What does interoperability have in common with Fortnite and this summer’s record-setting weather?
If you guessed that all are currently very hot, then you are correct.
Between the recent ONC Interoperability Forum, the big interoperability announcement from Information Technology Industry Council (whose members include Amazon, Google, Microsoft, Salesforce, IBM, and Oracle) and CMS’s renaming of the EHR Incentive program to the Promoting Interoperability program, it seems as if everyone has interoperability on their minds.
Obviously, interoperability has been a hot topic for quite some time. Yet, as we finish out this scorching summer it seems everyone is vocalizing support for improving interoperability and the flow of health information between providers. I am as pleased as anyone that the pro-interoperability movement is taking off and that tech companies, the government, health IT companies and providers all love the idea of interoperability. But will we be able to convert all this interoperability love into a framework that actually gives clinicians actionable data to improve patient care?
As eager as everyone is to support a super highway to facilitate data-sharing, the reality is that the highway won’t support more than a bicycle if we don’t establish data-exchange standards.
The myth of electronic paper
At the Interoperability Forum, CMS head Seema Verma announced her goal to replace faxes with digital health information by 2020. While making healthcare fax-free sounds great in theory, the reality is that many providers will move from faxing to the emailing of PDF files that contain patient records. Unfortunately, a PDF is nothing more than an electronic version of paper and does little to improve interoperability.
Imagine the challenge of managing a daily flood of PDFs containing pages and pages of unstructured data. In order to make the information of value for a provider, someone has to weed through each document and organize the data in way that provides actionable insights for each patient. Sharing clinical data is great – but the value of the information is diminished if the receiving physician can’t quickly find the right data at the right time for the right patient.
Standards are essential
HIMSS notes that for two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user. We currently have a number of highways that facilitate the exchange of data. Now we need to focus on defining the rules of the roads and identifying what types of cars must travel the highway to ensure end users receive usable information in a timely fashion.
Clearly electronic paper isn’t the right vehicle. Instead, providers need a a solution that facilitates the exchange of data in a structured format using defined standards. Without defined standards, clinicians will continue to struggle to find the contextually relevant information they need at the point of care.
Of course, the identification and enforcement of standards will be no easy task. In addition to technical challenges, politics will definitely come into play. Not every health system is willing to share records with their cross-town competitor, and some EHR companies fear that interoperability improvements might make it too easy for customers to switch vendors. Gaining a consensus on standards will be difficult and stakeholders will worry about financial details, such as who should pay for technology upgrades and the infrastructure required to securely transport electronic records.
Start with carrots, sticks and the basics
A well-developed incentive program will be essential to get providers, payers and vendors on board. Everyone may say they are in favor of interoperability but many will resist jumping on the interoperability bandwagon if there’s a negative impact to their bottom line. Assuming CMS takes the lead on this initiative, administrators will need to consider the impact on all parties and create a carrot and stick program that encourages participation and adherence and penalizes any record-blocking attempts.
Achieving true interoperability will be a mammoth task, so I suggest starting with just a few basic categories, such as medications, lab results, immunizations, allergies, and diagnoses. Once we have mastered record-sharing for these core elements, we can address how best to share the patient information that’s not as easily converted to a standard format.
Interoperability is more than just a hot topic: it’s essential for the delivery of safe and cost-effective patient care. And now is the time for the industry to move from the bike lane to the fast lane and start making interoperability a reality.
By David Lareau, CEO of Medicomp Systems