Healthcare has yet to achieve the promise of interoperability.
To be clear, the true meaning of interoperability goes well beyond the functional means of connecting EHR systems and exchange data. That capability is the tip of the iceberg. Essential components of interoperability include the quality, timeliness and usability of the data exchanged. We must ask, Is this information useful to clinicians at the point of care so they can take better care of patients? If the answer is no, true interoperability has not yet been accomplished — even if data was shared between two systems.
"When we work with and interact with folks who drive strategy across their healthcare systems, we see it's not necessarily 'interoperability' they're looking to achieve, it's really the vision of a healthcare platform," said Mike McAfee, area vice president of technology solutions of population health at Allscripts. This means interoperability is more about whether the data exchanged results in useful, timely information for members of the care team that drives better quality and lowers cost.
In April, Mr. McAfee led a discussion and real-time polling during an executive roundtable at the Becker's Hospital Review 10th Annual Meeting in Chicago, where hospital and health system executives discussed what interoperability means to them today and how their organizations are working to achieve it.
Allscripts connects to nearly 100,000 points of care across the country, and its vendor-agnostic interoperability solution enables seamless information exchange between 360 unique data sources, including every large vendor in the market and most smaller ones, labs and imaging solutions. By offering these capabilities, Mr. McAfee and the Allscripts team have come to appreciate how the ability to access real-time patient information from other members of a patient's care team directly influences the cost, outcomes and quality for an episode of care.
"This is what we hear over and over again, 'I need to drive the right process to the right point of view so whenever I see that patient, I already know what's going on with them,'" Mr. McAfee said. "'That way I won't do something duplicative or [by] trial and error. That way I can engage with the patient and reach out so he or she knows what it is they're on the hook for and what they need to be engaged in, then monitor whether they've actually done it.'"
4 key takeaways from health system executives
During the executive roundtable, Allscripts leveraged mobile polling to pose questions to executive participants and gain insights in real time to better understand how health system leaders define interoperability, what value it brings to their organizations, who and what they rely on most to achieve it, and the concerns they have about the data they share.
Here are a few of the questions asked during the roundtable, with summarized answers:
How do you currently define interoperability?
Executive respondents were nearly neck and neck in their selection of two responses: 13 participants said they define the term as the management of populations across a clinically integrated network, ACO or health information exchange. Eleven interpret interoperability as having access to external clinical information. Few participants view interoperability as the enablement of efficiencies between internal processes, such as admission, pharmacy or registration.
One participant noted that the body enforcing interoperability is as much of a concern to him as the working definition for the term itself. "Whether you define it A or B, it matters if we are going to have to create interoperability versus having some impetus from the outside to have the technology industry be able to create it," said the board member for an 11-hospital system in the Northwest. "There is a widespread perception that we missed an opportunity with the stimulus package of 2009 and instead got Meaningful Use, whereas interoperability would have been more productive. Over the last four years there continues to be more discussion about that in the regulatory environment."
What value does interoperability currently deliver for your organization?
The majority (17) of respondents said access to clinical information across all internal systems in the enterprise is the largest value. Comparatively, only three participants pointed to population health management as interoperability's driving value.
Although the majority of respondents see great value in the ability to seamlessly exchange information throughout the enterprise, some remarks illustrate how health system executives have come to accept the idea that this cannot be accomplished in a vendor-agnostic fashion.
"The easiest answer is having one platform for all of our sites," said the CEO of a hospital in Chicago. "At least in the city, we have Epic everywhere—so if one of my patients goes to a competing hospital's ER and they give me permission, I can see their information. Patients go everywhere. Forty percent of them are going out of network. You have to have access to that." This interpretation of interoperability in one market is limited in scope and distinct from the idea of interoperability for all in a multi-vendor healthcare environment.
What do you rely on to achieve interoperability?
Nine executives rely most on their staff. Five rely on national or statewide regulatory mandates, two on industry standards like FHIR or API, and one on vendors. Three participants said they rely on all of the above.
Although most participants rely most heavily on their staff to achieve interoperability, staff members face a number of barriers that impede their efforts. One participant, the CEO of an integrated hospital and clinic in the upper Midwest, made note of an opportunity for vendors to educate and support staff in bringing data together and presenting it in a meaningful way. "I wouldn't say there's a lot of help from our vendors to staff," he said. "There are tons of pain points staff face. There's too much data and not enough time."
What is your primary concern with the data you are using to manage your populations?
By and large, executives are most concerned about the timeliness of the data, with governance and information spread across several domains (clinical, claims, survey, etc.) clocking in second and third, respectively.
The CEO of a medical group practice with several locations in the south said challenges related to the timeliness of data are multifactorial and affect patient care plans and risk-based contracting, among other factors.
"It's gaps in care and information that is often from managed care organizations in our state that may be behind scheduled," she said. "If you are treating a high-risk patient population, patients can be readmitted to the hospital or visit the local ER while you are awaiting data. That's one aspect of timeliness. The other is when there's any transformation you're interested in at the state level. We have a higher volume of Medicaid patients, for instance, so we rely a lot on the state to feed us that information. That's why we're concerned about timeliness."
Key points in summary:
- Interoperability is more than two parties exchanging data. It is about whether the data exchanged results in useful, timely information for members of the care team that ultimately influences the quality, outcomes and cost of a patient's care episode.
- Most hospital and health system executive respondents in Chicago defined interoperability in one of two ways: the management of populations across a clinically integrated network, ACO or health information exchange; or the state of having access to external clinical information.
- Most hospital leaders said access to clinical information across all internal systems in the enterprise is the largest value of interoperability, but conversational remarks illustrate that hospital executives have come to accept the notion that this is only accomplished if all points of care use the same EHR vendor.
- Hospital and health system leaders are relying heavily on their staff and teams to achieve interoperability, while nearly 90 percent fewer respondents are counting on vendors. One participant noted opportunity for vendors to act as better collaborators with hospital staff in interoperability education and training.
- Timeliness of data is a major concern for health system leaders, as the promptness of data access directly influences patient care plans, risk-based contracting and other major tenets of care delivery and health system strategy.