The need for a connected healthcare system and the reality of healthcare reform has fueled our progression toward a more interoperable existence. Many other industries have also experienced a technological "disruption," but the overall complexity of healthcare, combined with a lack of widely-adopted standards, has made our journey a bit more arduous.
While we have been making great strides toward achieving true interoperability, barriers still remain.
Earlier this year, the Office of the National Coordinator for Health IT reported that more than half of U.S. hospitals have electronic access to patient health information 1. Additionally, a recent study commissioned by McKesson Health Solutions — Journey to Value: The State of Value-Based Reimbursement in 2016 — discovered that value-based reimbursement is at a tipping point, and that the majority of payers and providers are at least 50% along the way on the continuum to value-based reimbursement 2. However, there is still a long way to go before the industry can conduct patient-centered data exchange and be truly interoperable.
Our entire industry is witnessing and actively participating in patient-centered exchanges across provider and health systems, but we are employing disparate solutions. Secure, direct email exchanges, as well as broad based query and exchange services such as CommonWell, are growing in popularity, but the exchange of patient health data still is not seamless. Health data is sensitive, complex and often needed in real-time. Consistent with the consumer-first world (think money transfers) to which we have become accustomed, there is also a growing expectation among patients that they should be able to access their own data. Scaling connections across disparate software solutions and technology platforms adds another layer of complexity, so full deployment will take time, but we are getting there.
Currently, the four biggest barriers to achieving interoperability are:
1. Aligned financial and quality based incentives. Aligning financial and quality incentives with the best interests of patients will help drive the highest level of care at the lowest cost. Our industry still primarily uses a fee-for-service model of care, which is not going to get us to where we want to be. We need to expedite the shift to alternative payment models, which will in turn drive the need for greater care coordination and patient engagement. Until this alignment is achieved, interoperability will be in competition with myriad priorities on provider roadmaps. Unfortunately, we are not yet at a state where we can effectively manage the overall longitudinal care of patients with the click of a button. Information, such as most recent status and current medications for example, is not yet easily accessible. Ultimately, providers' main priority is the provision of patient care and until interoperability is integral to workflows and becomes necessary for providers' financial well being, providers will continue doing what's best for their bottom line.
2. Cohesive security framework. When connecting patients to providers and providers to providers, a solid, trusted framework for constituents is key. The goal is to ensure that information is exchanged securely — no easy feat, but providers are rising to the challenge while also focusing on patient privacy. Once the third stage of meaningful use begins in 2018, we will encourage broad scale adoption of web-based consumer applications that will connect directly to EHRs via an application programming interface. Of course web-enabled access and solutions also present a high degree of security and privacy concerns which must be responsibly factored into the equation.
3. Appropriate patient matching. Patients deserve to feel secure that their providers are confidently identifying, locating and retrieving records correctly. Unfortunately, this is still a challenge for many healthcare providers. Today, our industry largely has the capabilities to transfer a patient's episode of care and medical records from one provider to another, but confidence in the ability to accurately match patients as we exchange information across disparate systems still remains a concern. Industry efforts such as CommonWell and other similar solutions that offer trusted patient matching methodologies and services are maturing, and as their deployment scales, confidence will increase. However, until this happens, accurate information exchange remains a significant problem for the industry.
4. Standards that take advantage of mobile and web-based solutions. We live in country where 64 percent of adults own a smart phone, and this number is growing.3 In order to best serve patients and providers, our healthcare system must be mobile accessible.4 Standards such as FHIR and SMART on FHIR are evolving, and to use the web and mobile connectivity at its fullest, advancements in privacy and security models to support an API based ecosystem in healthcare must move in parallel.
Our industry can continue to push hard, and legislation and regulation will drive accountability and provide direction, but true progress cannot be forced. Payers, providers and vendors simply need time to evolve. Healthcare has made exponential progress considering how far we have come from the mostly paper-based systems from just a decade ago. Vendors are largely aligned and collaborating and many are working diligently towards the creation and adoption of new standards. However, we all must appreciate that patient-centered interoperability is a key component of the overhaul of our health system. As such, it will pace industry transformation. As more providers are presented with a comprehensive, longitudinal view of their patients, performance factors will become mandatory and not just "nice to have." We will need to see what programs and models work best, but it's important to remember that this is an evolutionary — not revolutionary — process and it will just take time.
1 https://www.beckershospitalreview.com/healthcare-information-technology/the-state-of-interoperability-5-statistics-from-the-onc.html
2 http://www.mckesson.com/about-mckesson/newsroom/press-releases/2016/value-based-payment-hits-the-tipping-point/
3 http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/
4 http://www.pewinternet.org/2015/04/01/us-smartphone-use-in-2015/
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