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Standardization Biggest Barrier to Healthcare Interoperability

With stakeholders on board to end information blocking, standardization remains the biggest obstacle to healthcare interoperability.

Healthcare Interoperability

Source: Thinkstock

By Kate Monica

- As one of the earliest adopters of health data exchange in its region, the Hattiesburg Clinic in Mississippi understands the importance of enabling healthcare interoperability to improve clinical efficiency and reduce provider frustrations.

The Hattiesburg Clinic first made the decision to begin participating in information sharing in 2011.  Though hospital officials knew health data exchange still had a long way to go before it reached maturation, the clinic embraced the capability and helped to pave the way for other hospitals that were hesitant to engage in the burgeoning practice.

Hattiesburg Clinic Chief Medical Informatics Officer (CMIO) Bryan Batson recently spoke to EHRIntelligence.com about how health data exchange has changed since his clinic first began sharing data and the barriers keeping exchange from reaching its full potential.

 The Introduction and Expansion of Health Data Exchange

The clinic first began participating in health data exchange after transitioning from a legacy EHR system to an Epic EHR. While the new Epic system enabled the clinic to exchange health data with many other providers to ease transitions of care and improve patient safety, data sharing capabilities were severely limited.

“We were early adopters of health data exchange in 2011, but that was limited because we were primarily exchanging data with other Epic customers,” stated Batson. “We found we were willing to exchange our data but many organizations in our area were not quite up to the level that they were able to reciprocate with that sharing. So it took a few years for them to catch up.”

READ MORE: Health IT Interoperability in Stage 3 Meaningful Use

Despite the technical hurdles barring the clinic from utilizing exchange to its full potential, Batson said the early days of health data exchange were exciting rather than infuriating. Providers at Hattiesburg and other facilities that had broken new ground in the area were happy to lead by example and see other organizations become more interested in improving their EHR systems to enable more liberated information sharing.

As both healthcare organizations and health IT companies worked out the kinks of health data exchange and interoperability over the years, exchange has expanded to allow for providers to share different kinds of data with more healthcare organizations operating on a variety of EHR systems.

Since the early days, Batson says data sharing capabilities at Hattiesburg have progressed rapidly. Most recently, the clinic connected to the Mississippi Division of Medicaid (DOM) and gained the ability to share and access health data about Medicaid patients in real-time.

“Now we’re able to exchange data in multiple ways – not only with Epic customers, but also providers on different EHRs and pharmacy databases, as well as state databases — and in this case, a payer database — Medicaid,” Batson said. 

Forging connections with new organizations — including payer organizations — will allow for more efficient and cost-effective care delivery.

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Policymakers, health IT developers, and health IT companies worked to address several barriers to interoperability to push health data exchange to its current state. Most notably, stakeholders worked to put an end to information blocking and improve health data standardization to enable more organizations to share a wider variety of data types.

Information Blocking and Health Data Standardization

Federal organizations including CMS and ONC have increased pressure on providers and health IT companies still engaging in information blocking. In addition to federal policies, incentive programs also underscore the importance of putting an end to information blocking. As part of the Merit-Based Incentive Payment System (MIPS) under the Quality Payment Program (QPP), providers must attest to a prevention of information blocking reporting requirement.

While efforts to end information blocking still persist, Batson stated the practice was only an impediment to data sharing for the clinic early on.  

“Vendors that may be working with providers and perceived each other as competitors had to get comfortable with the concept of sharing data across organizations,” said Batson. “That was a hurdle initially, but it’s become the expectation. It’s much better for patient care.”

Ensuring healthcare organizations and health IT companies understand health data belongs to the patient has greatly improved data sharing. 

READ MORE: Health IT Interoperability Helps Connect Medical Staffs

“That realization that the data is the patient’s and not the provider’s or vendor’s is so beneficial to the patient,” Batson maintained. “We’ve been able to see that in many of these exchanges. We’ve been able to improve efficiency and — from a patient safety perspective – it’s great because we share information across the country and the world on patient allergies and medications."

“It’s improved patient safety and then it’s also improved reduction of duplication of tests with much more ready access to lab work or imaging studies or progress notes,” he continued. “To have access to what the patients have done with other organizations is a great step forward in us trying to have a more efficient healthcare system.”

Accusations surrounding information blocking recently spurred conflict between policymakers and EHR vendors when ONC suggested some vendors were gatekeeping health data and leveraging ownership of patient EHRs for profit.  While the EHR Association (EHRA) called the accusations “inflammatory and inaccurate,” Batson believes ONC was justified in calling out vendors for inhibiting interoperability improvements.

“ONC’s position was an important one,” he said. “We’ve been fortunate to partner with Epic, which has championed the concept of freely sharing data for a long time, so we have not come along in that culture where data blocking or information blocking is acceptable.”

“We’ve seen some of it on the other side and we’ve had some difficulties from time to time, but I do believe those walls have come down in a significant way in the past few years. People have started to have a different perspective on the importance of data sharing and I’m glad it’s a taboo thing to data block,” he added.

With information blocking becoming less and less common among providers and health IT companies as a result of federal policy, Batson says the lack of health data standardization is now the industry’s most significant remaining obstacle to interoperability.

“The biggest challenge we have now is that this vast amount of data is only useful to us if there is standardization,” said Batson. “We struggled with that. It’s hard to manage this vast amount of data if there aren’t rules of the road or common way to present information.”

Progress in establishing and implementing widely-used standards may be slow-going, but the industry has made significant efforts to promote standardization so far in 2017.

Stakeholders across the industry — including ONC — have worked to improve health data standardization by establishing a Trusted Exchange Framework and Common Agreement per provisions in the 21 Century Cures Act, continually updating the Interoperability Standards Advisory (ISA), and holding a Patient Matching Algorithm Challenge, among other initiatives.

“Right now, we’re in a crucial point where the standardization of that data is so important as that data starts flowing much more freely between entities,” said Batson. “We have to have a way to manage the volume. The best way to manage that volume is to have a set of standards.”

While Batson maintained more healthcare leaders need to push for stricter standardization, he said the clinic has seen myriad benefits where standardization is already in place.

“We’re able to more seamlessly integrate discrete data from disparate systems into single systems, and that took a lot of work — developing industry standards and ensuring the parties involved adhere to those standards,” Batson said. “We reap the rewards of that because the data that’s exchanged is actually meaningful data.”

As health data standardization and interoperability continue to improve, the ripple effects should lead to benefits for the entire industry. 

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