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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

1. The Long Road to Interoperability in Healthcare Information
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.
 
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.

The Long Road to Interoperability in Healthcare Information

By Will Stabler

First published on March 27, 2017

With the withdrawal last week of legislation to repeal and replace the Affordable Care Act (ACA), we in health care are left with both the positive and negative effects of the ACA. Now I can get back to an issue I hoped was gaining great momentum late last year but that has languished because of everything else going on in the news of health care. As House Speaker Paul Ryan said Friday, it’s time to move on.

“I don’t know what else to say other than Obamacare is the law of the land; it’ll remain law of the land until it’s replaced,” Ryan said. “We’re going to be living with Obamacare for the foreseeable future.”

It’s time to turn to another healthcare law that was recently enacted and the positive effects it is intended to have on one of my most important issues of concern—interoperability in healthcare information systems.

The 21st Century Cures Act

Back in what seems like eons ago—mid-December of last year—I was encouraged by the passage of the bipartisan 21st Century Cures Act, which expands President Obama’s Precision Medicine Initiative, promotes several research activities, and encourages wider use of electronic health records by both federal agencies and the healthcare industry. 

The mission statement of the Precision Medicine Initiative explains the purpose behind it: “To enable a new era of medicine through research, technology, and policies that empower patients, researchers, and providers to work together toward development of individualized treatments.”

For fans of healthcare interoperability like me, the part of the 21st Century Cures Act that most grabs my attention is Title IV, which addresses “Delivery.” This section is meant to encourage interoperability of electronic health records and patient access to their own health data, and discourage information blocking. These three intertwined issues have been a focus for me during my career, especially during the past decade as these systems have rapidly evolved. The Act also is meant to help reduce the documentation burden on physicians and create an EHR usability reporting system, which are vital to moving forward toward interoperability.

A comprehensive plan to work on all of these issues together has been long overdue in health care, and it is the key to a holistic approach to healthcare informatics and analytics that I emphasized in my previous series of articles on risk adjustment. Interoperability is the centerpiece of tackling these challenges and it is the major focus of this series.

Defining Interoperability

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 as defined in section 3022(a).”

It remains to be seen whether the ambitious aims of the Cures Act will be able to help us meet the challenges of interoperability, which are many—from creating a national application programming interface, to providing intuitive user experiences, to letting disparate systems all over health care talk to one another in a meaningful way. The next step, which hasn’t taken place so far, is to complete the process of creating the Health Information Technical Advisory Committee, which is meant to merge and replace the existing Health IT Policy and Standards Committees. The Government Accountability Office is now accepting nominations for HIT Advisory Committee appointments that will be made in July 2017. That puts us a few months behind on the original schedule, but things are moving forward.

The long road to interoperability eventually leads to a place where patients and providers are enabled to work as a team toward preventive medicine, wellness and value-based care. Somewhere down that road it will mean giving all patients access to working versions of their full medical records, which is something patients should start insisting on.

In a Healthcare Informatics article published in the summer of 2016 titled, “Time for the Feds to Truly Open Up Patient Records to Fully Interoperable Data Use,” American Medical Informatics Association CEO Doug Fridsma, M.D., Ph.D., stated, “…to support things like discovery of new knowledge and to support precision medicine activity, we really do need to make sure that patients have access to their full medical record, in a computable format, not just a PDF format.”

The data can empower patients to become more involved in their health care in a proactive way that not only benefits them, but plans, providers and the system as well by creating a healthier overall population. Interoperability in healthcare informatics is the way we get there, and I look forward to the potential significance of the HIT Advisory Committee getting to its assigned task of making interoperability a priority. They have a monumental task ahead of them.

In the next article I will explore some of the major challenges of interoperability in health care, on the way to explaining how they can be overcome from both the top down and the bottom up.