Healthcare Interoperability: Why COVID-19 Responsiveness Depends on It

July 27, 2020 Anne Davis

With interoperability, health information systems can share data seamlessly across organizations and care settings. Access to comprehensive member and patient information means that plans and healthcare providers can treat individuals more effectively. We’ve recognized the value of interoperability in healthcare for several years, but the importance of interoperability has come into sharper focus with the COVID-19 pandemic.

Why Does Interoperability Support Higher Quality, More Responsive Care?

In a crisis like the current pandemic, healthcare professionals are working in uncharted territory. Research findings and best practices for treatment are continually evolving. This means that plans and providers must be agile and prepared to pivot quickly toward different approaches as new knowledge accumulates. Organizations need a complete, current picture of each person’s medical history, chronic conditions and other types of data that influence health such as social determinants of health (SDOH) to deliver the best care. The growing recognition that treating the whole person is key to improving health outcomes, combined with the continued shift from volume to value-based care means that it’s time to address the barriers that compromise holistic patient care across the healthcare continuum.

This is where interoperability comes in. Timely data sharing across information systems is the best way to give healthcare practitioners the actionable intelligence needed to combat COVID-19. A good example is Taiwan — the country’s electronic health records system enables doctors, hospitals and the Ministry of Health (the payer for health services) to access near real-time information about patients. This has supported fast, targeted responses to virus outbreaks.

Understanding which individuals are at risk for more severe cases of the novel coronavirus is critically important when developing treatment plans. Organizations that use risk intelligence systems built on evidence, science and advanced analytical techniques have greater insight into which people have rising risk for severe COVID-19 complications. HMS’ Elli, for example, ingests data from multiple sources including electronic health records, lab results, claims, health risk assessments, social determinants of health and other non-standardized datasets to predict exactly who is at-risk for increased clinical, quality and non-clinical issues. The use of predictive and prescriptive analytics gives health plans and providers actionable insights to support care pathways.

Interoperability is also essential for further improving the quality of healthcare. A recent article in JAMA noted that feedback loops required for quality improvement are only effective when that feedback is based on current data. In addition, interoperability forms the foundation for performance benchmarking across healthcare institutions. Without up-to-date, comprehensive data, it is difficult to compare performance or evaluate the impact of new protocols like telehealth services.

What Steps Can Organization Take Now to Improve Interoperability?

Unfortunately, interoperability challenges can’t be solved overnight. Barriers include technical, financial, operational and trust-related challenges. At the most basic level, individuals need a unique identifier that links their medical records across organizations, while maintaining their privacy and data security.

Government mandates may help to push healthcare organizations on the issue of data sharing. The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) recently issued the Interoperability and Patient Access final rule. Important dates to keep in mind include:

  • January 1, 2021 – This is the effective date that CMS and ONC have established for certain health plans to deploy a secure Patient Access application programming interface (API). This interface will support patient access to information related to claims, encounters, costs and clinical data.
  • January 1, 2022 – This is the deadline for health plans to implement a Payer-to-Payer Data Exchange.

Health plans and providers may also want to proactively adopt technology systems that support interoperability. Integrated population health management solutions are one way to obtain data and actionable information about members and patients. A set of integrated solutions enables your organization to respond effectively to public health crises like COVID-19, as well as support quality initiatives and the ongoing shift to value-based care.

Interoperability is an important factor in the war on COVID-19. The journey to data transparency and access, however, will take time. There’s no time like the present to get started or to resume your efforts. If not now, when?

 



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About the Author

Anne Davis

Anne Davis is the Director of Quality Programs & Medicare Strategy at HMS where she focuses on the company's Population Health Management product portfolio. Anne has spent the last 20 years focusing on healthcare quality, care and evaluation. Prior to joining HMS, Anne was responsible for care management, utilization review, and population management at a five-star Medicare Advantage plan and integrated delivery system. Since 2015, Anne has worked as a consultant, focused on HEDIS and Stars, quality programming, and reporting & evaluation. When she isn’t working, you’ll find Anne at the beach with her family, teaching yoga classes and hiking in her beautiful home state of Maine.

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