Interoperability: Health data-sharing is lacking inside and outside of hospitals, survey says

A new Center for Connected Medicine/HIMSS Media survey of healthcare tech leaders shows that most hospitals and health systems are depending on a single, integrated EHR to solve their interoperability woes. A new survey of tech executives at U.S. hospitals and health systems finds nearly a third indicate their data-sharing efforts are insufficient, even within their own organizations, and fewer than four in 10 say they are successfully sharing data with other health systems.


Additionally, the most popular solution being pursued to address the interoperability challenges that have long plagued healthcare is switching to a single, integrated electronic health record system, according to the survey, conducted by HIMSS Media and sponsored by the Center for Connected Medicine.

Jointly operated by GE Healthcare, Nokia and UPMC, the Center for Connected Medicine facilitates connections and provides resources that support executives pursuing healthcare improvement and innovation through technology.

The new research, which surveyed 100 information technology and business professionals at U.S. hospitals, examined how well healthcare organizations are prepared to advance interoperability and how those challenges are affecting organizational priorities. Healthcare interoperability is widely seen as essential to improving healthcare for patients, caregivers, health systems and payers, while lowering the cost of care.

Nearly 60% of the respondents cited moving to one EHR as an organizational step being taken to overcome interoperability challenges, much higher than other actions named, such as the adoption of widely promoted healthcare exchange standards, such as FHIR, cited by 37%.

MiHIN Adds to Use Case Portfolio, Creates Interoperability Sandbox

Michigan Health Information Network Shared Services (MiHIN) continues to expand the services it offers statewide, including the creation of a sandbox environment to enable healthcare organizations to simulate and test interoperability scenarios and a recently announced partnership with Care Convene, a telehealth platform.

In a recent interview, Tim Pletcher, MiHIN’s executive director, described the organization’s approach as a “use case factory.” MiHIN has created a methodology to work on bringing new use cases such as admission, discharge and transfer (ADT) notifications into production and add to their portfolio of shared services. “We put the use cases through a pipeline, including working with the state government or commercial payers to align financial or policy incentives. We have had payers involved in every single use case we have,” he stressed.

Once a new use case is in place, MiHIN runs the report cards on how health systems are doing. Are they sending data and how clean is the data and how consistent? “We are like teachers who want everyone to get an A,” Pletcher said. “We send report cards home to Mom and Dad – the payers or the state government. They decide whether they are going to give everyone their allowance. We don’t measure HIE participation, because just being part of a club does not mean you are creating value. But at the use case level, it does. For instance, we have 330 of the long-term care facilities/SNFs sending ADTs in Michigan, which is quite novel, but it is because we were able to create incentives to motivate them to do that.”

To help organizations work through issues with data sharing, MiHIN has a new nonprofit subsidiary called the Interoperability Institute and it has set up a sandbox environment called “Interoperability Land,” described as a shared online environment hosted in the Amazon Web Services Cloud where organizations, developers, and technology providers can engage in simulated interoperability scenarios to develop, test or demonstrate new application capabilities. It uses completely realistic but synthetic patient data.

“We started with immunizations, so people could practice submitting to the state registry,” Pletcher explained. “Very quickly we moved to ADTs and CCDAs, because nobody had any data to start priming the pump and work out all the kinks.”

The Power of Payer Interoperability in Healthcare for Value-Based Care

Interoperability is the backbone of quality care in the modern healthcare world and has been a staple of the health information management conversation for decades.

At first, this conversation focused on the clinical data exchange within a health system. Then interoperability rapidly expanded between enterprises with the meaningful use era. Over the past few years, the dawn of the value-based care era has ushered new stakeholders into the interoperability space. Population health, connected devices and consumer-mediated exchange became new buzzwords around interoperability in healthcare. And on the sidelines, payers began to quietly exchange clinical data with their contracted providers.

When a healthcare payer contracts with a provider for reimbursement based on the quality of care, measurements of the outcomes of this care are required for payment. This includes items like lab results, admission and discharge information, body mass index, vital signs and results of screening procedures and preventative health assessments.

