Health information must be shareable and accessible among all individuals involved in the care setting: primary care physicians, specialists, hospital physicians, and patients. I believe interoperability is the ability for information used to advance patient care to move between healthcare entities, regardless of the technological platform in place.
Within healthcare there is no single, agreed upon definition of interoperability. This is one of the challenges within the industry. According to HIMSS, “Interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged … [so that] health information systems work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.”
Interoperability started to emerge in the mid-2000s; however, the Centers for Medicare and Medicaid Services propelled the use of EHRs and interoperability innovation beginning in 2009 with the American Recovery and Reinvestment Act (ARRA). The ARRA authorized financial incentives for the adoption, implementation, and demonstrated “meaningful use” of EHRs.
Current state of interoperability
Interoperable functionality is now an expectation among stakeholders in the healthcare industry, although it is currently not a universal reality. One of the major building blocks currently in place to move toward seamless interoperability is the health information exchange (HIE). HIEs are citywide, statewide, or regional networks that enable hospitals and health systems to securely exchange data within their communities. HIEs are a way for hospitals to empower one another by providing access to patient data across the continuum.
While not all hospitals currently exchanging data are members of HIE networks, 78 percent reported exchanging patient information in some format in 2014. Of those same respondents, 48 percent reported their providers engaged in electronically finding their patients’ health information from sources outside of their organization or system.
One area that is expanding its interoperability capabilities is the long-term care market, including skilled nursing facilities, rehabilitation facilities, and specialty care centers.
Rocky Mountain Care, a home care, hospice, and skilled nursing facility company based in Salt Lake City and operates in five states, recently invested in advanced health IT solutions to improve connection within its organization’s facilities and beyond.
“Two years ago, we chose Cerner’s LTC PowerChart EHR because we needed a new system that could talk with other solutions. As an operator of skilled nursing facilities, we care for patients that are often referred from other care providers. We needed the capability to receive patient care records in a digestible format, whereas we used to receive patient records that were hundreds of pages long. No organization can sift through that much information and begin providing effective care in a timely manner,” says Johnathon Bangerter, Vice President of Operations, Rocky Mountain Care.
Rocky Mountain Care needed a solution that would help them connect with healthcare organizations of all kinds in an effort to collaborate with other care providers within the community, in the region, and beyond to share various types of clinical data including orders, results, clinical documents, images, immunizations, and prescriptions. The end result is more complete care for the patient and fewer medical errors.
“Long-term care organizations receive patients that oftentimes are plagued with complex chronic conditions, which require the specialized attention that Rocky Mountain Care offers. We need to understand what regimens, procedures, and medications the patient has received to develop go-forward care plans and be able to forward those care plans to future providers upon potential emergency and urgent care visits,” Bangerter says. “In addition, the government is increasingly requiring traditional care providers to monitor their patients beyond their facility and report value metrics in order to receive appropriate reimbursement. In turn, we have seen an increased level of requests to share information with healthcare organizations, such as our neighboring University of Utah and Intermountain Health system.”
If long-term care organizations do not begin to communicate bi-directionally with traditional care providers, they are at risk of losing referral partners.
“Ultimately, increased data sharing is good for the patient because care teams are equipped with more patient information to enable more holistic care decisions,” says Bangerter.
Vision for the future
The market is expected to demand continued innovation in approaches, solutions, and services to meet evolving interoperability requirements. Interoperability is key to supporting the continuum of care, improving population health, and enhancing information access to providers and patients. There are many public and private initiatives actively working to enhance data sharing among providers.
To achieve true interoperability on a national level, Cerner collaborated with other health IT companies to establish CommonWell Health Alliance, a not-for-profit trade association with the vision that health data should be available to individuals and providers regardless of where care occurs. CommonWell members are committed to building interoperability into their software, so that providers can maximize a trusted network for data exchange while maintaining their existing workflows. Cerner uses the services provided by CommonWell Health Alliance to allow clients to exchange relevant clinical information with other providers that use CommonWell services.
Public and private healthcare organizations worldwide are focusing interoperability efforts on Fast Healthcare Interoperability Resources (FHIR), a standard open application programming interface (API) to exchange data from EHRs. FHIR gives third-party suppliers access to its code so they can build compatible products. The use of open APIs is an effort to enable others to develop solutions that will interoperate with other health IT supplier networks. Cerner believes that EHRs must be open, providing independent developers the opportunity to build applications and extensions that work with existing solutions. These open platform environments provide clinicians with access to improved workflows and patient experiences.
