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Top 5 Challenges to Achieving Healthcare Interoperability

Health IT developers, policymakers, and providers have several challenges to overcome before true interoperability is possible.

EHR Interoperability

Source: Thinkstock

By Kate Monica

- Improved healthcare interoperability is a top priority for providers, policymakers, and patients in 2017. The public and private sectors are working across the industry to facilitate seamless health data exchange between a multitude of health IT systems to coordinate care across various health settings nationwide.

Years of healthcare interoperability initiatives, health data exchange frameworks, and health IT standards have yielded considerable improvements in proliferating efficient information exchange.

However, several challenges still bar stakeholders from achieving true interoperability for optimal care delivery and improved patient health outcomes.

The following are five of the top remaining challenges to true interoperability:  

1. Developing a standardized way of identifying patients                                                

READ MORE: Interoperability, Usability, Outcomes to Drive Health IT Changes

Organizations including CHIME and HIMSS have been pushing for the development of a national patient identifier for almost two decades.

Assigning a unique patient identifier to every individual in the country is one way to ensure hospitals can exchange medical information and patient health records accurately and efficiently. Mismatched patient EHRs can lead to errors in patient care and increase the likelihood of patient harm.

While efforts to create a national patient identifier have stagnated somewhat over the past several years, recent policy developments and burgeoning initiatives fostering health IT innovation show promise for progress in the near future.

Last week, the Regenstrief Institute announced a new initiative to develop an automated patient EHR matching solution. Using a $1.7 million grant provided by the Agency for Healthcare Research and Quality (AHRQ), the Regenstrief Institute’s Center for Biomedical Informatics (CBMI) aims to develop and test evidence-based solutions to improve patient matching accuracy and reduce patient harm resulting from health record misidentification.

Over the course of five years, Regenstrief’s CBMI will devise real-world, evidence-based guidelines for improving patient matching utilizing resources provided by the Indiana Network for Patient Care (INPC), which is presently operated by Indiana’s health information exchange.

READ MORE: Interoperability Implications of 21st Century Cures Bill

“Matching the correct individual to his or her health data is critical to their medical care,” said CBMI Director Shaun Grannis, MD, MS. “Statistics show that up to one in five patient records are not accurately matched even within the same health care system. As many as half of patient records are mismatched when data is transferred between health care systems.”

Federal agencies such as  ONC are also participating in the nationwide push for a unique patient identifier.

In June, ONC launched the Patient Matching Algorithm Challenge to promote the development of new patient matching algorithms as well as transparency regarding the performance of patient matching methods.

“From an interoperability perspective, the ability to complete patient matching efficiently, accurately, and at scale has long been identified as a key element of the nation’s health IT infrastructure,” wrote Posnack. “Patient matching is almost universally needed to enable the interoperability of health data for all kinds of purposes. Patient matching also requires careful consideration with respect to its effect on patient safety and administrative costs.”

The involvement of federal agencies in developing patient matching algorithms are partially the result of recent changes in legislation.

READ MORE: Interoperability Under MACRA Must Provide Standard HIE Tools

After nearly 20 years of urging from CHIME and HIMSS, Congress has clarified the extent of federal restrictions on assisting private organizations in launching a national patient identifier under its UPI prohibition.

“No longer is a UPI considered a credible solution for the magnitude of the challenge,” said HIMSS Executive Vice President Carla Smith in a recent statement. “Rather, the focus has shifted to patient data matching and the need for a coordinated national strategy across the public and private healthcare sectors.”

With new reporting language introduced into legislation, the public sphere will now have the ability to offer technical assistance to the private sphere to expedite the creation of a national patient identifier.

2. Enforcing health IT interoperability standards across care settings, facilities

While stakeholders agree on the importance of health IT standardization, healthcare organizations often interpret and enforce these standards differently. 

Cerner Vice President of Interoperability Kashif Rathore cited varying interoperability standards as one of the biggest challenges to interoperability advancement today.

“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.”

Lack of interoperability standards or poorly enforced standards can obstruct seamless health data exchange by complicating transactions and posing additional barriers to the flow of information.

“In some of these areas, we lack interoperability standards,” said Rathore. “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, Rathore stated the CommonWell Health Alliance is Cerner’s solution to this issue.

