Symphony of Collaboration

Through national and state initiatives launched or accelerated as the result of a 2004 Executive Order, eHealth is beginning to gain real traction in the United States. That’s good news for all industry stakeholders. Initiatives that thrive and create workable solutions advance system interoperability and streamline data exchange. Accelerating health IT adoption is essential to improving the efficiency, delivery and quality of healthcare and, ultimately, achieving the promise of eHealth.

For a variety of good reasons and good intentions, a great deal of this work has focused on clinical data exchange — modernizing medical records and making patient treatment data more accurate and accessible. The Healthcare Information and Management Systems Society’s (HIMSS) Integrating the Healthcare Enterprise initiative (IHE), for example, has been very effective in creating a framework for passing vital clinical information across multiple healthcare enterprises and their individual IT systems. The program actively drives the adoption of standards to address the exchange of radiology, cardiology and laboratory data across numerous systems.

There is no arguing that initiatives focused on clinical information are crucial components for the advancement of eHealth. But a national health IT solution must integrate both clinical and administrative information to transform healthcare. That means bringing the same sharp focus to improving consistent access to administrative data. It also means creating an environment in which all stakeholders exchange information by the same rules.HIPAA provides an important first step. It spells out the critical healthcare transactions, code sets and identifiers. But real-world application of HIPAA standards has shown that rules with greater specificity are required. As with the clinical side, improving administrative data exchange requires reaching industry consensus on how IT systems interconnect and transfer specific data content, which is no easy task.

Interoperability Requires Collaboration

What will it take to achieve this important goal? The key is industry collaboration. In fact, when collaboration occurs, the results can be profound. As Executive Director of CAQH (Coalition for Affordable Quality Healthcare), a nonprofit alliance of health plans and trade associations working to simplify healthcare administration, I’ve been fortunate to see first hand the mutual benefits that collaboration can bring.

Led by NACHA — the Electronic Payments Association — the banking industry used a rule-writing approach to create the Automated Clearing House (ACH) Network, one of the largest electronic payment networks in the world. NACHA succeeded in bringing together hundreds of diverse payment system stakeholders and organizations to administer, develop and enforce a set of operating rules that outline standards for data exchange between banks. The result has been that financial institutions located anywhere in the U.S. can
exchange ACH payments under a common set of rules and procedures.

Borrowing from the banking industry model, CAQH has brought together more than 100 of the country’s largest health plans, provider groups, associations, regional entities, standard-setting organizations, government agencies, technology companies and independent healthcare organizations to create a set of operating rules that dramatically streamline administrative processes between providers and health plans.

CORE

This initiative is called the Committee on Operating Rules for Information Exchange (CORE), and its rules are making real-time access to consistent administrative patient data possible before and at the point of care. CORE is achieving this by addressing both technical and semantic interoperability requirements. Technical interoperability, or connectivity, is crucial because it ensures that system frameworks are seamlessly connected with one another. Semantic interoperability ensures that systems can understand and process exchanged data. Encouraging interoperability throughout the healthcare industry is an important step to achieving consistent, reliable data exchange between all healthcare entities — regardless of the technology being used.

The impact of a multi-stakeholder process is impressive. Rather than taking an “if you build it, they will come” approach, a more powerful philosophy is “if you involve them, they will build it.” Stakeholders more eagerly implement the rules they have had a voice in shaping. Acceptance by a broad, diverse group such as CORE means that adoption spreads to every corner of the healthcare industry at a more rapid pace. It also means that participating stakeholders are more likely to promote the solutions to their trading partners, increasing the adoption rate and impact of the solution.

For example, Aetna became certified to use the CORE rules in early 2007. By the end of the year, they began requiring all of their administrative data-exchange business partners to become CORE-certified, increasing the value of the rules to the industry. It is reasonable to assume that Aetna’s partners will now introduce their other trading partners to CORE, expanding the reach even further and compounding the cost and time savings.

Collaborations Beyond CORE

Another good example of a forward-thinking solution made possible through collaboration is the work both RxHub and SureScripts initiated to engage their respective constituencies in developing rules for advancing e-prescribing. Those efforts led recently to a merger of two leading national health information networks into a single, secure, nationwide network for e-prescriptions and the exchange of health information.

In order for healthcare organizations to receive the greatest benefit from initiatives like the Healthcare Services Specification Project and CORE, it is important that they become actively involved in the process, instead of merely relying on their vendors. By joining and participating in these collaborative discussions, stakeholders can proactively ensure that their issues are being addressed. Collaboration also increases the likelihood that their contributions will produce solutions valuable to the entire industry.

After reviewing the rules created during CORE’s first phase of work, the Health Information Technology Standards Panel (HITSP) incorporated the CORE eligibility data content section into its first set of interoperability standards. Established by the U.S. Department of Health and Human Services (HHS), HITSP is working nationally to integrate public- and private-sector standards that will meet clinical and business needs for sharing information among organizations and systems. The HITSP interoperability standards were formally recognized by HHS last January.

Equally exciting, HITSP is now considering the role that CORE’s full set of Phase I rules and the Phase II connectivity rule can play in the set of standards the panel is striving to achieve. This development serves as a further example of the potential for initiatives, at every level, to work together to create universal solutions.

Integrated clinical and administrative data exchange, interoperability, more efficient IT systems, streamlined administrative processes, consistent access to data and an improved continuum of care is possible when industry stakeholders work together. While there is much being done and exciting movement is happening on the administrative front, it is still a long road ahead.

Hospitals, health plans, physician practices and other healthcare entities can offer important contributions. With their leadership, the full promise of eHealth gets closer every day.

Robin Thomashauer is executive director of CAQH. Contact her at [email protected]

October 2008