Interoperability: The paradox of perception and reality

July 31, 2017
By Thomas J. Van Gilder, M.D., J.D., M.P.H., Chief Medical Officer and Vice President of Informatics and Analytics, Transcend Insights

While new technologies have allowed many health systems to improve care coordination, most still struggle with achieving community-wide interoperability for medical information sharing. Contrary to this reality, 72% of patients believe that their doctors can easily share and access important information about their medical history—whenever or wherever care is needed. Without interoperable systems, we cannot deliver truly collaborative care, a more personalized care experience, and optimal population health.

Addressing the complexities of medical information sharing

A recent study conducted by the American Hospital Association (AHA) noted that 75% of hospitals now employ electronic health record (EHR) systems to transfer patient data between their departments and clinicians; however, few hospitals can do the same to collaborate with care teams outside of their organization. The problem, the AHA reports, is that EHR technologies often are too “unwieldy” and do not “speak the same language to one another.” Medical care information is, in some ways, irreducibly complex. However, electronic systems have added to this complexity by offering unpleasant user experiences ill-suited to clinical encounters and by using proprietary (or minimally standardized) data forms and formats. This added complexity requires intensive and sometimes difficult data normalization before interoperability is possible.

Patients regard medical information sharing as critical

The lack of medical information sharing continues to have a negative impact on the overall care experience. I have witnessed this myself working as a physician at an outpatient primary care practice. When a patient went to the local hospital for a procedure, a hospitalist from that facility would assume responsibility for the patient’s care, focusing his or her attention on the issue at hand and tailoring the visit or treatment accordingly. We accessed a patient portal system that allowed us to track the patient’s progress through the hospital’s information system. However, due to manual data entry processes, the system was only updated sporadically. In practice, this often worked out fine: A patient would receive the care he or she needed and then return to my office for a follow-up. However, one patient in particular demanded better care team collaboration to keep her “total-health picture” in mind. Though I explained the technology challenges prohibiting real-time communication between the care teams, and that our practice was relatively advanced in our data-sharing capabilities, she decided to look elsewhere for her primary care. This is just one example that substantiates the importance of medical information sharing to patients.

More recently, in my work at Transcend Insights, I helped lead a survey we commissioned to answer a number of questions around interoperability and effective population health management. Such questions included the following:

  • Do patients believe that medical information sharing (interoperability) is important to a personalized care experience?
  • To what degree do patients believe that medical information sharing is already taking place?
  • How might a clinician’s access to a patient’s medical history affect that patient’s perceptions of care quality?

According to more than 2,500 adult patients of diverse ages and geographical backgrounds surveyed, 97% believe it is important for any health institution, regardless of type or location, to have access to their full medical history in order to receive high-quality care. Similarly, 87% said that primary care physician access to their full medical history, in particular, is extremely or very important to receiving high-quality care.

The fact that some patients assume their clinicians’ EHRs are connected for community-wide interoperability and medical information sharing should give pause to anyone with a stake in population health technology. With people relying upon smartphones for nearly everything—from web searches, to texting, and to diet and exercise tracking—they expect their care teams to be able to do the same with healthcare technology. It is tempting, as a physician, to simply accept how things work now and make the best of the status quo. Yet, we have to remember that this is just the beginning and that our patients are demanding more—and those demands need to be met. True interoperability that requires the exchange of medical information across a care community will become ubiquitous.

The intersection between perception and reality

There are various hurdles to overcome if we are to make patients’ perceptions of interoperability and medical information sharing a reality. The technology, for one, must become more user-friendly—designed to fit within the workflows of physicians and their care teams so that accessing patient data does not require a special effort. In addition, the data itself will need to be clinically useful: Physicians do not have the time to sift through information that is more relevant to payors or health system administrators.

The good news for those among us who feel like we have been waiting for interoperability forever is that the technologies involved are evolving to meet the needs of population health. If we keep pushing for this evolution to continue, we eventually will reap the benefits of interoperability and ultimately give patients what they expect and deserve: better care-team collaboration for a more personalized healthcare experience.

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