July 31, 2020
If you’ve ever had to seek medical help in a country where you don’t speak the language, you know how frustrating it can be. Do they understand what’s wrong with me? Do I understand the treatment they are recommending? Will I get better?
Lack of communication is a problem the healthcare industry has been wrestling with since Lockheed introduced the first electronic health record (EHR) in the 1960s. In this case, the language barrier is between healthcare IT systems. When the health data for one person is sequestered in multiple siloed systems that don’t talk to one another, it’s impossible to get a comprehensive picture of that person’s health.
This is the story of healthcare interoperability, which the Healthcare Information and Management Systems Society defines as, “the ability of different information systems, devices and applications (‘systems’) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.”
As the American Hospital Association points out, “Everywhere we look, interoperability is in action: Your Android cell phone can call my iPhone. Your ATM card allows you to withdraw cash from any ATM. But if you present at an emergency department two towns over, your electronic health records might not be available to those treating you because health IT lacks a common platform to make that happen. It’s time for this to change.”
That’s a big ask and a big job for a distributed community made up of multiple specialist care providers, payers, pharmacies, diagnostic facilities, patients and more. This is why the quest for interoperability has been ongoing for decades. Despite the fact that more than 95 percent of hospitals and 75 percent of office-based clinicians are utilizing certified health IT, challenges remain in creating a comprehensive, longitudinal view of a patient’s health history. This disconnect is a hurdle to the integrated, value-based, cost-controlled care models the healthcare community is migrating toward.
Recent initiatives for health information standardization and government agency regulations seek to accelerate the pace of change. In an analysis released by the West Health Institute (WHI) at a hearing before the House Energy and Commerce Subcommittee on Health, they estimated that medical device interoperability – the ability of medical devices and health care systems to seamlessly communicate and exchange information – could be a source of more than $30 billion a year in savings and improve patient care and safety.
One obstacle to the free interchange of EHR is information blocking, described as activities that limit the availability and use of electronic health information, undermine public and private investments in the nation’s health IT infrastructure and frustrate efforts to use technology to improve healthcare quality and efficiency.
Initially, healthcare system development companies offered several justifications for keeping an organization’s electronic health information (EHI) private: proprietary technology and HIPAA concerns among them. However, the primary roadblock was the incompatibility of existing systems. As the American Hospital Association found in a survey:
As a solution along the way, and perhaps an attempt to eat the elephant one bite at a time, Health Information Exchanges (HIEs) provided a way for private companies, states, or cross-state consortiums to share clinical information electronically while maintaining HIPAA compliance. But HIEs faced some of the same road bumps of incompatible systems, proprietary technology, and security and privacy concerns from patients.
Over time, a series of legislative and regulatory efforts have attempted to overcome these obstacles in the interest of patient care and cost control, the most recent being from the HHS Office of the National Coordinator for Health Information Technology (ONC) and Centers for Medicare & Medicaid Services (CMS).
The new rules released March 9, 2020, are described by CMS as an important step in advancing healthcare interoperability, putting patients at the center of their health care, and ensuring they have access to their health information. The new ONC rule is based in the belief that “patients should have the ability to move from payer to payer, provider to provider, and have both their clinical and administrative information travel with them throughout their journey.”
While the new CMS regulations will require some seismic changes in how health plans handle and share claims and encounter data, only a quarter of plans appear to be prepared for the challenge. According to an Accenture survey of health plan executives, “26% of payers surveyed said they are “very familiar” with the regulations…” and “26% of payers believe their organization is “very prepared.”
Healthcare isn’t the first industry to face this challenge. According to HIMSS, “American railroads were initially built to serve specific cities and their surrounding areas, with little thought to eventually connecting one to another. By the 1870s there were more than 20 different railroad gauges used across the country, making it impossible for trains to move from one area to the next. It wasn’t until a common standard was established, and all railroad systems adapted to match this standard, that cross-continental travel and shipping could be achieved.”
Establishing one universal data standard is one of the goals of the new CMS rules, “Ensuring the privacy and security of patient information is a top priority for CMS. Identifying the right standards can help data flow securely and efficiently. CMS, in partnership with the Office of the National Coordinator for Health Information Technology (ONC), has identified Health Level 7® (HL7) Fast Healthcare Interoperability Resources® (FHIR) Release 4.0.1 as the foundational standard to support data exchange via secure application programming interfaces (APIs).”
