There’s been too much talk for far too long about achieving interoperability, said healthcare leaders during two panel discussions jointly hosted by the Healthcare Leadership Council and Bipartisan Policy Center Thursday at HIMSS19.
The time has come to tackle interoperability once and for all, and it will demand aligned incentives, public-private collaboration, and a spirit of compromise from providers, payers vendors and others.
“Society is demanding it,” said Change Healthcare CEO Neil De Crescenzo.
“Doing the right thing is not always financially advantageous,” added Jeff Rose, senior vice president of clinical strategy at Hearst Health. “We can do this. But there will be give-and-take.”
The event accompanied the release of a new report from HLC and BPC that outlines recommendations for advancing interoperability, capitalizing on the momentum of the proposed rulemakings announced this week by the Centers for Medicare and Medicaid Services and the Office of the National Coordinator for Health IT.
Among the recommendations in the report:
- Make a better business case for interoperability by encouraging payers and providers – and providers and vendors – to agree on basic shared expectations for data exchange, via model contract language or other mechanisms.
- Bolster technical infrastructure for interoperability by adopting standards to improve patient matching across systems, speed up adoption of FHIR and APIs and including testing of interoperability in the ONC Health IT Certification Program.
- Encourage adoption of a “notice of information access” and alignment consent policies for substance use disorder treatment under 42 CFR Part 2, in addition to aligning state privacy laws with HIPAA, making it easier for patients and providers to gain access to data.
- Expand public and private sector collaboration on ways to track interoperability progress and furthering private-sector actions toward that end.
A year in the making, the report drew from the insights of clinicians, health system leaders, payers, life sciences organizations, IT vendors, patients and others – more than 100 different stakeholders in all, according to HLC and BPC.
“Our objective from the very beginning was to bring together leaders from every sector of health care, to chart a course for private-public sector action that could help bring information to the point of care,” said Sen. Daschle, a co-founder of the BPC. “There is virtual unanimity around the need to support better clinical decision making and, importantly, to bring information to patients to help them manage both their health and their healthcare.”
For his part, National Coordinator for Health IT Dr. Donald Rucker said move toward open APIs was obviously encouraging: “the concept of using modern computing – application programming interfaces – and the big distinction there is that they’re standards-based APIs, as opposed to individual vendors,” he said.
“That is empowering for a couple of sort of obvious reasons in terms of vendor lock-in and the ubiquity of the tools,” Rucker added. “But it’s also empowering because it gets into new business models. Because the software stack we’re using is the same stack that basically powers all the apps on your phone. We’re trying to move healthcare back into the modern computing environment, where there are hundreds of thousands of people capable of helping us.”
Speaking from the hospital perspective, however, Terry Shaw, president and CEO of AdventHealth, said more needed to be done with the data that is already flowing. Merely having access to it isn’t enough, he said.
“Data is interesting, and we’re getting better at having pipes that push information around, but we’re not turning it into information,” said Shaw. “We need AI tools running across that that knows, your diagnosis is X and you’re in the ICU and this your background, and because of that, I need to push the right information to the clinician, both the nurse and the doctor to help them do a better job of taking care of you.
“Today, we say to the clinician, ‘Merry Christmas, click this icon and if you want to read the 800 pages that’s out there and glean something from it, that’s great,'” he explained. “That’s got to stop. We have to incentivize third parties to have smart AI systems embedded into the process that can help make sense of that information and drive it.”
Jonathan Scholl, president of Leidos Health Group, said there has been more progress on interoperability than many realize – albeit not nearly enough.
“Our most notable progress has been hospitals,” he said. “Almost 90 percent of hospitals send and receive information to each other. That’s a good success story.”
The problem, he said, has to do with what Shaw described. “It comes in the form of 600 page reports that doctors have to sift through, and it just doesn’t work. So, good progress on interchange, but let’s not call that interoperability.”
Meanwhile, “about two thirds of hospitals are able to electronically search within and across the medical record,” said Scholl. “But a lot of times that comes because they’re on the same system. We have to get to a point where we’re not asking health systems to spend exorbitant amounts of money to replace systems that already digitized information with other systems, just to achieve the objective of searchability and data-level interoperability.”
Add to the the fact that barely 50 percent of patients have easy access to their records, “and almost none of them share data with their providers,” and the scope of the problem is apparent.
“The technologies exist,” said Scholl. “It’s going to take investment and fortitude to get to the answer.”
For all the encouraging ideas, both in the panel discussions and in the HLC-BPC study, the question, said Daschle, is “how do you take a report and make it an action plan?”
That’s the challenge. And it will most likely continue to be. But it’s also fact that more and more stakeholders, from all sides of the challenge, now truly realize that the days of thinking “some agency’s going to do a rule and solve our problems” (as Rucker put it) are over.
It’s time to make the put into action the private-sector push that the keynote panel at HIMSS19 said was the necessary vector for true progress on interoperability.
“There’s wide recognition that it is an essential foundation for improving quality, cost and patient experience,” said Daschle. “We’ve made progress, but there’s still a whole lot more to be done.”
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