The Telephone Game is a great icebreaker for parties, company retreats or classrooms. The rules are simple: The group stands in a line or circle, with everyone close enough to whisper into each other’s ear, and the person at the beginning of the line whispers a phrase or word into the next person’s ear. The game continues until the message has been passed along to everyone.
The phrase heard by the last person in line is rarely the same one uttered by the first person – illustrating how information is transformed by factors such as personal experience, perception, listening skills and knowledge.
Healthcare information professionals face a similar challenge as they attempt to share data across disparate systems – some of which can’t easily communicate with others. The ability of different healthcare information technology to share data is known as interoperability.
Addressing the interoperability challenge has become more critical for healthcare as hospitals have merged or acquired physician practices and as new models of care, such as accountable care organizations, have increased the need for collaborative care that is supported by clinical and business information shared among different providers.
First, the basic question: What is interoperability in healthcare?
According to the Healthcare Information and Management Systems Society (HIMSS), interoperability is the ability for systems and devices to exchange and interpret shared data. Two systems must not only be able to exchange data, but they also must present that data in a way that can be understood by the user.
HIMSS also describes three levels of interoperability:
- Foundational interoperability allows data exchange from one information technology system to be received by another and does not require the ability for the receiving information technology system to interpret the data.
- Structural interoperability is an intermediate level that defines the structure or format of data exchange where there is uniform movement of healthcare data from one system in a way that preserves and does not alter the clinical or operational purpose and meaning of the data.
- Semantic interoperability provides interoperability at the highest level – the ability of two or more systems or devices to exchange information and to use the information that has been exchanged. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via disparate electronic health record (EHR) and other systems.
Why is interoperability so critical in healthcare today?
The advent of value-based care versus fee-based care places more focus on patient care that is designed to provide the best diagnosis and treatment based on scientific, data-supported evidence to optimize outcomes. Population health management strategies rely on data from distinct populations to evaluate care to identify best practices. New models of care such as accountable care organizations and patient-centered medical homes rely on the ability to easily share clinical and operational data across sites and disparate systems to enable collaboration.
Providing better access to patient records for all providers who see patients – including physicians, hospitals, urgent care centers, pharmacies, labs and other diagnostic centers – gives each provider a holistic view of the patient’s history, symptoms and conditions. EHR interoperability supports collaboration between providers, which can reduce medical errors and misdiagnoses as well as repetitive, costly diagnostic tests. This is especially true for chronically ill patients who visit multiple physicians and specialists.
From a process improvement perspective, interoperability allows healthcare professionals to access data on specific populations of patients to develop best practices that are proven to improve outcome while controlling costs. When researchers pull clinical as well as financial data to evaluate treatment, outcomes and costs, they are better able to identify strategies to address gaps in care – which benefits patients, payers and healthcare organizations.
Barriers to healthcare interoperability
According to the latest data brief from the Office of the National Coordinator (ONC) for Health IT, 52 percent of hospitals can electronically find patient health information, 85 percent can send patient summary of care records, 65 percent can receive such records and 38 percent can use or integrate those records into their own EHRs without manual entry in 2015.
Hospitals are also increasing their electronic exchange of laboratory results, radiology reports, clinical care summaries or medication lists with outside hospitals – from 41 percent in 2008 to 82 percent in 2014. Also, more than half of hospitals report that their physicians use patient information received from outside providers. However, only 18 percent said providers often used the information, 35 percent said they sometimes used the information, and 36 percent said they rarely or never used the information.
The most common reasons providers report rarely or never using patient health information is the inability to view it in their EHR (53 percent) or difficulty integrating information into the EHR (45 percent). Other reasons include information not being available when needed (40 percent) and format of information of useful (29 percent).
The ONC report highlights some key barriers to interoperability in healthcare:
- Lack of universal standards-based EHR system adoption. Although 96 percent of hospitals and 87 percent of office-based physician practices are using electronic health records (EHRs), not all EHRs are created equally. Outdated legacy systems are still in place due to the expense and perceived disruption to the organization to replace them with EHRs that can easily share data.
- Impact on providers’ workflow. Technology must enhance a provider’s productivity, accuracy and care, but when information is not available at the time the physician needs it, or if multiple screens and applications must be searched to find it, technology hinders patient care.
- Complex privacy and security challenges. Ensuring compliance with HIPAA and HITECH privacy and security requirements is a formidable task for one organization protecting data, but the complexity increases when data is shared among multiple organizations.
Healthcare interoperability challenges are exacerbated by the fact that each organization has multiple platforms to address different needs – financial, claims filing, human resource and clinical. Even within the clinical arena, there is no one platform to fit all needs. For example, a population health platform can support care management, disease registries and the aggregation of a large amount of diverse data – but that can differ from an EHR platform.
Overcoming healthcare interoperability barriers
There is no quick fix to the healthcare interoperability challenge faced today. It is essential that multiple stakeholders – C-suite healthcare leaders and clinicians – work together to drive the adoption of standards that enable healthcare data exchange. It is also necessary to address the technological, financial and human resources that are needed to implement and maintain effective data-sharing.
While these are daunting tasks, many healthcare leaders are turning to cloud-based technology and platforms that can support the aggregation, integration and harmonization of data to enable healthcare interoperability.
The growth and sophistication of cloud technology for healthcare supports expanded networks that go beyond specific sites and locations to tie all entities in a health system or health information exchange (HIE) together without a significant investment in new technology.
A cloud-based platform that can collect and translate data from multiple systems and devices, and make it available in actionable formats, addresses workflow and data-sharing barriers. By choosing technology that eliminates the need to replace legacy systems and can be managed by experts who are up-to-date on privacy, security and interoperability issues, providers can focus on what they do best – develop cost-effective patient care strategies that optimize outcomes.