- Having true healthcare interoperability nationwide has been a key goal for industry stakeholders for years, and recent federal initiatives and evolving technologies are helping to accomplish that goal.
Different healthcare organizations will have unique perspectives on the challenges that come with interoperability, explained Health2047 Managing Director Dr. Jack Stockert.
It is important to not overcomplicate interoperability, and instead focus on what drives poor interoperability, he told EHRIntelligence.com. From there, it will be easier to approach issues such as data connectivity and data liquidity. Oftentimes organizations want to be able to move data, but they are unable to.
Data rights is another key interoperability problem, Stockert explained. It’s similar to if two individuals have cell phones that are able to connect, but do both individuals have the rights from their phone plan to make a long distance phone call, he said.
“The data rights construct in the marketplace doesn’t function to support different things,” Stockert stated. “Now we have some broad sweeping data rights within HIPAA.”
“As a clinician I was always aware of the ones that allowed me to get immediate information related to the care of a patient in emergency situations,” he continued. “But while those use cases are important, they are only a subset of what folks are after when they want interoperability.”
There is also the incentives challenge with interoperability, Stockert added.
“There’s no business reason for why hospitals want to move a clinical record,” he said. “Down in the Texas triangle where you have that tax free zone where all those hospitals sit, bumper to bumper, you can walk out of one and into another. There’s an incentive to not have a free flowing set of information in that setting. That’s part of your business.”
Interoperability centers around data connectivity, data liquidity, and data rights, Stockert maintained. If organizations have the right connections, they must still determine what the rights and abilities are to move that information and data.
“There’s an incentives structure that needs to be in place,” he stressed. “Where you work to match where the incentives productively produce the right outcomes that you’re after.”
Current federal initiatives, along with national efforts such as CareQuality and the Sequoia Project, are all beneficial with regards to strengthening interoperability, Stockert said. The development of Fast Healthcare Interoperability Resources (FHIR) and its utility on the technology development side is also important.
“All of those things start to move and chip away at each of these core problems,” he explained. “It’s always helpful to simplify it and train energy against one of the pieces first.”
“How do we train against the data rights question?” Stockert posited. “How do we train against the incentive model matching, ensuring that those who want to utilize the data for appropriate means – with the appropriate rights – are incentivized and able to exchange that information?”
With the incentive structure, an asymmetry from data creators to data consumers has been created, he said. From there, a middle market where organizations can capitalize on that asymmetry has been created.
“Clarifying and bringing transparency to the incentives for why people want to use information and what they want to use it for is critical,” Stockert maintained.
The evolving approach to encouraging interoperability
Meaningful use was effective to drive the early adoption of EMRs, Stockert pointed out. Similar to the first three innings of a long baseball game, the program was important but there is still a lot of game left to be played.
“We’ll often hear all the reasons physicians dislike EMRs, but we should celebrate the victory, plant the flag, and then say, ‘We can do better, let’s go do better,’” he said.
Meaningful use was an effective tool for a market that had not really moved in the direction of digitization for numerous reasons. The rebranding of it, changing the name to Promoting Interoperability, was smart marketing because it carried with it the baggage of its early days, Stockert explained.
Reframing the program speaks to having to charter a new direction, but ensure that the same end goal is accomplished.
“My hope is we can play the third, fourth, fifth innings of this game with more market driven incentives and usability functions at play,” he said.
New technologies will also be critical tools to use in helping interoperability grow. Big data, artificial intelligence (AI), and machine learning can be greatly beneficial but they will need to be utilized in the right way and at the right time, Stockert explained.
“At a higher level, it’s important to contemplate where and how best the tools are used,” he said. “From a care provider and medical professional perspective, it seems optimal to have the users of the current workflow help understand how best to utilize those tools and innovate and change the way they practice.”
“Right now, it feels at times we end up with a binary type of situation,” Stockert continued. “It’s either, ‘The robots are going to take over,’ or ‘No, not in my house. It’s always going to be me, myself, and I as a practitioner, we don’t need any of those.’”
Both of those approaches are the wrong answer though, he said. The optimal way to navigate to the center is to think about how to transform the profession from training and engagement. The gap between leaders who are driving interoperability – such as the large tech companies – and organizations with the data and information must be bridged.
“How do we leverage that as a strength and not have it pivot as this tension?” Stockert asked. “It’s a longer term journey to get that right. From the care provider and patient perspective, the tools have to be useful for outcomes we think are meaningful.”
Getting to that outcome requires the industry to keep the empathy part of healthcare at its very core, ensuring that people always remain the top focus.
“It’s about figuring out how you scale that empathy, at the right times, the right places, and the right situations, to actually transform care.”