- Healthcare interoperability took many important steps forward in 2016, the most significant perhaps being a recent development that saw Carequality and Common CommonWell Health Alliance have reached an agreement to make several their capabilities of one available to members of the other.
That being said, much of the focus this year was the progress made by leading EHR vendors in improving health data exchange between their systems and the role of health IT standards in facilitating this sharing of health information between users of different EHR technologies.
While the goal of true interoperability remains at a distance, current thinking about the steps necessary to get there are at hand — that is, the need for use cases demonstrating the value of information sharing and use of health IT standards to serve the business needs of the provider community.
HealthITInteroperability.com takes a look back at the popular stories of 2016.
When the Office of the National Coordinator for Health Information Technology (ONC) established the State HIE Cooperative Agreement Program, the goal was to establish infrastructure capable of supporting information exchange in each state.
However, a NORC at the University of Chicago report presented to the federal agency in June concluded that statewide HIE capabilities generally fell short of enabling providers to share health information effectively in the six states surveyed by the research agency.
“Currently, private and state-led entities and point-to-point connections meet the need for infrastructure and services,” report stated. “However, the combination of expanded meaningful use requirements for HIE in 2014 and payment reform increases the need for more sophisticated exchange that cannot be met by point-to-point exchange.”
While the report focused on the HIE program in 2014, its main conclusion that HIEs need to support evolving provider health data exchange needs remains a challenge even today.
Two of the leading EHR companies in the country found themselves embroiled in a bit of row over claims that athenahealth CEO Jonathan Bush made regarding an alleged unwillingness by Epic to ease health data exchange.
In response to a MedCity interview with Bush in which he criticized Epic interoperability efforts, the Wisconsin-based EHR company published a fact check refuting many of the latter’s claims. The two companies have had contentious history around health data exchange, mostly precipitated by the head of the cloud-based EHR company headquartered in Massachusetts.
Following a March 2015 hearing the Senate Committee on Health, Education, Labor, and Pensions, athenahealth's CEO & President took to twitter to take shots at Epic for charging its customers to exchange health data, a practice Epic later abandoned. While Epic was able to stay above the fray at the time, this most recent slight appeared to have crossed the line.
Given that true interoperability has yet to be achieved, it remains a work in progress. Progress, however, is being made according to the head of the HIMSS EHR Association.
According to Richard Loomis, MD, EHRA Executive Committee Vice-Chair, EHR interoperability is progressing at a steady rate. Loomis credited the transition to value-based care as the impetus behind much of that progress.
“The transition to various value-based care models is certainly helping to advance or promote that, and we are now seeing several examples of where we’re able to see where hospitals, health systems, and ambulatory providers exchange data,” he explained.
As the federal interoperability roadmap and other visions for seamless exchange agree, widespread interoperability requires many steps.
University of Michigan’s Julia Adler-Milstein, PhD, has spent the past several years researching various aspects of health IT implementation and use, most recently focusing on health data exchange.
In an interview, the professor and researcher noted that many HIEs were facing a challenge that has plagued many of these networks since their inception — proving their worth to providers and other potential participants.
"It continues to be the Achilles' heel of HIE, a catch-22 of is there value and to whom. Until you build it, you don't know. Once you build it, are they really convinced that the value is there? It becomes a vicious cycle," she said.
What proves to be a key differentiator between states with sustainable HIEs and those without is the ability of the former to identify use cases and build momentum, such as in Michigan.
"It's the right way to go, but the challenge is keeping the big picture in mind because you don't want to build in such a use-case specific way that in the long run you can't build toward more comprehensive interoperability. That's the challenge — you have to have that long-term vision but see the use case building blocks that will get you there," added Adler-Milstein.
One thing Fast Healthcare Interoperability Resources (FHIR) has going in its favor is support from major health IT developers, such as Cerner Corporation.
And the EHR company has high hopes for using FHIR and other common health IT standards to support the development of an app culture in healthcare.
