Interoperability: The first step in paving the way to comprehensive patient care

Sept. 27, 2016
By Muhammad Chebli, Senior Interoperability Product Manager, NextGen Healthcare

More robust information sharing and analytics leads to enhanced care delivery and outcomes. This is the premise building momentum for healthcare interoperability, and it’s an idea that promises to increase the frequency of data-driven, collaborative workflows.

For instance, provider groups are increasingly leveraging industry tools that provide real-time notification of patient hospital admissions and discharges. Physicians are finding that these two fundamental pieces of information empower more proactive care delivery and less service duplication.

Sharing information, even on a small scale, is a critical first step to improving population health, enhancing the patient experience, and lowering costs. Interoperability is not so much a destination, but a process that entails collaboration around many approaches, standards, and technologies. Physician groups that have taken the initial plunge must now continue maturing their strategies in tandem with emerging industry best practices.

Evolving information exchange models

The early days of cross-continuum information sharing were largely characterized by movements around regional and state health information exchanges (HIEs) dedicated to advancing interoperability. As government incentives supporting these models dried up, many of these HIEs proved unsustainable, and movements shifted in favor of a more national, broad-based approach. Although a handful of state HIEs are still thriving, the financial and capital expenses associated with such efforts has been – for the most part – too high to maintain.

In recent years, decentralized information-sharing efforts, such as the Direct Project, have experienced explosive growth from early beginnings as a niche point-to-point interface. According to DirectTrust, the collaborative non-profit association of vendors and healthcare delivery organizations, Direct has evolved into a national solution where more than 1.3 million providers and organizations actively exchange clinical documents. In fact, more than 24 million secure healthcare transactions were sent through Direct messaging in the second quarter of 2016 – a 79 percent increase over the same period one year ago.1

In general, the DIRECT model, as well as similar frameworks, supports a “push” of data from one stakeholder to another. For example, when a patient leaves the hospital, the organization can send a summary document to a physician practice, so the physician can be aware of the patient’s condition and the treatment he or she received.

Although the efforts around these kinds of data-sharing systems represent critical successes, a number of barriers exist that limit their overall impact. For instance, the Consolidated Clinical Document Architecture (C-CDA) – an industry standard for exchanging clinical summaries – remains a massive file that often reaches between 30 and 40 pages.2 Providers can spend considerable time parsing the document to retrieve certain information, and locating actionable data in a timely manner can be difficult.

In response, infrastructure advancements are surfacing that support a “pull” of data, enabling providers to query and retrieve information as needed. These models show a tremendous amount of promise in that they support information exchange in a way that delivers relevant and timely information to physicians treating patients. Carequality, under the auspices of the Sequoia Project, is an early mover in the effort to streamline a nationwide query-and-retrieve model that can scale.

Taking control of interoperability

There are multiple options that health systems can leverage to enhance information-sharing capabilities. As the industry explores additional systems, many communities and health networks are starting to pursue structures that allow physicians and other clinicians to pull data from across the continuum as one of those routes.

This forward-looking strategy starts by engaging the right partners to establish a central data repository with the functionality needed to direct a larger interoperability effort. Supported by advanced analytics infrastructures that work in tandem with a variety of industry standards and information exchange frameworks, these repositories aggregate needed information from stakeholders inside and outside health networks. They provide longitudinal views of patient records across disparate systems and can be easily integrated into existing EHRs. Physicians and other clinicians can then query and retrieve specific patient information from the repository to support patient care initiatives.

Advanced API functionality is a key element in data repositories that enables users to build out query features based on need. For instance, if a provider wants to quickly review new information about a patient’s care, requests are designed to retrieve all new community data that becomes available during a specific timeframe. This way, providers are armed with critical patient information, such as new prescriptions, radiology consults, or test results.

This concept of pulling data addresses the challenge of receiving too much information at one time. Although providers are less inclined to deconstruct a 40-page C-CDA document, they are much more willing to query an advanced central repository for needed information. Ultimately, this framework supports information sharing that is meaningful and usable for directing patient care – the overriding goal of interoperability.