Researchers from University of Edinburgh polled government and health policy leaders, as well as physicians, payers, patient advocates, and vendors from across the United States. They found that “reform efforts are severely limited by problems with usability, limited interoperability and the persistence of the fee-for-service paradigm—addressing these issues therefore needs to be the federal government’s main policy target.”
Many providers cited issues with usability of computerized decision support systems and EHRs, and said that vendors needed to open their application program interfaces and that there should be more choices in the vendor marketplace. Dr. Nathan Gunn, an expert on interoperability, sat down with The Progressive Physician to give his views on the matter. He is the president of population health at Valence Health, a provider of value-based care solutions, where he oversees Valence’s software, analytics, clinical research and data operations functions.
Q: What is the current 'state' of interoperability?
A: The state of interoperability is as difficult to define as interoperability itself because everyone has a different view of what it means. For many providers, interoperability means having access to all of a patient’s data, even if it requires access to ten different programs. And under that definition, we are falling terribly short.
One of the biggest challenges is advancing interoperability in a way that’s not disruptive to physicians’ workflow. For patient information to be truly interoperable and transferrable between different health IT systems, it must be documented in a standardized way. Yet, this often runs contrary to how providers deliver patient care. The question becomes, who should have responsibility at the provider level to ensure that data is entered and validated as clinically accurate?
Because this individual responsibility varies from practice to practice, software developers are unable to take these roles into consideration. And therefore, all too often, the EHR platform isn’t necessarily configured to a particular doctor’s office or hospital workflow.
The other issue is that there is a large cost associated with implementing, upgrading or changing systems, especially traditional software-based systems, causing permanent damage to an organization’s balance sheet. This poses a significant problem for physician practices that don’t have the necessary budget, technical capabilities or time to support an EHR platform, so there can be significant gaps in patient information across a Health Information Exchange (HIE) network.
Currently, there are a few industry players working as part of the CommonWell Health Alliance to address this problem by developing EHR/HIE standards of interoperability. Progress made in this arena will empower and enable providers to deliver the best care to patients, while instilling consumer confidence in our healthcare system.
Q: When will true interoperability happen?
A: There are several companies banding together to create initiatives focused on achieving interoperability between HIE networks. The Health Level Seven International communication standard, which has been around for years, has been building a framework and defining the standards associated with integrating and exchanging EHR information to support clinical practice, as well as the Fast Healthcare Interoperability Resources (FHIR) initiative both have the potential to make interoperability a reality.
While there’s no silver bullet to solve this problem, removing the barriers for each proprietary EHR system to communicate to each other will support an environment where true interoperability can occur. These platforms must be able to communicate with each other and follow a codified standard that maintains the clinical fidelities and integrity of patient information.
We also need to continue to look beyond our own industry to find and implement solutions and tools that will support a strong IT ecosystem.
Q: What are the remaining barriers to interoperability and how do they affect the physician?
A: One of the biggest barriers is that there’s still no truly standardized structure and format for all patient health information, and therefore physicians are forced to input information into a variety of different interfaces and systems to meet their increasing documentation requirements.
All of this activity takes time away from what they should be doing – focusing on delivering care to patients. Another barrier to interoperability is the age-old issue of patient identification and privacy protection. There is no way for different systems to really know that Joan Doe is the same Joan Doe that was seen in the ER.
Once we cross that hurdle, we must ensure that what each entity knows about Joan is clinically relevant and doesn’t interfere with any protected healthcare information. But the financial and operational barrier remains as well: especially in smaller practices, physicians don’t have the bandwidth or resources to adopt and implement health IT solutions, particularly the larger systems often used by their partnering hospitals and health systems.
Even when health systems are successful in moving their members to a common EHR, there are often vastly different and customized versions of each platform that still can’t connect. Until all stakeholders put pressure on each other to address the need for EHR platforms to interoperate with one another, we will be left with ill-conceived solutions that don’t address clinical verification, patient identification, and workflow inefficiencies and will never achieve the elusive goal of true interoperability.