Interoperability: A Major Challenge in Health Information Technology
Artificial intelligence, big data and mobile applications cannot achieve their full potential without interoperability.
Summary
Health Information Technology (Health IT) adoption has increased but is still not easily accessible across systems to patients, healthcare providers and payers.
The goal of interoperability is to have a seamless exchange of medical information to improve health outcomes and reduce unnecessary costs.
The key barriers impeding interoperability consist of: sending; receiving; finding; and integrating necessary data.
Background
2015 Health IT certification criteria stipulates technical requirements allowing for innovation around APIs and interoperability focused standards to allow easier access and exchange of data.
2016: 21st Century Cures Act – established legal framework to strengthen interoperability and prevent information blocking by providers and EHR vendors.
2019: Rules to support seamless and secure access, exchange, and use of electronic health information
2020 Current rules will allow health plans to start giving patients access to their data, free of charge from January 1 to July 1, 2020.
Review
The National Coordinator of Health Information Technology (ONC) provides a very broad definition of electronic health information. Healthcare providers hold a vertical set of health data related to episodic care, but healthcare plans have longitudinal data over longer periods of time periods and across the health care system. In addition, the Cures Act defines 4 groups prohibited from information blocking which include:
healthcare providers;
developers of certified healthcare technology;
health information networks;
health information exchanges
A violation of this prohibition could result in fines of up to $1 million per incident.
The broad definitions around electronic health information and health information networks have health insurers concerned about release of claims processing, prior authorizations, coverage determination, and negotiated prices of service. Health plans would like the ONC to:
1. Substantially narrow the definition of electronic health information to
conform with existing privacy laws, and
2. Be excluded from the health information blocking prohibitions
Quicker adoption of interoperability is hindered by:
Barriers to receiving information: the most common barriers to receiving electronic data is from providers outside the health system and consist of:
Difficulty integrating information into the EHR (55%)
Information not always available when needed (47%)
Information not presented in a useable format (31%)
Barriers to sending information: Although the most commonly cited problem with sending data is difficulty finding a provider’s address, data sharing is hindered by 80% of the more than 340,000 medical concepts are in an unstructured format in various EHRs. Individual health plans lack a standardized approach to the unstructured format of diagnoses, tests, procedures, clinical data, clinician notes, medical history, progress notes and imaging narratives. In addition, currently, clinical data cannot be incorporated with generated data, social determinants of health, mobile health apps, wearable sensors accumulated from across the entire enterprise.
Conclusion
Sharing of electronic health data would aid in the potential decrease of duplicate tests, double medications, etc.
The ONC has proposed HL7 Fast Healthcare Interoperability Resources (FHIR) as a format, however problems remain with medical terminologies, nomenclatures and ontologies.
Payers need to ensure data is accurate, clean and actionable. This will require standardization and mapping of data, continuous management of standard updates and establishing a single source relationship between source silos and domains.