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Reexamining the Progress of Health Data, EHR Interoperability

HIMSS EHR Association's new committee chair shares his views on EHR interoperability and the industry's progress toward seamless health data transfer.

By Sara Heath

- As the healthcare industry continues to adopt more sophisticated forms of information technology tools, providers and policymakers are seeing a need for better health IT interoperability to be able to exchange health data seamlessly and efficiently using interoperable health tools.

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The problem, many say, is that health technology isn’t interoperable, or at least not interoperable enough.

But perhaps that assessment doesn’t quite hit the mark. According to Richard Loomis, MD, the new executive committee vice-chair at the HIMSS EHR Association (EHRA), EHR interoperability is progressing at a steady rate.

Although there will always be challenges, the push for interoperability is a continuous evolution.

“I think we are very much in an evolution of interoperability,” Loomis, who is also the chief medical officer at Practice Fusion, said in a recent interview. “We have several examples of that today in the form of laboratory data exchange, imaging data exchange, e-prescribing, and clinical data exchange. In fact it is happening with increasing frequency across various care delivery settings.”

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In recent decades, the healthcare industry has made strides in boosting health data interoperability, starting with the exchange of the data Loomis noted above. Now, he said, the industry is highly focused on exchange of patient clinical data, an area in which IT developers and industry stakeholders are working to improve.

“What the national discussion now has focused on is exchange of complete clinical data, or patient’s complete electronic medical records,” Loomis explained. “We are steadily making progress there as well.”

The proof is in the pudding, he contended, citing statistics from EHRA.

Some 85 percent of hospitals sent data outside of their organizations, for example, thanks in part to inter-provider programs. Between four different initiatives – CommonWell, Direct Connect, eHealth Exchange, and Carequality – nearly 100 million patients have benefitted from interoperable health technologies.

Much of this growth is a result of value-based reimbursement programs, which require providers administer patient-centered, coordinated care.

“When providers are now required to coordinate care across multiple locations, multiple providers, they need access to a complete patient record in order to do so both to coordinate the care that’s receiving, to manage the transitions of care, as well as to ensure that redundant tests, procedures, medications aren’t prescribed, as well as to promote overall patient safety,” Loomis explained.

To meet those needs, EHR vendors and developers have worked on helping providers communicate and exchange data, making health tools interoperable.

“There has been a lot of talk around the need for interoperability,” Loomis remarked. “The value-based care use case, or driver, in my opinion, is the most significant to advance complete interoperability.”

“We are steadily making progress there as well,” he continued. “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.”

None of this is to say that the push for interoperability comes without its challenges, Loomis said.

Notably, EHR vendors and IT developers have been facing challenges in developing use cases for interoperable technology, making it hard for them to know how these tools need to be developed. Market drivers have not existed for physicians and hospitals to share data in the past but now that we are moving to a value based reimbursement system, providers will have a business case to share information.

“There hasn’t necessarily been a need or a requirement for providers to exchange clinical data,” Loomis explained. “As I said earlier, we’re now seeing a shift in the industry toward payment models that demand that this information be exchanged. So that has certainly historically been a challenge, or something that has slowed the adoption of interoperability or the use of clinical data exchange.”

As the industry begins to overcome the use case challenge, Loomis identifies another hurdle: the need for health data standards and governance.

Through industry-wide collaboration, healthcare providers, EHR vendors, and policymakers are working to establish these kinds of standards Loomis says are needed for interoperability improvement.

“So ensuring that mature, robust, technical standards are in place to facilitate interoperability and then that the appropriate governance policies and processes are in place that will ensure that data is exchanged safely and securely,” Loomis said, describing the work stakeholders are doing.

Going forward, Loomis sees the interoperability evolution continuing. Ultimately, he sees value-based care imperatives driving the exchange of full clinical data, pushing the industry closer to its goal of nationwide interoperability.

“We’re in a state of evolution and growth and maturation toward robust infrastructure and systems that will facilitate interoperability,” Loomis concluded. “So historically it hasn’t necessarily been feasible for a number of reasons to exchange complete clinical data, and as the industry demands this functionality, we are starting to see the barriers overcome.”

Image credit: Niño-Eduardo C. Palaña

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