interoperability

Interoperability – all that’s old is new again

For some of us in health care policy, 2018 so far is the year of testing just how good our filing systems are. All that is old is new again and ideas to “fix the U.S. health care system” from years ago are popping back up. This week “interoperability” is the hot topic, in part because Seema Verma, Administrator of the Centers for Medicare & Medicaid Services (CMS), made a big announcement at the Healthcare Information and Management Systems Society (HIMSS) annual conference, saying interoperability would again be a focus of the federal government. She made three big announcements really, but today we are focused on Verma’s announcement that CMS will be overhauling the “Electronic Health Record (EHR) Incentive Programs to refocus the programs on interoperability and to reduce the time and cost required of providers to comply with the programs’ requirements.” Not surprisingly, when she mentioned the burdens on health providers of meeting meaningful use requirements and that CMS would be changing those requirements, the full ballroom broke into applause.

Patients Should Control Their Data. Yes, but…

The CMS administrator also announced a new initiative, “MyHealthEData – to empower patients by giving them control of their healthcare data, and allowing it to follow them through their healthcare journey.” It may seem obvious that patients should have electronic access to, and full control of, their health records, but the government does seem to need to intervene in order to get this information released from government agencies and payers, as well as from private health insurers and providers. Susan Morse (@SusanJMorse), who covered the HIMSS Conference for Healthcare IT News, explains that part of the issue is hospitals involved in data blocking. Verma told conference goers CMS would be strengthening requirements for providers to stop the practice: “It’s not acceptable to limit patient records or prevent them from seeing their complete history outside of (that) health system,” she said.

Data blocking may not be the primary barrier to patient control of their health care data, however. The March 2018 American Hospital Association Trendwatch: Sharing Health Information for Treatment shows hospitals and health systems have rapidly improved electronic sharing of clinical/summary care records over the past several years as the AHA Trendwatch chart below shows.

Can (Will?) Health Providers Use Patient Data?

Interoperability at its core means information can move back and forth between the various entities that have it. That could be from provider to provider, from plan to provider, provider to patient, etc. The fact sheet explaining the Trump Administration MyHealthEData Initiative Putting Patients at the Center of the U.S. Healthcare System mentions one of the goals of the effort is:

“Reducing Duplicative Testing – Provider systems typically do not share patients’ data, which can lead to duplicative tests when a patient goes to see a different provider. This increases costs and can lead to patient inconvenience or even harm. CMS is studying the extent and impact of duplicate testing, and will identify ways to reduce the incidence of unnecessary duplicate testing.”

In a study published in 2010, (all that’s old is new again…) in the Journal of the American Medical Informatics Association titled, “A Preliminary Look at Duplicate Testing Associated With Lack of Electronic Health Record Interoperability For Transferred Patients,” found approximately 20% of patients had non-clinically indicated duplicate testing resulting in added costs to the system. The study authors continued, “The most common setting for duplicate testing identified in the current study happened on admission from an outpatient clinic site. Patients from outpatient clinic transfer to hospital admission via several paths, including entrance via hospital admitting services or directly to the inpatient ward, either escorted or unescorted by hospital clinical staff.”

However, while hospitals and health systems have improved their sharing of clinical summaries with outside entities, the same AHA Trendwatch shows much slower progress in integrating information from outside sources. As the chart (from AHA Trendwatch) below shows, 65% of hospitals and health systems are either not able or not routinely able to integrate external information electronically.

Giving patients access to all of their health care data electronically is no doubt important. However, it is not sufficient to improve care or reduce costs, even for something as simple as avoiding non-clinically indicated duplicate testing. Achieving interoperability will also require payment incentives to change. As this blog has pointed out in other instances, money matters and you avoid what you have to pay for. Electronic health data vendors can still charge providers for building interfaces that help disparate systems “talk” and can charge providers to move data. Keith Aldinger, MD, an internist who practices in Houston, Texas wrote for Medical Economics in late 2017, physicians have “been assessed financial penalties for not attesting to meaningful use and yet the IT industry gets a pass.” His idea for improving interoperability is to put health IT vendors on the hook: “They should not be allowed to charge one cent for transferring information and any attempt to do so should elicit a financial penalty.”

All that’s old is new again. We still have to figure out how to get health care data moving in ways that improve health care for patients. Interoperability, you’re hot again. Let’s hope you do better this time around.

