- The push for nationwide healthcare interoperability has been fueled by organizations integrating EHRs and working toward as smooth of a transition as possible into the digital era.
Now that the technological aspect is there, it is becoming increasingly critical to ensure that providers understand the data and are able to properly utilize it, Massachusetts eHealth Collaborative (MAeHC) CEO Micky Tripathi explained.
While MAeHC currently works mainly with provider organizations to help them with health IT needs, the non-profit has evolved over time along with interoperability needs. More healthcare organizations have EHRs, so instead of focusing on the EHR implementation itself, it’s important to help organizations optimize their EHR.
It’s an exciting time right now for healthcare interoperability, Tripathi asserted.
“The fast movement and the push to accountable care into value-based purchasing has been the biggest driver more than anything else,” he told EHRIntelligence.com. “Organizations that now see it as being a direct part of what they need to do is just a fundamental change from fee-based payment models.”
Meaningful use was instrumental in providing a financial basis for the provider and for the healthcare delivery sector to actually have the core technologies that it needs, Tripathi added.
Previously, organizations didn’t even have the necessary technologies, so being able to do accountable care in any meaningful way was just a “fruitless exercise.”
“If everyone’s based on paper, there’s no way for them to be able to take risks or be able to manage according to performance,” he explained. “That was in part because they can’t figure it out themselves.”
“Let’s say a payer who’s paying for it has no good ability to even measure it,” Tripathi hypothesized. “How would you even know how to pay that organization aside from it just reporting, ‘Well, I did this,’ rather than ‘Well, I’d like to know if you did it well and I’m only going to pay you if I can tell that you did it well.’”
Meaningful use laying the foundation, and then the subsequent push to accountable care was just enormous, he stressed. It created this concept of network formation for interoperability.
“Both Carequality and Commonwell are these two nationwide networks that are kind of like AT&T and Verizon if you think about cell phones,” Tripathi explained. “They are the ones who provide that nationwide infrastructure for interoperability.”
“Starting this year they’re actually connecting their networks,” he continued. “They’re in pilot phase right now and before the end of the summer they’re going to go live with those networks being connected. Which, at that point that’ll just be huge because that’ll be like AT&T and Verizon finally connecting the networks.”
Nearly 80 percent of the providers on EHR systems are a part of either or both of those networks, Tripathi pointed out. Networks are now scaling up rapidly, which means that most providers will have the ability to have core interoperability right in their EHRs.
Essentially, providers will have the ability to either securely send an electronic medical record to most every other provider in the country or the ability to request, or search for a record.
“We’re really at a pivotal point,” Tripathi stated. “What’s interesting is those are all private sector funded initiatives. Commonwell and Carequality, all of that was not by regulation. All of it was private sector initiative; providers and vendors saying the time has come for us to have interoperability. Everyone has systems now, let’s now invest in the interoperability to connect up those systems.”
Federal initiatives, such as the MyHealthEData and Promoting Interoperability, are also key for furthering nationwide interoperability, he maintained. Many of the recommendations at the core of those initiatives were first being made within the HIT Policy Committee, before it became the Health Information Technology Advisory Committee (HITAC) under the 21st Century Cures Act.
“If you look back at those documents and all the government testimony, it was providers and vendors saying, ‘It’s now time to pare back meaningful use so it focuses on safety and interoperability. Get rid of all of the other stuff and focus on meaningful use on interoperability,’” Tripathi explained.
The Apple Health Records EHR data viewer will also play a critical role for improved interoperability, he posited. Apple took the implementation guide from the Argonaut project and said it was now mature enough with enough acceptance across the community, especially with the EHR members. Apple then decided to make it a standard in the iPhone iOS 11.3.
“It’s not even an app, it’s baked right into the operating system,” Tripathi said. “That’s huge. It gives patients access to their clinical data, unlike MyHealthEData, which is only claims data.
“The clinical data is really where the information is,” he added. “To the extent that there are apps and other things that you might want to get to be able to take your clinical data and do good things with it, that’s really where it’s going to happen; it’s not really going to happen from claims data.”
Apple first announced the move with 12 hospitals that it had been working with previously, and within one month there were close to 100 hospitals that wanted their systems to be connected, Tripathi said.
“That’s a huge driver in the market when a company like Apple starts to drive a standard like that,” he stated.
Overcoming interoperability challenges, barriers as the industry evolves
Healthcare is getting to a point where technology is less and less and less of a challenge, Tripathi said. Even just four years ago, EHR adoption was nowhere near where it is now.
“You can’t have a phone network if people don’t have phones,” he noted. “You can’t have clinical interoperability if people don’t have EHRs. That was a huge barrier, the fact that no one had an electronic system.”
Healthcare then got to the point where there are technical interoperability options, there’s governance questions, and there’s issues with consent. The industry needs to figure out how to deal with all of that, along with improving “the basic plumbing of connecting” those systems.
“Now we have Commonwell and Carequality baked right into the EHR systems, so increasingly technology isn’t the issue,” Tripathi said. “We’re almost at the point where with EHRs, with interoperability, it’s going to be where providers don’t even have to think about it. The technology is right there, it’s baked right into the EHR. Providers are trained on how to use it and it just works.”
The bigger challenge currently surrounds variation in laws around interoperability from one state to the next, he pointed out. There may be different consent laws, or varying requirements on how the data can be used.
“Now the networks are up and running, so the previous complaint of, ‘I can’t get any of this data’ does not exist,” Tripathi explained.
Instead, organizations have access to the data but it’s exceedingly complex, or perhaps providers are using different codes and the information is hard to read.
“The quality of the data that [providers] are getting, which is the next great frontier, is not about having access to the data: it’s about how do you get the data in good enough quality that you can actually do something with it,” he said.
Consumer directed interoperability is another prospect that some industry stakeholders are calling for as well. This can be driven by initiatives that want to give patients greater access to, and greater control of, their own data.
“This has lead to a thought that maybe there could be a paradigm shift where the patient themselves could be the driver of interoperability,” he explained. “That’s on the horizon. It’s not as if we have that right now or that we have the ability to do that right now. It would take a real paradigm shift for that to happen.”
Even just less than two years ago, patients may not have even had the tools to be able to ask more specific questions about their own health data, Tripathi said.
“Now we just start to see that there are pathways where patients could access their data,” he stated. “Maybe they could start to be the drivers of interoperability and almost flip the equation.”
The tools are going to be in place for patients to be able to exercise that desire for access. One of the biggest challenges with that though is once a patient has control over her own data, she has left the protective confines of HIPAA, Tripathi noted.
“HIPAA says that once the patient has their data, they can do whatever they want at that point and it’s not subject to HIPAA anymore,” he explained. “The nightmare scenario is now I’ve got the data on my phone and somehow some nefarious app has gained access to it. Perhaps because I gave them access to it because I didn’t realize. All of a sudden, a third-party has access to my clinical data and it wouldn’t be against the law for anyone to do anything with the data at that point.”
That control and ownership aspect is a big issue with policy makers right now, and others are just starting to recognize the need to get a handle on the issue, Tripathi said.
“We have a headlong rush to have patients have control,” he concluded. “Patients having their data in their control, we might want to think about what the unintended consequences might be. We might want to think about how we educate patients.”
“At a minimum, we need to educate patients so that they understand the risks. Perhaps we need to go beyond the minimum and set up data privacy regulations that govern data that is now in the hands of patients.”