The lingering challenge of healthcare interoperability

Front-line doctors, healthcare administrators, government officials—in fact, just about all everyone connected to medical care–support interoperability, saying it will improve patient care, reduce medical errors and create money-saving efficiencies.

But interoperability has yet to become a reality, despite such overwhelming support for the free flow of patient data between caregivers. In fact, healthcare isn’t even close.

“The potential promise and hope was that your [digital] record would be available wherever it’s needed by whoever needs it. But the records have not been as portable as people had hoped they would be,” Steven J. Stack, MD, president of the American Medical Association, told Medical Economics

 Many challenges—technical, financial and procedural—remain as healthcare moves toward interoperability.

One of the biggest hurdles is getting the technology to the point where it will allow the different electronic health record (EHR) systems to talk to one another—the key underpinning needed for interoperability, according to Kelly Aldrich, DNP, RN-BC, CCRN-A, chief clinical transformation officer at the Center for Medical Interoperability. The center is a non-profit organization bringing together executives from healthcare organizations and other stakeholders to accelerate the seamless exchange of health information.

The Government Accountability Office identified five obstacles in its September 2015 report Electronic Health Records: Nonfederal Efforts to Help Achieve Health Information Interoperability. They are: insufficiencies in health data standards; variation in state privacy rules; challenges in accurately matching all the right records to the right patient; the costs associated with work to reach interoperability; and the need for governance and trust among entities to facilitate sharing health information.

Stack said he thinks the federal government is also an obstacle to reaching interoperability. He explained that EHR vendors developed their software products to meet the Centers for Medicare & Medicaid’s (CMS’) Meaningful Use certification requirements but it didn’t do anything to promote interoperability.

“What we have to do is restore a marketplace where those of us who are purchasing these tools have more leverage and more power to tailor the technologies,” he said.

Progress is being made on that front.

For example, the Center for Medical Interoperability is pulling together stakeholders in an effort to bring about plug-and-play interoperability.

Major EHR vendors and some 30 large healthcare providers also came together last October at the KLAS Keystone Summit and agreed to establish measurements of interoperability performance across EHR systems.

Additionally, the U.S. Department of Health and Human Services (HHS) in February announced that the major EHR vendors, the country’s five largest private healthcare systems and more than a dozen professional associations and stakeholder groups pledged to implement three core commitments to improve the flow of health information to consumers and healthcare providers. Those core commitments center on consumer access, no information blocking and national interoperability standards.And there’s CommonWell Health Alliance, a nonprofit association of health IT companies that’s working together to create universal access to health data nationwide. It aims to create ad execute a vendor-neutral platform that allows for this data exchange.

Clinicians themselves, usually in conjunction with the healthcare systems with which they’re affiliated, are also moving forward.

“Physicians are increasingly working in large healthcare systems with relatively mature electronic health records. These systems are working with their EHR vendors to implement the nationwide interoperability roadmap as quickly as they can,” said Sam Weir, MD, a national leader in medical informatics and lead informatics physician at UNC Health Care, a position in which he ensures that medical technology supports patients in their ability to access medical care.

Weir also credited the Office of the National Coordinator of Health Information Technology and its “roadmap” for interoperability published last fall for moving the dial on interoperability and its work toward setting technology standards between vendors. 

As this work moves forward, Weir said clinicians need to prepare.

“If they don’t know already they need to find out if their EHR does meet or will meet the Healthcare Information and Management Systems Society interoperability standards. If their vendor won’t give them a straight answer they need to keep pushing. The train is leaving the station and they need to get on,” he said.