“Why would we think that an app-focused infrastructure that has dominated every other domain in information technology would exempt healthcare? If anything, healthcare has more need for apps because it’s more complex than most domains — and yet it’s the last bastion of an app-free system,” he noted.
Don’t tell the head of Health Level Seven (HL7) International that FHIR’s status as a draft standard means it’s not ready for the big time.
“We use the WIFI standard, which has always been a draft standard, so now we're up to 802.11ac,” he told HealthITInteroperability.com in August. “The industry is making modems and receivers to use that specification. It's not a normative standard, yet it works, yet it's hundreds of times faster than we had 2-3 years ago. Whether ANSI gives it its blessing or not, we have advances in technology which make it difference in how we communicate. And I believe FHIR will be the same way.”
While backing from federal agencies such as ONC will help promote FHIR use, Jaffe was adamant in his belief that the private sector will ultimately determine whether the use of FHIR takes off. “ONC is entirely behind the use of FHIR, but the fact is that the marketplace will decide the utility of FHIR,” he maintained.
Application programming interfaces (APIs) changed the way most consumers use their phones, laptops, and personal devices these days. So why should healthcare APIs have the same effect?
Given the healthcare industry's history with closed health IT systems and siloed data stores, many subject-matter experts and innovators continue to tout the potential of widespread API use in healthcare to enable health data exchange and interoperability.
The Merit-based Incentive Payment System (MIPS) and the Quality Payment Program are all the rage these days, but the EHR Incentive Programs are still hanging on.
While MIPS-eligible clinicians will no longer be participants in meaningful use in 2017, hospitals are still expected to do so and Stage 3 Meaningful Use requirements are just around the corner. And it should come as no surprise that the final phase of the Medicare and Medicaid programs takes aim at advancing health IT interoperability and health data exchange in many of its objectives and measures.
Healthcare interoperability as far as hospitals are concerned will be on display as part of meaningful use requirements ranging from patient electronic access to public health reporting.
Historically, Epic is one of the quietest EHR companies in the country. But something changed in 2016.
The company’s founder and CEO Judy Faulkner addressed perceptions of Epic as a contributor to a lack of EHR interoperability in healthcare. “We do about 26 million patient interoperability exchanges – that’s not the same thing as queries – every month,” Faulkner said in defense of her company.
“If it’s Epic-to-Epic, we’ve connected everyone,” she continued. “If it’s Epic-to-non-Epic, we do it any time they have a C-CDA available, because technically speaking, it’s the same thing. It doesn’t matter if it’s Allscripts or athenahealth or anyone. We can do that just about as easily as we can do it with our own software.”
No longer content to let its competitors dictate how industry stakeholders perceive the company, Epic now plays a visible (and audible) role in discussions of national debate in a variety of platforms, which brings us to the top HealthITInteorperability.com story of the year.
Want to know more about how Epic in working advancing healthcare interoperability? A few months ago, Epic's Vice President of Interoperability Peter DeVault pulled by the metaphorical curtain to reveal the various strategies the company has employed to enabled its end-users to benefit from health data exchange.
"In years past, there has been a lot of criticism and a lot of it has been unfair, but now we certainly have the numbers to prove that it doesn't pertain today," he told HealthITInteroperability.com.
One such strategy was and continues to be its role as an implementer of Carequality Interoperability Framework. Carequality and its framework have helped mitigate variation in EHR system design and implementation contributing to inefficient information sharing. And Epic has played a role in operationalizing the initiative’s efforts.
Additionally, Epic is a part of the Argonaut Project and its work with FHIR.
“Some of the things we know are going to be enabled by the technology is being able to have apps that are substitutable,” DeVault maintained. “We've had open APIs for our customers and their partners to use for many years now, but this will be industry-standard so that if one person wanted to write an app for an Epic system it could possibly be ported without much effort to other EHR systems as well.”
As the past year has indicated, the healthcare industry is demanding improvements to health data exchange. And next year should provide further illustrations of healthcare interoperability in action.