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Seeking Interoperability in a Sea of Data

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   November 19, 2015

While it has been an elusive goal for years, the costs associated with not having standardization are mounting and "interoperability is becoming the main act" for healthcare leaders, says an HIT expert.

This article appears in the November 2015 issue of HealthLeaders magazine.

Interoperability of electronic health records and other healthcare IT systems remains elusive. Healthcare organizations clamor for it and the federal government voices support, but until very recently providers and vendors have lacked incentive to do more than create isolated networks. Yet many providers around the country are creating their own workarounds to achieve at least partial interoperability. These efforts take a lot of work, but technology leaders undertake them in pursuit of cost savings and patient safety.

Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI

The Institute for Electrical and Electronics Engineering defines interoperability as "the ability of two or more systems or components to exchange information and to use the information that has been exchanged," and that is the commonly agreed-on aspiration of all stakeholders in healthcare.

"There is a cost for the lack of standardization and the lack of interoperability," says Jonathan B. Perlin, MD, PhD, MSHA, FACP, FACMI, who is chief medical officer and president of clinical services for Nashville-based Hospital Corporation of America, which includes 168 hospitals and 113 freestanding surgery centers in 20 states and England, and reported revenues of about $37 billion in 2014. "Organizations, ours included, are compelled to create workarounds to make different devices or different information systems share the information. We need standards that get us to plug-and-play."

In April, at the request of the U.S. Congress, the Office of the National Coordinator for Health Information Technology (ONC) issued its Report on Health Information Blocking, which concludes, "based on the evidence and knowledge available, it is apparent that some healthcare providers and health IT developers are knowingly interfering with the exchange or use of electronic health information in ways that limit its availability and use to improve health and health care."

The result of so-called information blocking, which has become a cause célèbre, is an additional layer of data charges.

"Clearly, the support that the government provided created extraordinary investment in health IT with the promise and the aspiration that information would flow along a superhighway to follow and inform patient care," Perlin says. "The promise was a superhighway, not a toll road."

Beyond the road map

The ONC is focused on this problem with its 10-year interoperability road map, initially released in January. But it is difficult to pinpoint just how much the lack of more seamless interoperability is costing U.S. healthcare. Health system executives are unable to produce a firm dollar figure, and various reports tend to lump interoperability costs in with the rest of the higher costs that uncoordinated, fee-for-service care imposes upon the industry.

A Robust Health Data Infrastructure, a 2014 report prepared for the Agency for Healthcare Research and Quality by JASON, an independent scientific advisory group, estimates that if data mining and predictive analytics could work on interoperable health information, it should be possible to reduce significantly the estimated $60 billion–$100 billion of annual healthcare fraud in the United States.

David Allard, MD

And perhaps more important, the report states that "the data also will contribute to improved understanding of the economics of healthcare delivery, both in the aggregate and for particular instantiations that either outperform or underperform the aggregate in achieving beneficial outcomes."

Choosing Wisely, an initiative of the American Board of Internal Medicine Foundation, aims to reduce the over-ordering of tests and procedures. "Think of interoperability as being a key way to reduce the extra ordering of tests," says David Allard, MD, chief medical information officer of Henry Ford Health System, a five-hospital system whose flagship Detroit hospital has 877 beds. Such reductions would save Henry Ford "probably tens of millions dollars" annually by following the recommendations of the initiative, he says.

Why interoperability is difficult

Studies published in 2010 and 2014 by the President's Council of Advisors on Science and Technology list numerous scenarios where enhanced health IT interoperability could benefit the United States. So why does the nation continue to come up short on interoperability?

The answer is complex, but part of it is that interoperability already exists in many forms—much as before the Internet coalesced it was a series of networks that eventually became joined together by common protocols. The good news: Healthcare already has a set of such common protocols that routinely pass information between information systems not well-known for exchanging and using each other's information. Some of these common protocols were set in place by the federal meaningful use incentive program. The bad news: The protocols are unevenly adopted, reciprocal use agreements to "share and share alike" patient information with consent still require too much negotiation, and shared use cases often emerge only when providers discover or develop common business incentives to share information with each other. Such use cases are still rare.

Scott Mace is the former senior technology editor for HealthLeaders Media. He is now the senior editor, custom content at H3.Group.

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