Spending More, but Getting Less: How Hospitals Can Work Together to Reap the Benefits of Increased Spending on New Technologies

By M2|2017-10-08T11:20:04+00:00September 25th, 2017|Health Information Technology, Uncategorized|

Spending More, but Getting Less: How Hospitals Can Work Together to Reap the Benefits of Increased Spending on New Technologies

Hospitals often buy new technologies without requiring that the technologies communicate with each other, even though this lack of interoperability results in lower physician productivity and an increased likelihood of medical errors occurring. Other hospitals, fearing exactly those inefficiencies, simply avoid buying innovative new technologies. Peter Pronovost and his colleagues at Johns Hopkins Medicine, give some advice on how to avoid these issues in “What Hospitals Can Learn from Airlines About Buying Equipment,” in the Harvard Business Review.

Hospitals’ spending on new technology “has ballooned,” the authors note. “For years, hospitals have invested in sophisticated devices and IT systems that, on their own, can be awe-inspiring,” the authors say. “Yet these technologies rarely share data, let alone leverage it to support better clinical care.”

“Part of the solution must involve hospitals,” the authors state. “If they truly want technologies that save lives and boost productivity, they will need to exert their considerable pressure as purchasers, requiring that manufacturers embrace openness and interoperability, and only purchasing devices that support this.”

“Too often, hospitals treat equipment and IT procurement in a siloed way, focusing on price without looking at how those devices will work as part of a larger system,” the authors say.

“For example, many new hospital beds come with a sophisticated array of sensors that can track such information as whether a patient is at risk of developing a bedsore, based on data about how often they move in bed. Such sensors may be 30% of a bed’s costs. Yet at one of our hospitals [within the Johns Hopkins system], that data is unusable — it’s in a format that our system cannot read.”

The situation is similar for “much of the data that is fed from wireless monitors of patients’ heart rate, blood oxygen levels, blood pressure, and breathing rate: This data doesn’t link to the medical record,” they note.

“The vision of an integrated hospital unit that is much safer and more productive will not be possible without widespread availability of products that share data openly and freely. Just as the U.S. Navy demands that its submarines and ships have interoperable technologies, this change can be driven by those who purchase these technologies,” they say. “Health care leaders that purchase technologies need to do the same.”

However, it is “unrealistic to think that each hospital should go it alone, exerting its purchasing power to move the marketplace,” the article states. “Hospitals could work together, writing specifications and functional requirements for the products that they will purchase and refusing to do business with manufacturers that don’t comply.” There may also be a role here for group purchasing organizations, they say.

As a further step, instead of assembling hospital rooms “one product at a time, hospitals should be able to purchase modules, sets of interoperable products that work together to support an aspect of care,” the authors continue. “This model makes sense, as few if any hospitals have the resources to design and manage all the connections between technologies, or to optimize how the data is used and displayed to support top-quality care. Ultimately, when a hospital is built or renovated, it would have the option to buy modular patient rooms, clinical units or floors — a ‘hospital in a box,’ built to its specifications.”

“We don’t expect airlines to build their own planes. They buy them from experienced system integrators such as Boeing or Airbus,” and hospitals should have a similar model, the authors note. “The question is whether health care leaders will have the resolve to require it.”

On the other hand, “even if digital devices communicate with one another, the lack of standards for health data puts full interoperability and data sharing out of reach,” according to an article in Healthcare Dive highlighting the opinion piece. “While we’ve made progress in the last three to four years and have the promise of FHIR (fast healthcare interoperability resources), the standards in health care from a data exchange standpoint are very weak,” explains Paul Shenenberger, CIO of Summit Health Management.

The lack of interoperability and data standards will be especially challenging as access to health care continues to change in the digital age, as a separate Healthcare Dive article points out. “From alternative care settings to telehealth companies, supply and demand for healthcare services is in flux.”

“Care is actually moving away from the hospitals,” the article quotes Dr. Rasu Shrestha, Chief Innovation Officer at UPMC, as saying during a panel at the National Health Policy Conference (NHPC) earlier this year. “’The brick and mortar hospitals that we know today will not be the focal point of healthcare delivery tomorrow.’ As care moves away from hospitals, whether at large or in part, it will be important to integrate health data from all over the care spectrum to get a full picture of a person’s well-being.”

This points to the persistent challenge related to use of new technologies in health care; in a siloed, non-standardized data world, how do we leverage the massive amounts of data generated in health care every day and facilitate data sharing in a way that actually makes health care more efficient and effective? The Hopkins op-ed authors take a step in the right direction – urging hospitals to leverage their significant purchasing power to demand interoperability. However, in order to do that, the data standards challenges will also need to be resolved. As Healthcare Dive summarizes, “though it may be a painful process, the need for standards and interoperability are desperately needed for innovative care to move forward.”