Healthcare Must Ensure Operability Before it Can Reap Full Benefits of Interoperability

Sixteen independent hospital systems jointly save $1.4 million annually.

Interoperability has become one of the hottest topics in healthcare and is recognized as an extremely worthwhile objective. Virtually all segments of the industry—payers, providers and vendors alike—support efforts to share critical information contained in electronic health records.

Sixteen independent hospital systems jointly save $1.4 million annually.

Pat Cline is president of NextGen Healthcare Information Systems, Horsham, Pa. Contact him at [email protected]

With this level of support, interoperability is a goal the industry will surely attain in the not-too-distant future. This country took a significant step forward several years ago when President Bush established 2014 as the target for comprehensive access to electronic health information. This commitment was applauded as the next critical step to improve patient outcomes and control rising healthcare costs.

However, before the healthcare industry can take advantage of interoperability, it must first ensure operability—in other words, promote widespread use of electronic health records (EHR) and ensure that data exchange is secure and seamless.

With this in mind, two primary issues must be addressed to accelerate progress towards interoperability: 1) incentives must be established to motivate physician use of EHR systems; and 2) national data exchange and privacy standards must be implemented to streamline the process.

Increase Physician Adoption
The industry must advance efforts to persuade physicians to adopt EHR systems. According to a survey conducted by the Medical Group Management Association Center for Research, only 14 percent of medical practices currently use these systems. Until the vast majority of physicians adopt the technology, widespread interoperability is unattainable. Virtually all providers seeing a patient must contribute to the comprehensive record, or the value of the information is undermined.

Vendors have made great strides in lowering barriers to EHR adoption—ensuring that software accommodates individual physician workstyles, for instance, while developing lighter, ergonomic laptops and resolving connectivity and wireless network speed issues. Now it’s time for other stakeholders to step up and provide incentives. Fortunately, a number of initiatives encouraging physicians to implement these systems have already been undertaken.

The Center for Medicare and Medicaid Services (CMS) has launched its pay-for-performance (P4P) program that links reimbursement with patient outcomes. Although still voluntary, P4P will someday require practices to verify success in achieving patient compliance with clinical measures. EHR systems provide the tools necessary to establish practicewide protocols, measure outcomes, analyze progress and trigger alerts for physicians to meet requirements.

Similarly, private payers have initiated incentives to launch wellness programs and monitor management of chronic diseases. In 2001, the Institute of Medicine released a report, “Crossing the Quality Chasm,” which prompted a group of employers, physicians, health plans and patients to create the Bridges to Excellence program. This initiative is designed to realign all stakeholders’ incentives around higher quality. Again, an EHR system is the ideal tool to support increased accountability for performance improvements.

In addition, companies providing malpractice insurance have a stake in widespread EHR use. Because the systems make comprehensive patient data available at the point-of-care, providers make better decisions, deliver more effective treatments and improve patient safety.

The federal government is also clearing the path for increased use of EHR and eventual interoperability. On August 1, the Department of Health and Human Services (HHS) announced several exemptions and safe harbors relative to Medicare anti-kickback regulations and Stark rules on physician self-referral. At that time, HHS Secretary Mike Leavitt revealed final regulations permitting hospitals and other specified entities to donate interoperable EHR software, information technology and training. Previously, these entities were unable to subsidize or provide technology to physicians who wanted to implement secure EHR systems, but found it cost-prohibitive.

Implementation of National Standards
Equally important is the development of national data exchange and privacy standards. Currently, the healthcare industry finds itself in the same position retailers occupied when electronic credit cards were introduced years ago. Issuers aggressively placed credit cards in the hands of consumers, but until merchants were able to access a unified system to transmit transaction data, the technology benefited no one. Standards paved the way for seamless credit transactions and will have the same effect on the transfer of healthcare information.

The industry is already seeing the development of some standards that can facilitate interoperability—Health Level Seven (HL7), for instance, is a common “language” that enables disparate healthcare applications to exchange clinical and administrative data.

HHS also sanctioned the Certification Commission for Healthcare Information Technology (CCHIT) to certify health information technology products, with the first flight of certifications awarded to 20 EHR systems in July. Although a step in the right direction, physicians must recognize that participation in this program is voluntary and therefore doesn’t provide a comprehensive rating of all available systems. Physicians must look beyond certification to assess whether any given EHR provides the functionality necessary to meet both internal operability objectives and broader interoperability goals.

Eventually, the development of these standards will support even greater opportunities to optimize interoperability. Patients could conceivably carry personal health records on a data chip or USB drive hung from key rings. Whenever they access any component of the healthcare system—primary care physician, specialist, urgent care center, pharmacy—providers would have comprehensive information at their fingertips. Any service would immediately be uploaded, so all files are up-to-date.

The goal of interoperability is well within reach. But to achieve it as quickly as possible—and to make the most of its vast potential—the healthcare industry must undertake renewed efforts to encourage provider operability, as well as adopt vital data exchange and privacy standards. To this end, CMS and private payers must expand pilot P4P programs so they become mainstream. It is vital that they promote the value of comprehensive clinical information and provide incentives for physicians, health systems and other providers.

Likewise, the government must smooth the path for collaboration by removing barriers and encouraging adoption of best-of-class technologies. Providers must commit themselves to seeking out advanced EHR systems that support efficient workflow and provide maximum functionality, enhancing access to important clinical information in-house, with an eye to eventual participation in a data-sharing partnership to benefit patients communitywide.