FHIR was developed by Health Level Seven International (HL7), a not-for-profit, ANSI-accredited standards developing organization. The FHIR standard uses modern web-based API technology that the ONC describes as “messengers or translators that work behind the scenes to help software programs communicate with one another. If you have ever used a web-based application or a mobile ‘app’ on your computer, smartphone, or tablet to purchase a flight or pay a bill, you’ve probably used an API. ONC has adopted API certification criteria for electronic health records to help enable access to health information for clinical and patient-facing uses.”
From the patient’s perspective, apps powered by APIs bring the ease and immediacy of their interactions with other industries into healthcare. Data from fitness trackers can be added to a patient’s personal health record. Soon, diagnostic information like blood pressure readings, blood sugar levels, and other health information patients generate themselves could be shared directly with physicians in real time.
The industry is gearing up for such opportunities made possible by the Internet of Things (IoT). Gartner surveyed 500+ U.S. IT managers and found that “IoT adoption is becoming mainstream. Eleven percent of those surveyed worked in healthcare enterprises, and 86% of those respondents reported having an IoT architecture in place for most lines of business.” The survey also revealed that among organizations with annual revenues of more than $100 million, 79% of the healthcare providers are already using IoT in their production processes.
As CMS explained, giving patients better access to their own medical data is at the core of the new rules. “By prompting clinician providers and payers to give patients access to their medical records and claims data through API-enabled third-party applications, patients should gain greater control of their own health.” ONC head Don Rucker, MD said, “Delivering interoperability actually gives patients the ability to manage their healthcare the same way they manage their finances, travel and every other component of their lives.”
The push for more access to health data is coming from patients as well. Medical practice technology company, ElationHealth notes that “Electronic health records (EHRs) are key to communicating with patients, providing patients with access to their own medical records, and engaging those patients so that they become more participatory in their own healthcare. Face-to-face time is still important and effective for the independent physician, but technology options that enable electronic engagement before and after the visit will prove invaluable in keeping those patients engaged.”
Patients are fully onboard with this approach, a Transcend Insights survey of patients found that 64 percent say that they use a digital device (including mobile apps) to manage their health and and 71 percent believe it would be helpful for their doctor to have access to this information as part of their medical history.
Healthcare interoperability can also improve the efficiency of care delivery. An example that Healthcare IT News cites is, “A healthcare provider organization, for example, can input a patient’s information into a system that works with insurance companies and nearly automatically determine the patient’s coverage for a specific procedure or medication.”
Giving patients access to clinical and administrative data on their healthcare has become table stakes for providers and payers. On the payer side, the new CMS rules emphasize their role in ensuring that full patient data is accessible and interoperable, noting that health plans are in a “unique position to provide enrollees a complete picture of their claims and encounter data” and that plans need to “improve access to and the quality of information that Americans need to make informed healthcare decisions, including data about healthcare prices and outcomes.” HL7 summarizes the to-do list for payers as:
These efforts are increasingly important as healthcare migrates to a value-based care model that relies on member engagement to improve outcomes. As McKinsey observes, “Health insurers have long recognized the importance of engaging members to improve the value of care, particularly in the context of traditional care/disease management… health insurers are beginning to leverage the digital, advanced analytics, and personalization capabilities developed and refined in other industries…: and “are starting to improve clinical outcomes, enhance member experience, and reduce near-term medical costs.”
Patient health network, WEGO Health confirms that, “Engaged patients are more likely to take preventative measures like having regular health checkups, screenings, and immunizations. They are also more likely to eat healthfully, exercise regularly, and avoid risky behaviors like smoking. Fewer illnesses, and illnesses that are identified earlier and therefore easier to treat, are the result.”
A Healthcare Financial Management Association (HFMA) survey sponsored by Humana found that healthcare interoperability is a critical component for value-based care success. “Over 70 percent of healthcare financial executives say that data interoperability must improve within the next three years to ensure the success of value-based care, and that organizations are aiming to improve both their external and internal interoperability to allow greater visibility into financial and clinical opportunities.”
While the recent CMS rules have put healthcare interoperability on the fast track, there is wide agreement in the industry that interoperability is a requirement for patient engagement, value-based care and improved outcomes. The inclusion of payers in the rule is a recognition that for a complete picture of their health, patients and members must have access to both clinical and administrative aspects of their care.