“Interoperability” is health industry jargon that is critical to the widespread use of data in healthcare. Essentially, interoperability is an exchange of information between technology systems. Sounds basic, but for those trying to improve processes, patient care, and become more proactive in treatment plans, the lack of this essential functionality is impeding the widespread adoption of business intelligence models in the industry.
“Without interoperability, it’s impossible for providers to know for sure if a patient’s records are comprehensive,” says Anil Jain, M.D., VP and Chief Information Officer, VBC at IBM Watson Health and former senior executive director of IT at the Cleveland Clinic. “And without key information from disparate systems collected and available in a single place, it’s impossible to use data analytics to develop the insights that ultimately improve performance. Although that exchange of information is often not enough, it is the key first step to make information that is subsequently actionable and credible.”
As a top technology challenge for the industry, interoperability has played a major role in what some are calling a blame game, using it as an excuse for not moving forward with the full on adoption of data science.
And this challenge, while a massive hurdle that has yet to be overcome, is not an issue in other industries that leverage big data. Interoperability happens in all aspects of our life, not just when it comes to our health data.
Take for example the online shopping experience. You purchase a product on Amazon and you later see ads of similar products on other sites you frequently visit or in your social media feeds. This is an everyday example of individualized data being exchanged, or data interoperability. Examples like this leave experts scratching their head as to why the same foundational elements are not yet possible with exchanging health information.
Some blame how the policy makers drafted original legislation, specifically, around the 2009 Health Information Technology for Economic and Clinical Health (HITECH) legislation. The definitions of health information exchange (HIE) were not made clear by key stakeholders such as the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC), according to Julia Adler-Milstein, Ph.D. of the University of Michigan.
“CMS and ONC decided to defer the initial HIE criterion — electronically transmitting a summary-of-care record following a patient transition — to Stage 2 of the Meaningful Use program. While many of the capabilities required for providers to meet this criterion would have been challenging to develop on the Stage 1 Meaningful Use timeline, deferring HIE to Stage 2 allowed EHR systems to be designed and adopted in ways that did not take HIE into account, and there were no market forces to fill the void. When providers and vendors started working toward Stage 2, which included the HIE criterion, they had to change established systems and workflows, creating a heavier lift than if HIE had been included from the start.”
In short, incentives around prioritizing interoperability are weak from a regulatory front, which is now forcing the industry to work backwards to retrofit the core step into the already massive and complex health IT ecosystem.
It’s Not Too Late to Take Action to Dissolve The Challenges Around Interoperability
Without a viable HIE that is fully interoperable, sharing patient information becomes a legal nightmare and essentially, an impossibility.
Partnerships forged between health plan organizations and health data exchanges are making headway into an interoperable reality, according to Kate Monica of EHR Intelligence.
“If we steadily and aggressively advance our progress we can make it a reality,” says the Office of the National Coordinator for Health Information Technology. “We must focus our collective efforts around making standardized, electronic health information securely available to those who need it and in ways that maximize the easy with which it can be used and useful.”
IT stakeholders’ focus, according to the ONC, should include:
- Improving technical standards and implementation guidelines for priority data domains and associated elements.
- Rapidly shifting and aligning federal, state, and commercial payment policies from fee-for-service to value-based models to stimulate the demand for interoperability.
- Clarifying and aligning federal and state privacy and security requirements that enable interoperability.
- Coordinating among stakeholders to promote and align consistent policies and business practices that support interoperability and address those that impede interoperability.
Improvements to data sharing, according to Dr. Jain, include:
- Establishing interoperability criteria.
- Providing training as necessary and monitor adoption.
- Staying current on regulations and choosing vendors and partners who do the same.
- Giving specialists and out-of-network providers the assistance they need to achieve interoperation.
“Whatever you do, keep the end game in mind: Every step you take to connect your organization brings your providers and patients that much closer to the future of health care,” says Dr. Jain.
Interoperability Is in Need of a Business Case
Despite the challenges of standardizing a way of identifying patients, enforcement across care settings, and industry-wide measurement standards — to name some of the top interoperability challenges today — developing a sound business case that prioritizes health information interoperability beyond the policy level will encourage initiatives to overcome these challenges.
Learn more about the need for an overarching business case for not only interoperability, but the use of data in healthcare as a whole in our recent free resource, You Are Here: The Pioneer Days of the Relationship Between Healthcare and Data.