When you deposit your paycheck, you expect your bank to process it. If you travel out of town, you count on being able to access your money from an ATM. But patients discharged from the hospital to a rehabilitation center or nursing home may not experience such a seamless transition of their healthcare information.
This useful information exchange is called interoperability, and the lack of it can cause serious issues for patients. Communication breakdowns are a key cause of medication errors. One report indicates that “an estimated 60% of medication errors occur during times of transition.” This puts patients at risk for poor outcomes, including rehospitalization.
Not only does the exchange of health information enable more coordinated care, but also, as healthcare delivery and payment increasingly shifts to value-based care, interoperable health IT is integral to the effective communication that will help improve the quality of care, better the health of communities, and lower per capita costs.
Why is interoperability so hard to achieve? Healthcare interoperability itself is complex. The term interoperability refers to the ability of two or more systems or components to exchange information and then use that information. It should be noted that health information exchange is different from health information interoperability. Exchange is the most basic of the three levels of health information technology interoperability, as defined by the Healthcare Information Management Systems Society (HIMSS) in 2013.
This chart shows the levels of Health Information Interoperability
|Foundational Interoperability||This basic level of interoperability allows data exchange from one information technology system to be received by another, but the system receiving the data does not need to be able to interpret it.|
|Structural Interoperability||An intermediate level that ensures that data exchanges between information technology systems can be interpreted at the data field level, meaning that the clinical or operational purpose and meaning of the data is preserved.|
|Semantic||The highest level of interoperability, which is the ability of two or more systems to exchange information and to use the information that has been exchanged.
This level supports the electronic exchange of patient summary information among caregivers and other authorized parties via potentially disparate electronic health record (EHR) systems and other systems to improve quality, safety, efficiency, and efficacy of healthcare delivery.
Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data.
The challenges to achieving semantic interoperability transcend the technical. The US Department of Health and Human Services, in an April 2015 Report to Congress on Health Information Blocking addressed the “information blocking” practice by some healthcare providers and health IT developers that undermines the national goal to achieve secure, appropriate and efficient sharing of electronic health information across the health care continuum.
There are several reasons for information blocking, including competitive pressure and concerns about liability. According to the 2015 Nationwide Interoperability Roadmap, the reasons for not sharing data include “concerns around the increased liability risk of exchanging data, competing technology priorities or a lack of ready trading partners. In other cases, providers may believe interoperability will jeopardize competitive advantages they gain from exclusive access to patients’ health information. Likewise, technology developers may contribute to high interoperability costs by making it challenging for providers to extract and share data, for instance, in order to prevent providers from easily switching to a competitor’s product.”
From February 29 – March 4, some 40,000 health IT professionals, clinicians, executives and vendors gathered to discuss interoperability at the 2016 Healthcare Information and Management Systems Society (HIMSS) Annual Conference & Exhibition http://www.himssconference.org/ with a goal of developing strategies to facilitate health information exchange. Because interoperability is not “one size fits all,” each stakeholder need not implement exactly the same technology, leaving providers with the task of evaluating and selecting the appropriate approach.
Remedy Partners’ Episode Connect Enables Interoperability
Remedy Partners’ mission is “to organize the delivery and financing of healthcare around the patient experience – achieving improved quality, lower costs and better outcomes.” The company helps a variety of healthcare organizations succeed under value-based payment programs, including physician groups, home health agencies, hospitals and skilled nursing facilities. The crucial interoperability component is enabled through Remedy’s Episode Connect tool. Our organization is committed to supporting providers seeking to achieve interoperability with other applications.
The organizations supported by Remedy’s Episode Connect are depicted on this map:
The Remedy Partners data integration team has worked with numerous vendors and they have successfully integrated Episode Connect with every major EMR. The Episode Connect tool is continually being enhanced and updated in collaboration with the partner providers who are using the tool.
Interoperability promises to be an issue at the forefront of healthcare transformation in 2016. The Medicare Access and CHIP Reauthorization Act (MACRA), signed by the President in April 2015, will take important steps toward streamlining and expanding the use of value-based payment and quality reporting programs. As it phases in, MACRA will consolidate current physician reporting programs, including the Medicare EHR Incentive Program, Physician Quality Reporting System (PQRS), and the Value Modifier into a unified Merit-Based Incentive Payment System (MIPS) and create incentives for providers to participate in eligible alternative payment models.
As these programs integrate providers across care settings, they will reach a provider base that includes critical providers ineligible for the Medicare and Medicaid EHR Incentive Program, such as many post-acute care and behavioral and mental health providers. In addition, the link to value-based payment promises to incentivize providers to invest in resolving interoperability challenges in their communities.
The US healthcare system is evolving. Coordinating care among all of a patient’s providers, as well as including the patient in their care, is pivotal to improving the quality of care. It is imperative for providers across the healthcare continuum to consistently send and receive accurate and meaningful patient data. Otherwise we will fail to realize the benefits of interoperability: improvements in clinical decision-making and patient safety, operational process improvement, and support for value-based payment.
Find out more: Helpful Resources, Information and Links
Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap
2016 Interoperability Standards Advisory
Connecting Health and Care for the Nation: A 10-Year Vision to Achieve an Interoperable Health IT Infrastructure
- National Transitions of Care Coalition. Improving Transitions of Care: The Vision of the National Transitions of Care Coalition. May 2008. Available at: http://www.ntocc.org/Portals/0/PolicyPaper.pdf.
- IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries (New York, NY: 1990)
- Health IT in Long-term and Post Acute Care Setting, https://www.healthit.gov/sites/default/files/pdf/HIT_LTPAC_IssueBrief031513.pdf
- The Merit-Based Incentive Payment System (MIPS) & Alternative payment Models (APM), https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html