- At its most fundamental level, health IT interoperability means two or more systems or components having the ability to connect and exchange information — and to use the information that has been exchanged. Aside from that straightforward definition, however, interoperability is a complex concept that can veer off into many domains depending on what needs to be accomplished. And sometimes even well intentioned stakeholders get caught up in misunderstandings that gradually perpetuate into the lore of industry myths.
HealthITInteroperability.com talked to two healthcare market experts — Jeff Peters, vice president of operations at Mirth, and Larry Schor, vice president of corporate development and analytics at Medecision — for their views on what’s really happening in regard to a half-dozen interoperability misconceptions, and where things are likely to go from here.
1) Hospitals are in a controlling position in regard to interoperability. Like some myths, there’s a bit of truth to it, but it’s not the complete story, according to Peters. It’s accurate, for example, that a public health information exchange trying to quickly build support in a particular market will often target hospitals for their initial connections. “Hospitals are very influential in the marketplace. They control a lot of the dollars,” he explained, “but that’s not where it ends.”
Peters added, “A lot of the most useful data — especially when you start talking about population health, value-based reimbursement, care management and care coordination — are used for functions that go beyond medication reconciliation or lab results delivery. Those higher-level use cases require data from ambulatory practices. You need the participation of primary care physicians and specialists who are seeing patients in their offices on an outpatient basis or just for scheduled visits. That rich data set is often more valuable for the higher level cases than just the record that shows somebody had a hospital visit and what took place during that visit. If anything, it’s the follow-up care that’s more interesting and more important than simply the record of the inpatient visit."
2) Mandated standards will eventually ensure interoperability among healthcare stakeholders. “As opposed to standards promulgated by the federal government or a trade group, at the end of the day, commerce will drive the adoption of effective standards,” said Schor. “There’s demand for standardization so that high-quality care at the lowest price motivates stakeholders to begin to adopt standards and really do so in a fashion that drives true interoperability and transparency around the content. Safety in the delivery of care is actually what they end up providing their patients.”
He continued, “The only way to deliver a high-quality, low cost, well designed service is for data to be freely exchanged. That will become a requirement when the economics demand it to be so. As risk shifts down to the providers, even non-employed providers will end up having to conform to certain standards if they want to have trade with the health systems in a given area.”
3) Sharing data will put healthcare organizations at a competitive disadvantage. “It often takes longer to negotiate an information-sharing agreement than to actually build the interfaces when you are establishing an exchange relationship,” said Peters (pictured). “In reality, the data belongs to the patient. There is a lot of fear that stems from what amounts to competition in the healthcare space — and that fear runs counter to the goals and needs of interoperability, which are to improve care, reduce costs and streamline the patient experience.”
Peters elaborated: "The nature of care that a patient receives when data is shared across the spectrum of providers makes for a better experience. If the patient is having a good experience, receiving good care, good followup...if they are seeing that the hospital and primary care physician and specialists are coordinating well and things are running smoothly, he or she is likely to frequent all of those points of care. A rising tide lifts all boats type in that type of situation.”
4) Interoperability is an immovable object. The dynamics of healthcare are changing almost monthly, according to Schor, and that is creating opportunity for creative solutions. For example, due to industry consolidation and the need to drive cost out of the healthcare system, payers are putting pressure on providers to share data in a much more liquid fashion.
“I wouldn’t be surprised to see payers act as a catalyst because they are going to need access to clinical information that they’ve never really required in the past,” said Schor. “This will require interoperability at a scale that really requires adherence to standards. It won’t work otherwise.”
At the same time, group health insurance — once the “bread and butter” of large payers — is experiencing a surprising resurgence. “Employers may end up saying to their payer partner, ‘I’m not going to give you my business unless you can guarantee that my employees and their families have transparency on price, access to quality data and access to the right doctors in network,’” observed Schor (pictured).
5) It’s hard to find the value in making systems interoperable. “There may be some folks who don’t want to put the effort into the relationships and the technologies that are needed to achieve interoperability, but I don’t think they truly doubt the value of it,” said Peters. “They may be comfortable in their current position and place in the industry and aren’t necessarily motivated to make forward progress.”
“I’d like to think we’ve gotten to a point where we understand that sharing information and collaborating and being able to have the big picture — whether we’re talking about data for a population or a longitudinal view of data for an individual — that the value of interoperability is almost unquestioned,” he continued.
6) Nothing disruptive is happening in the technological aspects of interoperability. Cloud-based technologies, by their nature, shield customers from complexity. “The idea of installing enterprise software on-premises is clearly no longer going to happen at almost any scale,” said Schor. “And that means time to value has collapsed. We have the ability to deliver components that scale to a larger set of requirements as business needs change.”
Schor added: “Stakeholders are experimenting because they’re still not quite clear what the business requirements are going to be around this thing called population health management. There is no recipe for how to do this. If I’m a chief medical officer at a large health center, I want to get my arms around making sure we avoid an unnecessary readmission for a patient. That requires coordination of services for post-acute care with health agencies and the post-acute care primary doctors that are out of my network and so forth. As that plan gets laid out, the cloud-based solution allows me to actually manage my patient over time. I can then learn from that experience what’s working, and incorporate those lessons into what could be deployed at scale very easily within the cloud-based infrastructure. It can be expanded on demand from one or two or three users to potentially hundreds of users.”