- Despite gaining notoriety as a 2015 most buzzed-about word, “interoperability” stands in the Health & Human Services (HHS) Interoperability Roadmap as the ultimate challenge to be met nationwide by 2024. As provider organizations move away from a siloed mentality and health IT enables greater sharing of patient data across care settings, interoperability will become central to more informed decision-making, reducing the care mistakes, redundant testing and avoidable readmissions that result from today’s gaps in care information.
To help clarify and standardize interoperability and to gauge the healthcare industry’s movement toward it, the Office of the National Coordinator for Health Information Technology (ONC) has released the final 2016 Interoperability Standards Advisory, with six characteristics for each standard including cost, federal requirements and test tool availability.
Adding fuel to the discussion, HHS Secretary Sylvia Mathews Burwell announced at HIMSS16 a major interoperability commitment among the companies that provide 90 percent of EHR systems used by US hospitals, with these vendors all sharing a focus on consumer access, interoperability standards and information-blocking prevention.
Still, healthcare providers are highly unclear regarding vendor ability and performance in interoperable exchange. KLAS recently measured healthcare providers’ general perceptions regarding which vendors struggle the most with interoperability. Epic received the most votes for interoperability struggle, with 44 percent; eClinicalWorks and MEDITECH followed much lower at 15 percent and 13 percent respectively, and the remaining vendors were lower still.
However, KLAS also found that among providers and competing vendors with actual Epic experience (rather than simply a perception), Epic was named the most effective to connect with. This group ranked Epic as the best vendor in five of eight interoperability measurements, including proactivity, commitment to industry standards, working with other vendors and standards, minimizing costs and maintaining interoperability during upgrades. Epic also tied with athenahealth regarding ease of connection setup. As the KLAS findings illustrate, provider perception of interoperability – possibly influenced by a 2014 RAND report that identified Epic as a “closed system” – does not necessarily link with provider reality.
Interoperability is twofold
Interoperability comes down to a twofold issue. The first half of the issue deals with EHR integration with medical devices within a healthcare provider organization. Addressing the medical device industry, the FDA recently issued draft guidance to developers. Directives include “conducting appropriate performance testing and risk management activities” and “specifying the functional, performance, and interface characteristics in a public manner such as labeling.”
The second half of the interoperability puzzle is connectivity among different providers and EHR vendors. The biggest hurdle for providers is expense in integrating with varied EHRs from one physician practice to another practice or community hospital. While the interoperability commitment announced at HIMSS16 will certainly help, small physician practices just don’t have the financial means and technical savvy to easily participate. Beyond that, each facility may differ in its organizational culture, knowledge level and willingness to optimize with technology.
The mobile component
Mobile health information for today’s patient is becoming increasingly important in utilizing actionable data. Patient-generated data such as steps walked, daily blood sugar testing and dietary logs need to be integrated into providers’ EHRs in yet another interoperability hurdle.
An additional challenge in large-scale interoperability lies in patient identification. Imagine a medical emergency in which a traveling patient arrives unresponsive at the emergency room of a hospital outside his provider community. How does a provider quickly discern this patient from others of the same name across interoperating EHR systems, or reconcile dissimilar records for the patient that reside in different locations? The vast amount of duplicate patient records in existence hinders information flow across a patient’s care journey. It’s difficult to identify every practice, system and database that contains the records of a specific patient.
Clinicians as champions
In any facility, no matter the EHR system, budget or size, clinicians are the key to successful interoperability and should be engaged as primary stakeholders in integration projects. They will champion and promote the right attitude and leadership by example to extend an organization-wide culture focused on interoperability. These clinicians will then have the necessary focus and goals in mind to ensure that devices properly interface with the EHR system to require less data entry time for nurses, freeing more time for patient interaction.
What else can help?
Aligning with physicians’ charter of medical professionalism, physicians commit to improving quality of care and efficient distribution of finite resources. They want to improve the physical condition, engagement and overall wellbeing of individuals who come to them for care. If those patients emphasize to the various members of their care teams the importance of information sharing, physicians will become more motivated toward interoperability measures.
In seeking to address patient concerns and all of the other reasons why providers need to share patient information electronically, providers should keep in mind that outside resources such as integration experts can assist their IT departments in moving us all toward the HHS goal of nationwide interoperability.