By Diane M. Carr, M.A., FHIMSS, Advisor
As the health and information technology industries prepare to convene at the annual HIMSS conference in Las Vegas, the “interoperability experience” will be top of mind for many participants. Tens of thousands of individuals and companies who collect, access, analyze and exchange data about patients and their care will exhibit and examine IT products and policies during the first week of March. As spending on health care in the United States reached 17.9% of the Gross Domestic Product in 2016, opportunities to advance technology to improve health abound.
Against the backdrop of the 21st Century Cures Act, passed by Congress in December 2016, the challenges of sharing health and non-health data to improve all aspects of care for consumers will be a primary focus of conference activities. The Cures Act defines interoperability as the secure exchange of electronic health information and allows its complete access, exchange and use. Today, there are numerous Health Information Exchanges (HIEs) operating regionally, locally and nationally. Many do not, however, exchange health information with each other due to lack of participation agreements and perhaps competitive interests.
Historically, electronic clinical data collection has focused on encounter-to-encounter and task-to-task transactions. These days, there is a strong buzz about semantic versus syntactic interoperability, and content versus context. Data need to be shared, but first they must be de-duplicated, normalized, and contextualized according to standards which may differ for various uses. At the end of the day, for consumers and doctors, interoperability means having the right information readily available when they need it!
To support exchange of clinical and non-clinical data collected in traditional healthcare and non-traditional settings, there must be trusted agreements about what data are exchanged under what circumstances. A strong sentiment is developing that a patient’s individual rights of access to health information should not be impeded by traditional business rivalries. These include competition between hardware and software vendors, labs and imaging and other ancillary services, medical device manufacturers, insurers, even hospitals and physicians. The Cures Act defines and prohibits information blocking and provides for penalties up to $1M per violation.
A panelist at the 2017 ONC Annual Meeting on barriers to interoperability stated that HIE should be a verb, not a noun. What is holding us back? The technology exists to design and share public data sets. Still, concerns about total cost of ownership of EHRs loom large. Who “owns” the data? Who benefits from EHRs? Who bears the costs of installing and maintaining the infrastructure, coding, testing? How is the cost of exchanging the data being assessed?
The Cures Act proposes a Trusted Exchange Framework based on existing HIT capabilities, and requires a common method for authentication, a common set of rules for trusted exchange, and organizational and operational policies to enable the exchange. While HIE requirements differ by state, the current exchange infrastructure includes document, messaging, data, and transport standards to build on. The focus must be to resolve inconsistencies concerning consent, privacy, and security.
Addressing these challenges may encourage vendors to compete on providing data services, not hoarding data, in a competitive marketplace. StarBridge Advisors have the expertise to support your search for technical and operational solutions to achieve interoperability.