Healthcare organizations across the country are restructuring and realigning their operations to manage costs and improve outcomes through interoperable systems. Provisions within the Affordable Care Act have provided the foundation on which to build real-world, value-based models for connected healthcare. Meaningful-use Stage 2 will go into effect in 2014, further incenting healthcare organizations to seek interoperability solutions.
However, while much talked about, interoperability remains an elusive goal. “The need for interoperable EHRs across a community is ever-more pressing,” according to a recent report by Chilmark Research. “As quality-based payments proliferate over quantity-based payments, every healthcare organization will need visibility into other providers’ clinical and administrative data to coordinate care and minimize financial risk.”
A truly connected healthcare environment enables access to health information across the full continuum of care. Traditional connectivity between internal systems provided by simple interface engines and messaging systems are not sufficient to meet the demands of a complex healthcare system. This has created a need for a new generation of informatics platforms designed to enable strategically important connections to systems and data from external organizations. These may include system-owned and affiliated hospitals, patient-centered medical homes, acute-care facilities, laboratories, physician practices, health plans and health information exchanges (HIEs), as well as human services and other government agencies.
Building a complete patient record requires aggregating, normalizing and sharing data from multiple, specialized applications from different vendors as well as home-grown systems. As the number of applications and the diversity of data increases, an interoperable environment becomes even more crucial to the success of EHR initiatives. Larger healthcare delivery networks are looking to integrate data sources to create longitudinal care records, not only to make patient records available to caregivers, but also to provide a rich source of population data for clinical research and other strategic initiatives.
Hospital IT staff are seeking new tools and platforms to facilitate these new initiatives as they move along the path from simple integration and messaging to what is the full promise of healthcare interoperability – enabling strategic mandates such as population health, coordinated care, reduced readmissions, and more engaged patient and physician communities. These mandates will demand new competencies and new technologies.
Interoperability has become a strategic imperative, moving from a tactical, nuts-and-bolts task to a top-line business enabler. As a case in point, interoperability will be a key factor in reducing hospital readmission rates.
Currently, almost 20 percent of Medicare patients are readmitted, costing payers roughly $17 billion per year. The Centers for Medicare and Medicaid Services (CMS) has enacted its Hospital Readmissions Reduction Program, commonly known as the “readmission penalty,” which focuses on patients admitted for acute myocardial infarction, heart failure and pneumonia. Institutions that have higher than expected readmission rates face a 1 percent Medicare revenue penalty 2013, increasing to 2 percent in 2014 and 3 percent in 2015.
Strategic interoperability is critical to addressing readmissions because it fosters care coordination, not only within the hospital, but also across the care continuum. Our health system is fragmented and increasingly more complex with an aging population. Three out of four patients above 65 years of age suffer from multiple chronic conditions, and many require care from multiple specialists.
Given that a wide variety of organizations – such as hospitals, health plans and physician practices – typically have records on any one patient, the ability to consolidate such data is critical. For example, imagine a patient who has multiple encounters with a primary care physician, specialist and the emergency department for treatment of a chronic disease. It is not only possible, but likely, that these encounters occur at different locations that use disparate EHR systems. Ensuring all the information is aggregated in a single composite record is key if healthcare organizations truly hope to coordinate a patient’s care.
Only by connecting all the data, systems and users, both inside and outside the healthcare organization, can the full benefits of EHRs be unleashed. Strategic interoperability becomes a bridge to the larger healthcare environment in which the care provider operates. Ultimately, an interoperable environment enables better healthcare decisions by making the right data available to the right people at the right time.
About the author
P. Nelson Le, M.D., is the senior HealthShare advisor at InterSystems.
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