Health IT Interoperability: How Far Along Are We?

Electronic health record adoption is on the rise. The number of hospitals using basic EHR systems tripled from 12.2 percent in 2009 to 44.4 percent in 2012, according to a report released by the Office of the National Coordinator for Health Information Technology and CMS.  However, the move towards efficient care coordination and care delivery through health IT does not end with EHR adoption alone. Clinical information needs to be able to flow seamlessly between EHR products within one health network and among different networks. Various healthcare industry sectors and software vendors are, therefore, focusing on advancing the interoperability of health IT systems.  

Interoperability refers to the seamless and secure flow of data between IT systems. "We have long recognized the importance of healthcare data interoperability," says Leigh Burchell, vice president of government affairs at Allscripts. "It is a cornerstone of the larger delivery and payment system reforms that must be enacted to improve quality, reduce costs, enable regulatory compliance and ensure better access to fully informed healthcare for millions of people."

There is a tremendous amount of work being done by the ONC, industry consortiums and various other initiatives to further interoperability, says Pam Matthews, senior director of informatics at the Health Information and Management Systems Society, but achieving complete interoperability will take more work, and there are still several challenges to be overcome.  

The differences in structure, format and meaning of healthcare data is one of the biggest barriers to true interoperability, says Ms. Matthews, which is why having standards and specifications in place to support information exchange is essential. Ensuring that software vendors and industry initiatives are working together for the advancement of interoperability is also important. To assist in the industry understanding, HIMSS published a definition outlining three levels of interoperability. According to Ms. Burchell, the issue is further complicated by the fact that there are areas where providers are interested in care coordination but still lack the necessary technology infrastructure.

The healthcare industry is attempting to remove barriers to interoperability and implement the necessary technology infrastructure in various ways. Here is a snapshot of some of the initiatives that have been established.

Public sector
According to Ms. Matthews, on the government side, the Health IT Standards Committee is leading the charge towards standardization and interoperability. The committee makes recommendations to the ONC on standards, implementation specifications and certification criteria for the electronic exchange of health information. Standards and interoperability is a key point for the ONC, says Ms. Matthews, particularly because the move from meaningful use stage 1 to stage 2 and then stage 3 will result in increase in requirements around interoperability. Interoperability of health IT systems will have to increase to ensure that the expanded data, resulting from the advancement in meaningful use stages, can flow smoothly between organizations. The ONC's Standards and Interoperability Framework, overseen by the Office of Interoperability and Standards, is another government initiative that aims at furthering interoperability. The framework uses input from the public and private sectors to build model-driven, repeatable processes that leverage the best practices in the industry to create standardized health IT specifications.

The ONC has established the Exemplar HIE Governance Program as another example of interoperability activities, says Ms. Matthews. Under this program, the ONC has, so far, granted cooperative agreements to two organizations working to further interoperability.

Private sector
One of the most significant steps that the private sector has taken towards addressing the issue of interoperability has been the formation of the CommonWell Health Alliance — a non-profit alliance of six major healthcare software vendors. The vendors that make up the alliance are Greenway, Athenahealth, Allscripts, RelayHealth, Cerner and McKesson. According to Ms. Burchell, the alliance is collaborating to remove barriers to data access by creating an open forum for secure patient data exchange. Among its goals is to define and certify a national infrastructure that includes cross-entity patient linking and matching services, and patient consent and data access management. It expects to add several participants in the near future, says Ms. Burchell.

Public-private partnership
Healtheway, a non-profit, public-private partnership is also working to expand interoperable exchange of health information, says Ms. Matthews. Healtheway operationally supports the eHealth Exchange, formally known as the Nationwide Health Information Network Exchange. The eHealth Exchange began in 2007 as an ONC nationwide health information network program and it now operates independently, supported by Healtheway. The core values of Healtheway include protecting information exchanged, maximizing the effectiveness of health information exchanged and encouraging participation from a diverse set of stakeholders. To become a Healtheway participant, organizations have to meet certain criteria, which include ensuring a certain level of interoperability of their systems, says Ms. Matthews.

The healthcare industry is taking definite steps, through government and non-government initiatives, toward making health IT systems interoperable. And while the industry is moving at an impressive pace, "there are still quite a few obstacles that need to be removed in order for a seamless digital ecosystem to really take root," says Ms. Burchell.

Ms. Matthews points out that as we continue down the path of healthcare reform, we will find new data and new ways to use data, and that in turn will affect our work with interoperability. "It has to change along with our needs," she says. "We are on a journey."

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