- Achieving true interoperability is paramount to maximizing the myriad benefits of health IT and delivering safe, efficient patient care.
Federal agencies, healthcare organizations, and health IT companies alike are working to facilitate seamless health data exchange between all systems and overstep technical barriers obstructing the creation of a single, longitudinal patient health record capable of following an individual anywhere.
While federal officials have made broad efforts to spearhead advancements in health data exchange through various incentives and initiatives, Cerner has fashioned its own approach.
As one of the nation’s leading health IT companies, Cerner specifically intends to springboard interoperability improvements by fostering industry-wide standardization and collaboration.
Health data exchange standardization
According to Cerner’s Vice President of Interoperability Kashif Rathore, one of the biggest roadblocks to interoperability today is the lack of standardization EHR vendors and healthcare providers run into when moving data between different healthcare settings.
Promoting consistent standards across the continuum of care, he said, is imperative to advancing health data exchange and improving patient care delivery.
“What we need to remind ourselves is that care is happening in multiple venues,” Rathore told EHRintelligence.com. “You’re seeing patients in homes, in long term care facilities, and in hospices. That’s the ecosystem we live in today. So it’s not necessarily just the clinic in the hospital, but multiple venues of care.”
“In some of these areas, we lack interoperability standards,” he continued. “In many venues where the standards aren’t enforced or followed, it makes data exchange hard. It still happens to be a limiting factor.”
However, Cerner has an answer to the problem of incomplete or inconsistent nationwide standardization: the CommonWell Health Alliance.
“The CommonWell Health Alliance is a network we are using to further interoperability at the national level,” he said. “For national standards and national connectivity, that is the network we are relying on.”
Beyond CommonWell, Cerner is also broadening its involvement to support additional standards for more seamless health data exchange between health systems operating on different EHR systems.
“Cerner has also broadly adopted the Direct standard,” said Rathore. “A vast majority of our clients use it. We also connect to eHealth Exchange, and as you know through CommonWell’s new agreement with Carequality, we will have reach to some of those vendors that aren’t part of CommonWell to support broader interoperability.”
The agreement between CommonWell and Carequality came to fruition in late 2016 when both initiatives signed on to expand their networks and promote standardized health data exchange through collaboration.
Last month, Carolinas HealthCare System and Novant Health similarly forged an agreement to exchange patient EHRs in a move that signals an effort by rivaling vendors Cerner and Epic Systems to share patient health data and improve care coordination at facilities using either technology.
These mutually-supportive dealings between different interoperability initiatives and vendors are emblematic of the kind of harmonization and coordination Rathore believes needs to happen before significant progress is possible.
No vendor or initiative can have a monopoly on data sharing — they’ll need to work together.
Less proprietary information, more collaboration
Cross-industry collaboration will lead to rapid innovation and widespread standardization. On the flip side, information blocking is a surefire way to stagnate progress according to Rathore.
“We also run into instances where the health organizations and other vendors may think this is their data and may use this for competitive reasons,” he observed. “That mindset isn’t good because it’s not helping the patients. For the patients, we need to exchange information and not hold information because we think it’s ‘my record’—it’s not my record, it’s the patients.”
Ultimately, interoperability needs to be a foundational element of healthcare as ubiquitous as EHR technology.
“Interoperability needs to become a utility, and not used for anyone’s competitive advantage,” Rathore said.
By instead embracing collaboration, health IT companies can surpass health data exchange and begin focusing on addressing larger problems and projects. For example, collaboration could make the distant dream of a national patient identifier much more attainable.
“The country needs a national patient identifier,” Rathore maintained. “And I know there’s a history to this, but if we’re going to maximize the ability for health IT to exchange information, we need to ensure the best possible outcome for the patient. A unique patient identifier is the solution, and it’s up to us in the industry willing to collaborate for the betterment of others and remove this hurdle so we can make this identification part a non-issue.”
Rathore reasons that if the finance industry and others can find ways to avoid issues with consumer identification and manage transactions across multiple IT systems, the healthcare industry can do the same.
“It’s like ATMs,” Rathore explained. “I’ll land in Cerner’s Prague or Germany office—or anywhere in the world—and I can connect. I remember 18 or 19 years ago, we were stuck in a city on the West Coast and it didn’t take our ATM card because it didn’t support our system. If the banking industry can progress to manufacture credit cards allowing for seamless distribution—even the cellphone industry—so can the healthcare industry.”
The development of application programming interfaces (APIs) in particular will lead to the technological advancements necessary to facilitate seamless health data exchange mirroring that of the finance industry. To that end, Cerner also believes collaboration is key.
“Our thought process is that we need to invest and give ability to any innovators to come in and create things on our platforms,” said Rathore. “This ability is given to them via standard, so we can support broader collaboration. It is this collaboration that will help the industry advance the way care is delivered through improved information exchange.”
Innovators are jumping at the IT development opportunities Cerner has presented.
“We have about 1500 unique users using applications or smart applications on our open platforms each month,” he said.
Collaboration and standardization will provide the ideal breeding ground for innovation and interoperability at Cerner. Also driving improvements at Cerner in the near future is the recent contract the company scored with VA.
“We’re honored and it’s humbling to be selected to lead the VA’s project,” said Rathore. “That’s an understatement for how excited we are to lead this project in conjunction with ongoing progress implementing DoD’s MHS GENESIS.”
Falling in line with Cerner’s mission, the health IT company is building a standardized commercial EHR for VA standing on a similar platform as DoD’s MHS Genesis.
Enabling seamless health data exchange between VA and DoD has been a years-long, complex struggle for both federal agencies. By building EHR systems on standardized Cerner platforms, VA and DoD will at last have the compatible infrastructure required to share information efficiently.
If successful, the project has the potential to serve as an example for the healthcare industry to follow when approaching interoperability improvements across healthcare organizations, facilities, and care settings.
“It will lead to ongoing innovation, improved interoperability, and a single longitudinal health record to facilitate the exchange of data among military care facilities and the thousands of civilian providers where current and former service members receive their healthcare,” he said.