By Abhinav Shashank
I am sure I am not the only one who has lost count of the times I've been asked "Why can't the systems talk to each other?" or, in more technical terms, "Why don't we have interoperability?"
The numerous health IT solutions that we have around us today were meant to improve not just the delivery of care, but also enhance patient outcomes as the care continues across multiple practices. At the most basic level, I suppose we can define interoperability as two or more systems communicating with each other- how and when you want something to interoperate and talk. We may have EHRs all over the nation, but that has not led to an easy flow of health data across different care settings. Even today, there are essential pieces of information that are either missing or hard to access.
Where does value-based care take a hit?
Over the last few years, there has been a substantial rise in the use of health information technology, but the lack of a proper channel of data exchange and interoperability is by far the biggest barrier. This failure of interoperability leads to wasted time, gaps in care and worst, errors in care. Patients are frustrated and owing to inaccessible information- clinicians can't make informed decisions.
Moreover, the time that goes into dealing with redundant paperwork and inputting data is just too much. Nurses spend almost one-third of their day just transcribing or imputing data. Doctors happen to spend as much as 49.2% of their time on EHRs- this is time spent away from patients. Imagine how easy will connected technology for data exchange and record make all the processes easier and accurate?
What more does value-based care need?
There have been years of healthcare interoperability initiatives, numbers of health data exchange frameworks and health IT standards that have resulted in considerable improvements. The public and the private sectors have been working across the healthcare industry to ensure seamless data exchange. However, there are still a few challenges that still bar healthcare from achieving a truly interoperable value-based ecosystem:
- A standardized way of patient identification Assigning a unique patient identifier will not only rule out redundancies in healthcare but is a sure way to ensure hospitals and healthcare organizations can exchange patient health records accurately and efficiently. Mismatched information can lead to errors in patient care and organizations like CHIME and HIMSS have been pushing for national patient identifiers for almost two decades now.
- Uniform health IT interoperability standards There a number of care settings today, and care coordination across these settings is a cumbersome process. Some of these care settings may have different protocols and data exchange standards, and some may not even have any at all. Lack of these standards or poorly enforced ones make data exchange a complicated process, posing barriers to information flow.
- Information blocking One of the major challenges is information blocking and it is still a prevalent problem in healthcare data exchange. A study conducted on 60 HIEs revealed that information blocking is still rampant in healthcare. About 50% of the respondents admitted to engaging with health IT companies participating information blocking. There are some existing policies which have yielded some results, but if we are looking forward to a connected, seamless health care, information blocking has to end.
What does an interoperable value-based system look like?
So far, developing a national patient identifier, improving standardization across the industry and terminating information blocking are the hurdles remaining in the way of 100% interoperability. Still, what can we achieve with a connected healthcare?
Consider a patient, George. George is 67 years old with slightly high blood pressure and lives alone. After he felt his blood pressure rise and ran off to the nearest ER a couple of times, his children insisted he started using an app that takes just one tap to notify his doctor and his children of his condition. Although his episodes weren't severe, George decided he might as well use the app just in case something serious did happen, and he needed assistance.
Last month, George was diagnosed with sleep apnea and started using some medications. The suggestions for most of these medications popped up on his phone's screen. And, just a few days ago, George decided to get a fitness tracker- he uses the tracker to count the number of steps, his resting heart rate, his blood pressure and whatnot.
Each of these devices and apps provides value to George, helping him manage his health and keep a stroke at bay. However, if these devices were to share information, it might be possible for George's doctor to figure out symptoms of a stroke from the quality of his sleep and share better-suited care plans. Indeed, the data would be much more valuable, helping George's caregivers be aware and notified, identify patterns in his health and monitor his health on the go.
There lies the promise of data sharing and interoperability in a true value-based care world.
The secret to an interoperable, value-based system
Interoperability is critical in healthcare. Be it in terms of innovation or preventive care- having access to complete information at the right time is important. Despite the complexities in healthcare, we have to take a step towards interoperability to understand healthcare, analyze it and determine solutions.
Advancements in technology is definitely a key. Other sectors like manufacturing, banking, etc. are using API-based exchange and flexible interfaces to their full potential. They truly represent a promising avenue for seamless healthcare data exchange and it's time healthcare put it to use. It is important that we simplify the underlying technologies that connect EHRs, lab systems, wearables, and other health systems before advancing off. A simple and flexible solution like Datashop that is source-agnostic and can ingest a number of data feeds- be it ADT feeds, CCDA documents, clinical data or even flat CSV files- simplifies the process of data integration and exchange and gives a consistent view of patient information.
However, none of these technological advances will do much good if there is little collaboration between providers and patients. Even as population health management and personalized care become integral, patients and providers are still reluctant to trust one another. A lot of providers and healthcare organizations think that data is already protected and its integration or exchange will sabotage the security. Both of these misconceptions are false. There has to be a clear, mutually beneficial framework that puts patients at the center and makes it easy for patients and providers to access all the health information across the care continuum.
The road ahead
There have been many changes in the reimbursement structures and providers do realize the importance of healthcare data interoperability. Although this evolution is a slow and difficult one, the evidence of interoperability has only grown over the years. The amount of data in healthcare is immense and healthcare being disconnected doesn't just cost us dearly, it has a grave impact of population health as well. Having an interoperable healthcare is a way to ensure that providers are able to make the best decisions for their patients and enhance the quality of care, no matter where they are on the care continuum.
Abhinav Shashank, Co-Founder & CEO at Innovaccer, is an expert in population health management and robust technologies. For the better part of the decade he has been working to revolutionize healthcare delivery with 25+ value-focused organization and making over 10 million lives better.