“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.”

Interoperability initiatives such as CommonWell facilitate health data exchange between organizations and provide services to promote interoperability using software already embedded in a provider’s EHR system.

The expansion of healthcare organization-led alliances designed to facilitate exchange and promote standardization could assist in surmounting the lack of standardization between care settings.

3. Enforcing industry-wide interoperability measurement standards

Enforcing standards is also a challenge for interoperability measurement.

With new interoperability improvement initiatives frequently sprouting up across the industry, federal agencies need a way to measure the progress of these initiatives by assessing the state of health IT interoperability in a consistent way.

However, interoperability measurement standards often vary between stakeholders.

In April, ONC devised a potential solution to this problem with the proposed Interoperability Standards Measurement Framework.

The framework was designed to evaluate the industry’s progress toward implementing interoperability standards and assess the way standards are used to measure interoperability improvements.

Improving measurement standards will assist in tracking progress on a national scale.

The framework recommended requiring health IT companies to report the percentage of end-users utilizing a particular standard, the volume of transactions by standard, and the conformance and customization of standards following implementation.

By promoting consistent standards measurement nationwide, ONC can inhibit health IT developers, healthcare organizations, and HIEs from applying standards differently.

4. Coordinating stakeholders across the industry

At a press conference earlier this year, ONC addressed the ways federal agencies intend to improve interoperability in the coming months.

According to ONC Principal Deputy National Coordinator for Health IT Genevieve Morris, one way the federal agency will improve interoperability is by carrying out the objectives outlined in the ONC Interoperability Roadmap of 2015.

 “We are going to be building strategies around those four targets, but making sure that we’re pulling in from the roadmap the items that haven’t been accomplished yet but still need to be accomplished in order to move us forward,” explained Morris.

One of the primary objectives of the ONC roadmap was to coordinate stakeholders to develop consistent policies across the industry and discuss policies obstructing interoperability.

Work toward achieving this objective began this summer with the first of three multi-stakeholder meetings to develop a national plan for standardizing health data exchange through the 21st Century Cures Act trusted exchange framework and common agreement.

Over 500 stakeholders attended the meeting, including National Coordinator Don Rucker, MD.

Panelists emphasized the need for seamless health data access, improved population health management, and competitive, open application programming interface (API) development to encourage innovation.

In the coming months, stakeholders will collaborate to create policies and standards enforcing the priorities outlined in the July 24 meeting.

These meetings mark an effort to fulfill the objectives of the ONC Interoperability Roadmap of 2015, and ensure stakeholders are on the same page regarding interoperability policies moving forward.

5. Ending information blocking and data sharing impediments

Despite Congress deeming the practice illegal, information blocking is still a prevalent problem in health data exchange.

A study published earlier this year surveyed 60 HIE leaders and found that information blocking is still widespread, and policies put in place to curb the practice have been ineffective.

The study by Adler-Milstein et al. found 50 percent of respondents reported engaging with health IT companies participating in information blocking, and a quarter of respondents reported hospitals and health systems were guilty of the practice.

“Among hospitals and health systems, the most common form was coercing providers to adopt particular EHR or HIE technology,” wrote Adler-Milstein.

However, efforts to further impede information blocking are already underway.

“Current ONC efforts and bills in Congress pursue enforcement by authorizing the OIG to investigate and establish deterrents to information blocking,” researchers concluded. “If successful, reducing information blocking will help ensure that data follow patients across provider organizations, which is essential to improving the quality and efficiency of care.”

Additionally, while information blocking has not been entirely eradicated, some existing policies have yielded improvements.

“Increasing transparency of EHR vendor business practices and product performance, stronger financial incentives for providers to share information, and making information blocking illegal were perceived as the most effective policy remedies,” wrote researchers.

Cerner Interoperability Vice President Kashif Rathore believes promoting collaboration between health IT companies, hospitals, and HIEs could further curb information blocking.

“We 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,” he added.

Developing a national patient identifier, improving standardization and collaboration across the industry, and ending information blocking are all remaining hurdles standing in the way of true interoperability.

However, with initiatives to overcome these challenges already gaining traction, interoperability advancements will likely continue despite these obstacles. 



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