It’s Time to Accelerate Healthcare Interoperability

November 7, 2019 Anne Davis

Healthcare is an industry rife with nebulous buzzwords. But if CMS’ recently-proposed policy changes are any indication, interoperability isn’t one of them — or at least, it’s one that’s coming into focus.

What Is Interoperability?

The volume and complexity of healthcare data has rendered the term interoperability inherently ambiguous. Simply put, it describes the ability of various health information systems to communicate with one another, enabling the transmission of patient data across different entities and care settings. It’s a vital component of value-based care models, whose success relies heavily on having current, comprehensive patient data — including SDoH data — in order to care for the whole person.

Barriers to Adoption

Interoperability has been a big part of the healthcare conversation in recent years, but with much of the focus on the obstacles to its realization. This isn’t without reason — The Office of the National Coordination for Health Information Technology (ONC) outlined a number of technical, financial, operational and trust-related barriers to interoperability in its 2018 Report to Congress. Some of the most resounding concerns among stakeholders include the lack of a unique identifier to effectively link patient records across organizational boundaries and maintaining the privacy and security of patient data (i.e., HIPAA compliance) in an interoperable environment.

Gaining Momentum
Though concerns have been well documented, data shows that the industry understands the value of interoperability as a catalyst for higher quality care at a lower cost. A recent survey conducted by the Trusted Network Accreditation Program (TNAP) found that 95 percent of respondents agreed or strongly agreed that improving electronic data sharing will improve the efficiency and effectiveness of care.

Several large health plans are partnering with technology companies to facilitate the sharing of patient data across the healthcare system to break down silos within departments, organizations and the sector as a whole. And while these “early adopters” may be slightly ahead of the curve, recent regulatory developments indicate they may not be for long — and that those who haven’t begun investigating or operationalizing data sharing could be at risk of falling behind.

CMS Proposed Rule

As part of the federal government’s 2018 MyHealthEData initiative, the Centers for Medicare & Medciaid Services (CMS), together with ONC, has proposed new policy changes intended to give patients greater control of their healthcare data while accelerating interoperability. The Interoperability and Patient Access Proposed Rule highlights several provisions to remove barriers inhibiting access to and transfer of patient data. Additionally, CMS’ proposed interoperability rule requires that insurers participating in programs like Medicare and Medicaid — as well as those on the exchanges — allow members to access their personal health information at no cost.

The proposed rules represent a significant step in transforming interoperability from healthtech buzzword to industry norm. But in order to achieve meaningful, widespread progress, simply going through the regulatory motions isn’t going to cut it. According to a recent Deloitte survey of payers and providers, 43 percent of health system and 63 percent of health plan leaders intend to implement the regulatory guidelines into their broader interoperability strategy, substantiating Deloitte’s recommendation that organizations look beyond compliance alone to realize the large-scale and long-term value of an interoperable health system.

Data Integration Is Paramount

Despite measures to narrow the scope of interoperability into practical strategy, the concept is as broad and infinitely evolving as the healthcare data sets themselves. There are, however, several foundational elements of an interoperable system that the industry must look to prioritize to facilitate the transition. These include:

  • A wealth of data through broad, systematic participation.
  • The infrastructure to incorporate data from various sources (clinical, non-clinical, patient-reported and more) and facilitate its transmission through different applications.
  • Matching functionality to ensure personal health information follows patients and members throughout their lifetime.
  • Implementation of AI systems to reduce manual interventions and optimize the patient and member experience.
  • Continuous evaluation and quality improvement to reduce clicks and streamline processes.

Making Interoperability Part of Your Organizational Strategy

Achieving system-wide interoperability is one of the most crucial components of patient-centric care — from integrating medical, behavioral and socioeconomic considerations into a patient’s care plan to enabling productive communication among holistic care teams. It’s also key to reducing provider burden — by minimizing data processing efforts, providers are able to place “Patients over Paperwork,” mitigating physician burnout and increasing patient satisfaction.

While CMS’ proposed rule provides a solid baseline for prioritizing healthcare interoperability, achieving these standards at the organizational level takes substantial, long-term investment —and outside support. Health technology partners well-versed in the implications of healthcare data exchange are helping to drive data interoperability through strategic relationships with key healthcare stakeholders.

How is your organization advancing the interoperability initiative?

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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