While interoperability -- the exchange of data in easily readable formats -- isn't a new concept in the healthcare field, physicians are now starting to ask about acquiring specific data on patients that will improve their ability to provide the best care plan, which may be more of a concern as the industry pivots to value-based care.
The industry-wide push for improving health IT systems and devices as well as increasing interoperable solutions could be key for the success of population health management. But from hospitals to pharmacies, patient data is gathered across a variety of disparate systems and devices so hospitals and health systems face several challenges with interoperability.
For example only 23% of hospitals in 2014 were able to use their EHR to "find, send, receive and use electronic information due to substantial barriers," according to the American Hospital Association. A 2015 GAO report found such challenges could include insufficient health data standards, different state privacy rules, and accurately matching patients' health records.
Healthcare Dive spoke to Jitin Asnaani, executive director of the CommonWell Health Alliance, a nonprofit trade association with a focus on cross-vendor interoperability, about the current interoperability barriers to keep the conversation on solutions for interoperability going. Asnaani is the former standard and interoperability coordinator at the Department of Health and Human Services, and he served as the director of athenahealth for about three years.
Healthcare Dive: Why has CommonWell focused so heavily on helping health IT vendors achieve interoperability goals?
Jitin Asnaani, CommonWell Health Alliance executive director: The mission is wherever a patient goes to get care, there is a follow-up snapshot. It's a fairly simple mission but there’s a lot of complexity behind it. One of the key values that correlates to our mission is that we believe that the access to patients’ data should be accessible in the system the caregiver uses to take care of them. When you take that sort of approach, you really do need a strong collaborative effort of the organizations that are participating because we want to be able to enable all customers to access everyone else’s data. So, we have to ensure that your product is updated and that allows new users to be able to get data from the network to take care of their patients.
Healthcare Dive: What makes interoperability so difficult?
Asnaani: Once you build the software, it's not like we all use Windows 1.0. There are a lot of versions and most versions get better and better and better. So, the hard part is to continuously develop and improve [interoperability] just like any other product feature that you have already built within the old platform walls. It's not actually that hard but that's what takes a little bit of time.
Healthcare Dive: What are some of the other priorities EHR vendors have?
Asnaani: Having worked at an EHR vendor previously, I have a very good sense of what EHR vendors spend their resources on. It seems we should often expect, for example, improving the usability of their product and improving the number of features available in their product. One of the the beauties and curse of the U.S. is that we have tremendous sub-specialization in healthcare and each subspecialist needs a different workflow or a different type of data. So, if [the EHR vendor] wants to serve all of the subspecialties in the U.S., that is in the vicinity of 200 sub-specialties, which means 200 different workflows. Each one requires significant work. We need those engineers to do much more valuable things around population health. Interoperability is no longer a vice to have like it was 20 years ago but actually crucial now that we need care coordination between sub-specialists and specialists and nurses and social workers and so on. The space between the care is actually just as important as the care itself.
Healthcare Dive: What makes interoperability important?
Asnaani: From the health system's point of view, more and more health systems are not accountable only for their hospital. Even independent physicians are responsible for a patient even when they leave. So I need to make sure wherever they go they are healthy. So there’s a direct benefit because payments are being adjusted by how healthy patients are regardless of whether or not the patient is in your specific four walls or not, which is why the demand for interoperability has been surging over the last few years.
Healthcare Dive: Has the healthcare industry removed any barriers to interoperability as of yet?
Asnaani: The biggest one for a while was we did not have standards defined. We can define how to exchange the data and when data arrived at a different location, how it could be interpreted. There’s a lot more improvement to be made there but there was a big gaping hole before.
Healthcare Dive: What are some of the remaining barriers?
Asnaani: Now, the biggest barriers that I'm seeing are really two issues. One is within the provider organizations where for the first time providers actually have the opportunity to collaborate with each other. After so many years of not being able to do so, it is a cultural change for the provider to realize that they should be getting the data, that they did get the data when and where they wanted. It’s also a challenge for the vendors because for the first time providers are saying, "Hey, I actually wanted that data. I thought I could get it but I couldn’t." So, the old barrier used to be supply of interoperability, the new barrier is how do you stimulate the demand for interoperability now that you actually can exchange data and providers are using it. So, I'm very excited because that means that people are using our software to actually try to do the job we want them to do.
Healthcare Dive: What is the second big issue you're seeing?
Asnaani: There is variability on privacy in the consent laws from one state to the next and that’s a little challenging, especially if you are a national network and you want to make a simple and straightforward experience that’s relatively uniform. You want to be Google. You don't want to make a Google New York and a Google Texas. You want to do a single service called Google, which everybody can use and you type in a topic and you get data. In our case, you type in a patient and you get data on the patient. Right now we don't look different from state to state because we have a conservative approach but if we could make the system more intelligent, there would be an evaluation of some states’ laws. Unfortunately, some states have made it more complicated for the state than they need to be.
Healthcare Dive: Are there any hurdles associated with the provider's experience?
Asnaani: Another barrier is when you ask providers, "What is it about the interoperability experience that you like and don't like?," what they like is getting new data that will help with the patient and the degree that the data is most relevant. What they don't like is the added friction, another window that they have to go through, another system that they have to log onto, another set of clicks they have to make. That is huge in the user experience because its not really a Google experience if you have to wait five minutes for a page to load. You would stop using Google and that is why providers don't interoperate. They know they have to go to a different portal, remember a different password, a different username, and try to get that data to the patient. They really don't have time for it.
Healthcare Dive: What should be the federal government's role in this?
Asnaani: The role of the federal government now is painting some of the end goals. What is the behavior for interoperability? What does an outcome for patient engagement look like? What are good metrics of measuring how well and how healthy our patients are? Facilitating those forward-looking discussions rather than the tactical, “Heres the standard that we’re going to use.”