Industry, feds, focus on ways to ramp up interoperability efforts
Ascension Health, Carolinas Healthcare, Catholic Health Initiatives, Dignity Health, Geisinger Health System, Hospital Corporation of America – and 10 other healthcare systems – have taken the pledge. So have vendors who provide 90 percent of hospital electronic health records used nationwide, and more than a dozen healthcare provider, hospital technology and consumer advocacy groups.
IT jargon aside, the pledge signals a commitment to work toward interoperability, that is, the ability of electronic health records to “talk” to each other, so that provider A can share a particular patient’s medical records with provider B.
The industry has reached this point because while individual providers – both inpatient and outpatient – have done a pretty good job of implementing electronic medical records within their four walls, the system breaks down when a patient migrates from one provider to another.
“Beyond technical barriers, there are business barriers, complex privacy laws, workflow challenges, and misaligned incentives that conspire to slow progress,” according to the Health Information Technology Policy Committee in a December 2015 report to Congress titled Challenges and Barriers to Interoperability.
“Any one of these barriers could – and do – prevent the successful transfer of information from one place to another. Recommending a patchwork of individual steps to address interoperability will not work as well as motivating the entire ecosystem to work on the multi-dimensional challenges of achieving interoperability.”
Hence the pledge.
On Feb. 29, U.S. Department of Health and Human Services Secretary Sylvia M. Burwell announced that EHR companies as well as a large complement of healthcare providers agreed to implement three core commitments:
- Consumer access. To help consumers easily and securely access their electronic health information, direct it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.
- No more information-blocking. To help providers share individuals’ health information for care with other providers and their patients whenever permitted by law, and not block electronic health information (defined as knowingly and unreasonably interfering with information sharing).
- Adherence to standards. Implement federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information and adopt best practices including those related to privacy and security.
In addition to the IT developers and big health systems who took the pledge, a number of physician groups did as well, including the American Academy of Family Physicians, American College of Physicians, American Medical Association, and the American Hospital Association, as well as the Health Information and Management Systems Society.
Barriers to interoperability
In its December 2015 report, the Interoperability Task Force identified some of the barriers to interoperability.
- Too many chefs. “Interoperability appears deceptively simple,” they say. “Although the definition is short and the target end-state is defined, there is little agreement on the ‘right’ approach. Further, these decisions require multiple stakeholders to act in a coordinated manner. No single provider, vendor, or policymaker can take unilateral action that would enable widespread interoperability in the near-term.”
- ‘Perverse’ payment system. “The long-standing fee-for-service reimbursement model creates a perverse incentive to ignore information from other sources,” according to the report. “With an increasing shift from fee-for-service reimbursement to value-based reimbursement, incentives for interoperability are beginning to shift from perverse to aligned.”
- Data as a competitive advantage. “The US health care delivery system continues to have a culture that lacks a team-based approach and too often treats data as a competitive advantage (in some cases leading to passive or active data blocking) rather than as a basis for coordinated care. As the percentage of reimbursement under alternative payment models increases, the demand for broad interoperability will increase. Developers who fail to adequately support interoperability will be under pressure to serve their customers operating under alternative payment models.”
Recommendations
In its report, the Health Information Technology Policy Committee made the following recommendations “designed to accelerate the pace of change toward meaningful interoperability that is driven by business and financial incentives.”
- Develop measures of health-information-exchange-sensitive (HIE-sensitive) health outcomes and resource use. An example of an HIE-sensitive measure would be medically unnecessary duplicate testing. Payers could provide incentive clout by declining to reimburse for medically unnecessary duplicate testing.
- Develop measures to hold IT vendors accountable for their ability and willingness (or lack thereof) to promote interoperability. “Although vendors have strong incentives to pass the interoperability requirements for EHR certification, this process is ‘one-time’ and occurs in a lab. It has not been shown to translate into interoperability that is affordable or easy to implement in the field.”
- Penalize ($) providers for blocking the exchange of information, leading to such things as medically unnecessary duplicate testing.
- Convene a working summit of major stakeholders, including the federal government and the private sector. “We believe that in order to achieve meaningful interoperability, collective, synchronous action must be undertaken by multiple stakeholders across the whole continuum, from professional education and training programs to health care organizations, consumers and payers, both public and private,” says the Committee.
Editor’s note: To read the report, “Challenges and Barriers to Interoperability,” by the Health Information Technology Policy Committee, go to https://www.healthit.gov/facas/sites/faca/files/HITPC_Final_ITF_Report_2015-12-16%20v3.pdf.