In our previous article, we discussed the importance of healthcare interoperability and some of the challenges that impede its progress. In this second part, we will delve deeper into the factors that hinder the advancement of healthcare interoperability.
By understanding these barriers, we can work towards overcoming them and achieving a more interconnected healthcare system.
Fragmented Health IT Landscape
The healthcare industry operates within a fragmented landscape, with various electronic health record (EHR) systems, medical devices, and health information exchange (HIE) platforms in use. These systems often lack standardized data formats and interoperability capabilities, making it challenging to exchange information seamlessly.
The lack of a unified approach leads to data silos, where patient information becomes trapped within specific systems and organizations.
Proprietary Systems and Vendor Lock-In
Proprietary EHR systems and vendor lock-in practices can hinder interoperability. When healthcare organizations heavily invest in a particular vendor’s system, it may restrict their ability to share data with other systems or switch vendors.
This limited interoperability can impede the seamless exchange of patient information and hinder collaboration between healthcare providers.
Information Blocking Practices
Information blocking refers to practices that intentionally impede the access, exchange, or use of electronic health information. Although regulations such as the 21st Century Cures Act in the United States discourage information blocking, instances of such practices have been reported. Some vendors or healthcare organizations may restrict data sharing for competitive or financial reasons, hindering the free flow of information necessary for interoperability.
Welcome to this three-part series examining healthcare interoperability in the United States and the reasons for its slow progress. In Part 1, we delve into the fragmented healthcare landscape and the technical challenges that impede seamless data exchange.
The Fragmented Healthcare Landscape
The need for interoperability in healthcare can be attributed to the fragmented landscape of the industry. In the United States, the healthcare ecosystem comprises a wide range of organizations, including hospitals, clinics, and specialty practices. Each operates with different electronic health record (EHR) systems, infrastructure, and data models, creating significant interoperability gaps.
The fragmented landscape hinders the seamless exchange of patient data and poses a barrier to efficient care delivery.
Technical Challenges
Technical challenges play a crucial role in impeding healthcare interoperability. One of the major obstacles is the diversity of data formats and standards used by different healthcare systems and EHR vendors. Historically, proprietary data formats were implemented by vendors, resulting in compatibility issues and difficulties in exchanging information between systems.
We have made strides in improving interoperability but are not where we need to be. It’s a complex issue that requires collaborative efforts among stakeholders to overcome technical and policy challenges. These technical challenges include data standardization, data exchange protocols, and semantic interoperability.
Legacy systems also contribute to the lack of interoperability. Many healthcare organizations still rely on outdated systems not designed with interoperability in mind. These legacy systems may need more capabilities or face compatibility issues with newer technologies, making sharing and exchanging patient data challenging.
The impact of legacy systems on interoperability remains a significant hurdle in healthcare. The lack of standardized data exchange and the presence of proprietary systems hinder the seamless flow of information, impacting care coordination and patient outcomes.
By Jerry Rankin, strategy director of healthcare interoperability, Infor.
Jerry Rankin
The unrelenting if unpredictable movement of continental plates builds new mountain ranges and reshapes continents, but for the most part, we do not notice their progress. Such a shift has come to healthcare.
This spring two US Federal agencies, ONC and CMS, announced complimentary Final Rules, signaling tectonic movement in healthcare interoperability. These rules are very consequential for the industry, but while no one can claim that they went unnoticed, the industry has been understandably instead fixated on responding to the COVID-19 pandemic. In response, the federal agencies involved have pushed the implementation timelines back by roughly six months.
The Final Rules
On May 1, 2020, the ONC published a Final Rule implementing provisions of the 2016 21st Century Cures Act. Known in the industry as the “Information Blocking and Health IT Certification” Final Rule, the Provider and EHR focused rule requires developers of Certified Health Information Technology (e.g. EHRs) to make standard APIs available for the delivery of individual and population records, as well as defines the data set and transaction standards of the APIs to be United States Core Data Set for interoperability (USCDI) and FHIR, respectively.
In a parallel action, the CMS issued a ruling implementing provisions of the Cures Act, known as the “Interoperability and Patient Access Rule,” leveraging “Conditions of Participation” in Federal Health programs. The finalized rule requires payers to provide a Patient Access API which gives patients access to certain health data including personal data.
These rules represent an important federal nudge to the industry to move in the next few years to implement and adopt standard, digital friendly APIs for the exchange of key patient information, eliminate policies and practices of health IT vendors, providers and other data holders that constrain the free flow of healthcare data, and, importantly, bring payers and consumers into the interoperability discussion, enabling data to flow across the healthcare ecosystem.
These rules are just the tip of the iceberg, though. The industry has been hard at work for years developing the FHIR API standard, and there are abundant examples of voluntary industry led collaborations working to improve and streamline healthcare leveraging FHIR. For example, the HL7 Da Vinci Project sponsors collaboration among payers, providers and HIT vendors working to define standards-based implementations to improve some of the more costly workflows in the industry. In addition to adoption by traditional HIT vendors, even IT “gorillas” are adopting FHIR. We recently saw this with the launch of Microsoft Cloud for Healthcare which extensively leverages FHIR APIs and data standards.
What to expect for payers and providers?
Payers and providers and their health IT vendors have a great deal of work to do on a tight timeline to meet the requirements put in place and to simply keep up with the pace of change in the industry. Given the massive investment in and footprint of legacy systems, there is a vast amount of work to do to connect systems and data to the emerging FHIR API ecosystem.