Just knowing that the provider had performed the procedure/test/assessment was enough for payment under a fee for service contract. However, under a value-based contract, the healthcare payer also needs to know the results to measure the quality outcomes of the care. This brings exchanging clinical data between a provider and payer under the Treatment, Payment, and Operations section of HIPAA, and makes it possible for payers to utilize the power of clinical data to improve the health of the populations they serve.

SMART on FHIR Team: Proposed Interoperability Rule ‘an Enormous Step Forward’

The SMART on FHIR team members who 10 years ago proposed that EHRs could serve as a platform with a universal application programming interface (API) supporting substitutable apps are enthusiastic about the 21st Century Cures Act Proposed Interoperability Rule, calling it an enormous step forward. “The rule addresses and reinforces virtually all of the major underpinnings which are currently feasible and needed to produce an interoperable apps-based ecosystem,” they wrote in submitted comments. But they do offer suggestions and constructive criticism on a few specifics such as immature standards.

Among the key recommendations from Dan Gottlieb, Josh Mandel and Kenneth Mandl on electronic health information (EHI) export is that the Office of the National Coordinator for Health IT (ONC) should require certified EHRs to support full EHI export at the patient level via patient-accessible API, and at the population level via data-provider-accessible API.

The ONC proposes the “API Resource Collection in Health” (ARCH) Version 1 implementation specification, which would list a set of base FHIR resources that health IT modules certified to the proposed API criterion would need to support. The SMART team suggests that ONC populate it using community-developed standards by groups like Argonaut and HL7, who can take functional requirements from USCDI versions, and produce implementation guides. “If ONC maintains an ARCH definition, this definition should be limited to referencing implementation guidance from community-developed processes; ONC should not ‘get out ahead’ of the community process. For example, the ARCH should not make unilateral determinations about which FHIR resource or data elements are needed to meet a given USCDI requirement. Instead, that determination should be made through a community-driven, iterative process with real world testing of use cases.”

While they noted that the vast majority of referenced standards in the rule are mature, in real world use, and widely embraced, the team members expressed concern about two, data segmentation for privacy (DS4P) and Consent2Share, which they called “not ready for prime time.” Saying they recognize privacy maintenance and consenting are essential functions in healthcare, “we are very concerned that a premature push for adoption of these immature standards would have unintended negative effects. ONC should omit these from the certification criteria (including voluntary certification) and focus on driving real-world implementation experience before pursuing regulations.”

Healthcare in 21 years will be driven by 'radically interoperable data'

The Physicians Foundation Announces Interoperability Fund to Improve Health Information Exchange in…

The Physicians Foundation, in association with six state medical societies, today announced the formation of the first of its kind interoperability fund, known as The Physicians Foundation Interoperability Fund, which will assist medical practices in effectively sharing clinical information with other physicians and hospitals through health information exchanges (HIE). Funding is available for physicians in participating states with an electronic health record system (EHR) and will be allocated to practices on a first come basis. Participating medical societies include the Connecticut State Medical Society, Medical Association of Georgia, Louisiana State Medical Society, the Missouri State Medical Association, Medical Society of New Jersey and the South Carolina Medical Association.

The six state medical associations will collaborate on an innovative, physician-led program that will dramatically improve the sharing of clinical data and drive improvements in patient care, while supporting physician independence in the newly emerging health care environment. This program leverages the enormous potential represented by true EHR interoperability to improve quality and create value for medical practices. The program supports the physician-patient relationship while providing critical, timely clinical data that promotes quality health care, identification of health disparities, health care transparency and health care access to support patient care and physician-patient relationships.

“Our national survey of physicians tells us EHRs are the least satisfying part of physicians’ jobs, and oftentimes, a leading factor in burnout among America’s physicians,” said Gary Price, M.D, president of The Physicians Foundation. “The Physicians Foundation is proud to lead an initiative that will help alleviate unnecessary burdens on both physicians and patients. Through improved information sharing, The Physicians Foundation Interoperability Fund will further enable physicians to be their patients’ strongest advocate and partner in decision-making for their care.”

Sharing timely clinical patient information among physicians and hospitals with disparate EHRs relies upon a connection to an HIE. Through The Physicians Foundation Interoperability Fund, HIE participants can access patient data regardless of where the patient received care. Sharing of this timely information will improve clinical outcomes, reduce inefficiencies and improve patient safety when fully implemented.