The government is also committed to the advancement of interoperability. The Office of the National Coordinator for Health Information Technology (ONC) released its final interoperability road map in October 2015. It offers guidance to have the nation’s healthcare system fully interoperable by 2024. The goals are:
- 2015-2017: Send, receive, find, and use priority data domains to improve healthcare quality and outcomes.
- 2018-2020: Expand data sources and users in the interoperable health IT ecosystem to improve health and lower costs.
- 2021-2024: Achieve nationwide interoperability to enable a learning health system, with the person at the center of a system that can continuously improve care, public health, and science through real-time data access.
The ONC plans to have standards organizations agree on semantic standards for health information exchange, have more than half of technology developers provide access to electronic health information through open APIs by 2020, and enable patients to regularly access and contribute to their EHRs by 2020.
The goal for vendors is to work to develop technologies to not only consume and transfer patient data but also to incorporate analytics at a macro and micro level to produce actionable insights. This is more commonly known as “big data” – extremely large data sets that can be analyzed to reveal patterns, trends, and associations.
Patient-centric interoperability ensures the right people have access to the right data at the right time. Cerner has a vision that interoperability should not be a competitive advantage; instead, sharing patient information should be a foundational capability of a health IT system that enables providers to improve healthcare across the world, regardless of what vendor or provider is included in the continuum of care.
Why digitization is changing the way healthcare providers share data
With digital transformation progressing across various industries, including healthcare, the ways in which information is transferred and shared between parties are also rapidly evolving. As smartphones and mobile devices become more commonplace, efficiency and productivity continue to rise, and the digital transfer of information only becomes faster (at least, in theory), the sharing of information between systems should naturally become easier. Yet, while digital transformation is currently sweeping across the healthcare industry, numerous challenges remain when it comes to facilities and providers sharing patient information.
The need for digitization
The need for a smooth information sharing process is heightened by an aging baby boomer population. Consider the following scenario: Betty is 78 years old and, after having a stroke, has been staying in a local hospital for the past two weeks. After receiving initial care and diagnostic tests, it was determined that Betty lost motor function on the left side of her body and has trouble speaking clearly. As a result, she needs to be transitioned into a nursing home with a specific treatment plan.
What does it take for this transition to be completed seamlessly while ensuring a high quality of care along the way? Traditionally, this type of transition requires a significant amount of paperwork for both the hospital and nursing home staffs to successfully transfer Betty’s private health information (PHI) — including medical records and history, medication lists, allergies, treatment plans, etc.
Transferring such a large amount of information inevitably results in a high volume of fax transfers and phone calls, not to mention a mountain of paperwork. This leaves much room for potential error when it comes to Betty’s treatment plan and medical history arriving in the right hands of the next care provider.
This is why the implementation of digital health records is a vital step. In fact, the future of patient care depends on it – because when there’s a lack of digital process between providers, the quality and satisfaction of patient care is at risk.
The challenge to seamlessly integrate
Since the adoption of digital solutions for healthcare has traditionally meant implementing a time-consuming and expensive system transformation, it’s not surprising that many hospitals and healthcare facilities have been slow to implement this change, making the lack of and/or slow adoption of digitization the major challenge to seamlessly sharing information between providers.
However, with new cost-effective, cloud-based technology being created every day, the sharing of sensitive information through secure channels has never been more efficient. Given the amount of paperwork necessary to transition a patient from one care facility/provider to another, the digitization of such systems is clearly a crucial step toward streamlining the process – and improving overall patient care.
The next generation of care transition
Patients transferring to long-term care facilities often remain apprehensive about such life-altering circumstances. On top of that, dealing with the time-consuming paperwork needed to ensure quality care during the transition can be extremely overwhelming. However, when providers do their part to securely transfer information between specialists, pharmacists, and other healthcare professionals, it can also lessen the amount of paperwork for patients (or their families) and ease the emotional ramifications of such a transition.
When information can be transferred and obtained through technology, providers are able to save time sifting through medical records. Providers can also eliminate second-guessing treatment plans, resulting in quicker and more accurate patient treatment.
With technology only continuing to shape the future of healthcare, the need for
a next-generation system that can seamlessly handle the transfer of information
between providers remains essential.
