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Healthcare IT Interoperability

A Six-Part Series by Will Stabler

About This Series

I wrote this article series in six parts over two months during early 2017 when there was considerable news being made and on the horizon in healthcare IT interoperability.

Articles in This Series

Interoperability is the way we get to data that can empower patients to become more involved in their health care in a way that benefits them, plans, providers and the system as well by creating a healthier overall population.
 
As efforts to achieve interoperability move forward, many challenges and obstacles lie in the way, including reluctance to share information for many reasons, including competitive advantage for both providers and developers, costs and liability.
 
This article examines the two most important users of healthcare information—the clinician and the patient—and where they interface, in the electronic Health Record (EHR).
 
Everyone involved in EHR interoperability and adoption needs to take seriously physician concerns over loss of patient interaction & the squeeze on time that can potentially result in loss of revenues.
 
We need patients using their health information and giving their feedback to clinicians in shared decision making and care management relationships. From there we can improve the interaction that goes on there among those two human elements and the technology so we can create that world where patient-generated data comes to the forefront.
 
6. Work Moves Forward for Healthcare IT Interoperability
Interoperability should eventually take us to a place where patients and providers are enabled to work as a team toward preventive medicine and value-based care. This is a place where patients have access to their full medical records, and are working in decision making partnerships with their healthcare providers.

Work Moves Forward for Healthcare IT Interoperability

By Will Stabler

First published on May 16, 2017

Throughout this article series, attitudes toward interoperability and the perception of its importance in healthcare information technology have been key issues. There is a lot of emphasis on achieving interoperability, but where is the motivation; how much work is being done to make it happen?

The Business Case

There is often no stronger motivation in any industry for action than the bottom line, and interoperability—or the lack of it—can have a big effect. The latest annual Report to Congress from the Office of the National Coordinator for Health IT (ONC), released in November 2016, addressed the business case for healthcare IT interoperability and where some of the most meaningful drivers and some of the biggest barriers may be found.

“Beyond moving to technical standards that enable the flow of electronic health information, shifting payment models to those that pay for quality versus quantity of services is pivotal to building the business incentives that drive demand for interoperability,” the report states. “While the Medicare and Medicaid EHR Incentive Programs have often been a primary motivator for the adoption and use of certified EHR technology among specific groups of clinicians, these programs alone are insufficient to overcome barriers to seamless information flow. The traditional business environment does not adequately reward, and often inhibits, the exchange of electronic health information, even when exchange is technically feasible.”

If you have any doubt whether people are actively working on interoperability in healthcare informatics, just go to the Office of the National Coordinator (ONC) for Health IT’s Interoperability Proving Ground (https://www.healthit.gov/techlab/ipg/). At this site you’ll find ongoing and completed projects in interoperability from all over the country and the world. It’s inspiring and a little daunting all at the same time, but you might be able to find a group of people who have come up with a solution for some of the challenges you might be facing. You can click on a map with links to information about the various projects or search through descriptions of more than 250 active and complete projects. All have contact information.

Enforcing the Free Flow of Information

There are not only business carrots for driving interoperability—there are also some big sticks. Information blocking as a challenge to healthcare IT interoperability, and not just the kind created by healthcare IT vendors, is being addressed on several fronts. Perhaps most notably is the provision in the 21st Century Cures Act, which went into effect in December 2016, which makes developers, exchanges and networks subject to civil monetary penalties of up to $1 million per violation if they have been found to have engaged in information blocking and have submitted a false attestation.

In the MACRA Quality Payment Program final rule published in October 2016, which went into effect on January 1, CMS began requiring those eligible to participate in the Medicare and Medicaid EHR Incentive Programs, as well as the Merit-Based Incentive Payment System (MIPS) to attest to a three-part statement related to supporting information exchange and the prevention of information blocking. In another effort, former Department of Health and Human Services Secretary Sylvia Burwell announced in February 2016 that nearly every major healthcare technology vendor had pledged to use standardized application programming interfaces, to make patient access easier and to not block information.

“Companies that provide 90 percent of electronic health records used by hospitals nationwide as well as the top five largest private healthcare systems in the country have agreed to implement three core commitments,” Burwell said. “The organizations that have made commitments represent hospitals, integrated health care organizations, medical groups and physician offices, academic facilities, long-term and behavioral health care settings, professional and advocacy organizations and patients throughout the country.”

The three core commitments in the pledge are to the following:

  •  Consumer Access: To help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.
  • No Blocking/Transparency: To help providers share individuals’ health information for care with other providers and their patients whenever permitted by law, and not block electronic health information (defined as knowingly and unreasonably interfering with information sharing).
  • Standards: Implement federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information, and adopt best practices including those related to privacy and security.

Moving Ahead With standards

In late April of this year the ONC released its Proposed Interoperability Standards Measurement Framework, and public comments are being encouraged on this proposed industry-wide measurement framework for assessing the implementation and use of health care interoperability standards. According to the ONC, the purpose of the framework is to help health IT developers, health information exchange organizations, and healthcare providers develop a set of uniform measures for assessing progress of interoperability.

 “Stakeholders’ current capabilities to measure interoperability standards vary significantly across the health IT ecosystem,” the framework states in introducing the problem. “This variability presents significant challenges to tracking national interoperability progress on the implementation and use of standards.”

Through discussions with stakeholders ONC has identified two key areas of opportunity for uniform measures for supporting the ability to measure nationwide interoperability progress:

  1. Implementation of standards in a health IT product
  2. Use of standards, including customization of the standards, by end users to meet specific interoperability needs

You can learn more by reading the ONC blog post, titled, “Wanted: Feedback on Ways to Measure the Implementation and Use of Interoperability Standards.” To go to the public comment page and download the framework, click here.

ONC is seeking feedback from stakeholders that include healthcare providers, payers, health IT software developers, health information exchange organizations, medical associations, consumers/patient groups and others. Public comments on the Proposed Interoperability Standards Measurement Framework will be accepted until 5pm ET on Monday, July 31, 2017.

The ONC explains that over the next few years the plan is to collect data on implementation and use of standards through surveys of health IT developers and exchange networks, along with self-reported information from other data-holding stakeholders. In three to five years they plan to coordinate efforts to define uniform electronic measures for implementation and use of standards, which can then be incorporated into health IT products.

Putting it all Together

I would like to go back to the first of the six articles in this series by reiterating how the 21st Century Cures Act defines interoperability: as health information technology that…

“(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user; (B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and (C) does not constitute information blocking…”

Again, interoperability should eventually take us to a place where patients and providers are enabled to work as a team toward preventive medicine and value-based care. This is a place where patients have access to their full medical records, and are working in decision making partnerships with their healthcare providers. When we get there, everyone in the healthcare system can make best use of that patient-generated data, which is predicted to be so valuable in the future. We’re going to get there.