this healthcare crisis has the potential to attenuate the relationship between the patient and the healthcare system, putting provider organizations at increased risk from “digital disruptors” like Amazon, Google and Apple, whose ambitions to take over consumer relationships in healthcare are stronger than ever.
As patients re-orient during the pandemic around other points of care (hospitals, urgent care, pharmacy, etc.), the relationship patients have with their PCPs (which is one of the health system’s biggest and most meaningful advantages against the advancement of healthcare disruptors), can lose value to the consumer. As such, it behooves health systems — who are understandably all hands on deck working to address the COVID-19 crisis today — to be giving serious consideration to ways of fending off digital disruptors as their big challenge in a post-COVID-19 world.
This means focusing on leveraging the unique strengths and assets they have and getting smart about aggregating and using the disparate consumer/patient data sets they manage, to deliver a consumer experience only they can provide.
Digital disruptors excel at delivering exceptional digital customer experiences by using the massive data sets at their disposal that render rich insights into customer trends, needs, behaviors, preferences, proclivities, etc. With that said, hospitals and health systems have an advantage in their exclusive access to patient data and their in-depth medical knowledge.
Health systems need to thoughtfully but aggressively leverage these advantages if they want to successfully retain primacy in the consumer’s healthcare brand relationships. With non-emergent care rapidly shifting to the digital space, digital brands have a golden opportunity to disrupt the traditional patient-health system relationship should provider organizations miss the opportunity to reinforce those relationships by delivering much more personalized digital interactions.
It’s important to remember that healthcare organizations do not need to match the digital sophistication of the big data-driven consumer tech giants. They just need to use what they already know about patients, communities and medicine to create the kinds of experience for patients that only they can.
As hospital leaders aim to protect their organizations from digital disruptors in the post-coronavirus aftermath, these three considerations should be top of mind: