The last decade of evolution in our world of Health Information Technology (HIT) has brought massive changes to the way providers deliver care and can deliver care.
In large part due to government initiatives and the pull-through effect of value-based reimbursement, interoperability has become a reality and has become expected in many care settings. There are a few niches of care delivery, especially post-acute, where this impact is just being seen, but data does not lie. Between 2008 and 2015, the number of non-federal acute care hospitals who exchanged healthcare data outside of their system rose to more than 80%. After incorporating interoperability into their health IT capabilities, nearly 90% of providers report improvements to the quality of patient care – which doesn’t even take into account improvements in their efficiency and peace of mind.
While all this is wonderful news, there is still much work to be done. Of the 10 million Medicare beneficiaries discharged into the post-acute environment every year, more than two thirds have two or more chronic conditions, and approximately 14% have six or more. These patients are seen by sometimes dozens of providers in a calendar year. Oftentimes these patients are discharged after an unplanned care encounter in an acute setting. Because they are unplanned, no efforts are made to push information from an HIT platform to the acute care setting and it is still rare when the patient records are pushed out to a home health or LTPAC setting. While those HIT platform systems that had the patient, record may have the technical capability to exchange information, what we really need to migrate to is a patient-centric approach to interoperability. Simply put – it is no longer good enough to say “we can send this information if need be.” Instead, the industry must move to an environment where the data flows automatically around the needs of the patient.
What is necessary for this to happen, above and beyond the capability to generate or read discrete clinical data or codified documents? Several things are needed, but the first is the attitude that it is possible and it does need to happen. On top of the proper attitude, we need the right clinical triggers to set things in motion. We need complete content – clinical information is gold for patient care – but we also need a lot of information and documents to justify the delivery of post-acute care. And last but certainly not least, we need scalability.
While writing interfaces is getting less time-consuming every day, all the king’s horses and all the king’s men and women would take decades to write all the point-to-point interfaces to make interoperability as ubiquitous as our patients deserve. Additionally, managing interfaces when they break would become a cumbersome task. This is why we need nationwide organizations to help with scalability.
Direct Trust, CommonWell Health Alliance and Carequality are all doing wonderful things to enable data to better follow the patient from care setting to care setting. Direct Trust enables the various HISPs who power Direct Secure Messaging to work seamlessly with one another. You should expect referrals to leverage this technology, as it brings a host of data on the patient and offers information that will allow providers to take advantage of other networks where data can follow a patient without provider intervention.
CommonWell Health Alliance offers not just an ability to query for and retrieve data from additional care settings on a patient that was referred to your organization, but it also adds the ability to link patient identity on a nationwide level and a record locator service to alert providers to other expected or unexpected care encounters. Leveraging technology that utilizes both networks, platforms that have the correct architecture (such as a cloud-based platform) can share large-pipe interfaces across their entire customer bases. This drives costs out of the system while also reducing deployment time.
In one of the biggest news stories in interoperability a year ago, CommonWell and Carequality announced their agreement to connect. Anticipated to go to pilot early this year, this connectivity will allow patient data to flow to and from even more locations across their large footprints. To put this in context, more than 90% of the non-federal hospital beds in the country are in hospitals powered by vendors who belong to one or both of these organizations.
In January, the Office of the National Coordinator for Health Information Technology (ONC) released their draft Trusted Exchange Framework and Common Agreement. Directed by the 21st Century Cures Act, the draft ONC document calls for the inclusion of record locator services and more support for patients to access and control their care records. These are huge wins for both the patient and the provider.
On the topic of clinical triggers and content improvements, there are great strides being made every day. When I speak with interoperability teams from major EHR vendors, very rarely do I get a “we can’t do that” when I make a request for post-acute improvements. Most often, it is “we had not heard of that issue before, but I bet we can come up with a solution.” By combining smart conversations with scalable solutions, we will enable a patient-centric world that is effective for care delivery in the post-acute care setting.
To circle back to the needs to migrate from a platform centric to patient-centric world of interoperability, we need you. The attitude that it is possible and needs to be put in place comes from the knowledge that this can be done and is being done. Smart providers are plowing these fields today, and you need to expect an experience that puts your patients and your workflows first.
About the Author
Nick Knowlton is the vice president of strategic initiatives for Brightree, where he leads the company’s approach to health care interoperability. Knowlton also co-founded CommonWell Health Alliance and serves in a leadership role. He graduated from the University of Notre Dame, and lives in Denver with his wife and three children.
The views, opinions and positions expressed within these guest posts are those of the author alone and do not represent those of Becker's Hospital Review/Becker's Healthcare. The accuracy, completeness and validity of any statements made within this article are not guaranteed. We accept no liability for any errors, omissions or representations. The copyright of this content belongs to the author and any liability with regards to infringement of intellectual property rights remains with them.