By Balu Nair | May 21, 2019
America’s healthcare system is notoriously disjointed, with patchwork information technology and disparate data. The quest for interoperability as an answer – the ability to easily share health records between sites of care – has had varying levels of success. But it’s a solution that is crucial to healthcare’s value-based transformation and can’t be allowed to fail, especially by going too slow to be meaningful.
The challenges associated with interoperability – from fragmented sources of patient information to data being kept in varied formats, to difficulties using an electronic health record (EHR) as a secure central “home” for a patient’s data – were highlighted in a recent American Hospital Association (AHA) report on “The Hospital Agenda for Interoperability.”
The report highlighted challenges for providers and underscored that a collaborative approach is necessary for improving the lives of families and their caregivers for the long-term. The AHA report not only represents frustrations with EHR and Health Information Exchange (HIE) but calls for extending efforts at digital transformation that logically layer on top of that.
As the debate and progress inches forward to 2020, it is vital to return to what hospitals are telling us.
Beyond technical challenges
The difficulty in interoperability goes beyond technicalities. For example, while healthcare providers generate clinical data and payers create claims data, their current structures are not conducive for synchronization and insight generation. Payers and providers have different objectives (whether it’s clinical notetaking, billing, clinical decision support, etc.) so there’s more to the underlying friction than just a variety of data formats.
The AHA calls out additional reasons for issues with interoperability and the high costs that result. That includes expensive workarounds, overcomplicated user interface design, lack of documentation consistency, unrealistic expectations for technical solutions, issues with regulatory compliance for data security, privacy and use, and pricing models that “toll” information sharing. It’s also clear that business and technical challenges with interoperability should not be conflated – each technology Band-Aid further burdens healthcare organizations with ad hoc, un-intuitive technology that will cost more over time and fail to solve interoperability challenges.
In the quest to use technology to save money, improving interoperability between healthcare systems and using powerful data analytics to extract insights from systems working in concert appears to be an expensive and elusive goal. But the cost of not committing to a more universal approach is far greater, because it prevents clear and effective insights on where improvements are needed. Insights are only ever as good as the data that feeds them, and if there isn’t a clearly defined data analytics and data governance strategyaligned with industry best practices, the results will be half-baked.
The need for leadership
Leaders who may have not been exposed to technology outside of healthcare may not be aware of open source, cloud-based tools to rapidly and more cost effectively meet interoperability needs. As they implement piecemeal or outdated, point-to-point solutions, technology costs rise significantly, while perception of technology’s efficacy goes out the window. Worse, paying to ship data to third-party vendors instead of focusing on an internal and overarching connectivity strategies involving every vertical means opportunities to maximize their data’s potential will be lost.
In other words, healthcare organizations might find that they are ironically spending immense amounts of money on technology intended to reduce costs under a value-based payment system. But they might not be spending it wisely. And as other industries steam ahead with movements akin to interoperability on a national scale, leaders in healthcare need to stay focused on the larger task of consistency as not to fall even further behind. Unlike industries like retail, the quality of lives for patients and their caregivers are at stake.
Technology – and business – challenge
As the AHA report emphasizes, the challenges involved go beyond technology and land firmly in the realm of business. Healthcare organizations need to be open to making health data available, whether it’s a secure transfer to another provider, or to the patients. CMS recently renamed “meaningful use” to “promoting interoperability” in efforts to provide a model and further incentives for “advancing care information.”
Starting this year, hospitals must share EHR data with patients the moment they leave the hospital, which is a big step in the right direction towards cost-reduction by empowering patients to engage more in their care.
A compelling parallel is the progress toward interoperability in financial services. Open banking has spurned a monumental shift in the way financial institutions not only exchange data but conduct business. Instead of control and centralization, open banking has shifted focus on collaboration and inclusivity. Put another way, open banking is more a philosophical commitment to openness than a mandate or technical guideline, and it’s a standard by which all financial institutions can create, share and access data amongst each other.
This thinking allows financial institutions to bridge partnerships with each other or third parties more rapidly and with far greater accessibility. A customer at a Chase Bank location in the United States can seamlessly establish a money transfer relationship with a customer in Caisse D’Epargne in Paris because of open banking powered by application programming interfaces (APIs). APIs and interoperability standards allow unaffiliated financial institutions secure access to relevant information stored in proprietary legacy systems while safeguarding customer privacy and ensuring regulatory compliance.
Because of APIs and open banking regulations, banks are also required to be more transparent about their services and offerings, promoting healthy competition between banks and encouraging them to act in the best interest of consumers. In turn, banks can use these open data feeds to better detect fraudsters with AI, more carefully align security process and standards, and automate bookkeeping. The banks can also provide more tailored recommendations for products and services, whether it’s better accessibility for a customer with a disability or the optimal payment plan for a small business loan.
Better, more effective healthcare?
If we compare technology adoption at a legacy bank to a hospital that is bootstrapped to an inflexible, walled garden-style EHR, we may see similar challenges that can be overcome by liberating healthcare data. For many hospitals, their only way to get a bird’s eye view of their patient populations, financial performance, cost-savings, etc., is to scrape and aggregate data, a process that can be fraught with errors and resource challenges.
The potential for APIs in healthcare to open up innovation and provide a better experience for the user is huge. If a healthcare system connects data from various systems with APIs across different facilities, community organizations, and any other care provider that collaborated on a single patient’s health journey, they can form a 360-degree patient view. This view can provide a golden record per patient where eachencounter is captured.
New sources like smart health gadgets and fitness tracking apps will enhance the golden record, provided the health systems have infrastructure to consume the generated data. The health system can then layer data analytics on top of these consolidated health records and perform exhaustive audits to identify care gaps, medical histories, unnecessary costs, clerical errors, and ultimately improve care across an entire health system.
Bigger is better?
If we take a step back, according to a recent Hooper, Lundy & Bookman survey, large hospitals are better equipped to lead the way in a value-based payment system because they are developing strategies that include post-acute care, whether it’s developing a network of providers, preferred providers, or even joint-venturing or acquiring providers. A merger or acquisition can add significant complexities, but with that come opportunities to get all systems and applications that don’t “speak” to one another streamlined and in conversation.
Larger health systems are in a position to resist archaic point-to-point integration and instead prioritize an API-led approach and take on the 360-degree view. Larger systems also can invest in innovation that is necessary to propel seamless interoperability into reality, and then collaborate with their communities to have a meaningful impact downstream.
These advanced systems can be inspired by peers at the cutting edge of innovation. Or they can be inspired by industries that conscientiously choose vendors that build robust data analytics strategies. The challenge may be a lack of deep industry experience and technical talent to go around, requiring partnerships and outsourcing with the right teams to get access to data analytics. So, choosing the right partner is vital.
A goal should be a collaborative approach to building a data analytics platform to sit within an organization’s infrastructure and workflows. Where a health system hasn’t yet devised a robust analytics strategy, it can partner with an external organization in deploying the platform to successfully extract and feed data in a standardized format to develop insights across business, financial and clinical verticals. Crucially, technology should be built to support healthcare standards like HL7 and FHIR to enable interoperability. This means avoiding customizations and building an analytics framework that can smoothly import or access data, especially in the event of a merger or acquisition.
The tragedy of interoperability’s slowness in reaching its full potential is that solutions are actually readily at hand, and critical players haven’t caught up to what is available. By looking at other industries and using partner organizations in healthcare that have been leading the way as models, there is a lot to be gained.