Interoperability is a hot topic in health care today—with new rules for health plans and health care providers by the federal government. While you may be familiar with the term, this post covers a key concepts, examples and definitions to help you better understand what the buzz is all about – and what interoperability will mean for health care in the years ahead.
What does interoperability really mean?
According to the Healthcare Information and Management Systems Society (HIMSS), Interoperability in health care is “the ability of different information systems, devices or applications to connect, in a coordinated manner, within and across organizational boundaries to access, exchange and cooperatively use data amongst stakeholders, with the goal of optimizing the health of individuals and populations.”
Let’s break that down. At its basic level, interoperability is intended to allow people and their medical providers to access all of their health care data easily and conveniently, at no cost to them. There are many players in the health care space – from health plans to health systems to individual providers and even health-related applications and tool vendors. Each is collecting data that if shared could employer people to better manage their health care and improve their health. Today there are data silos that ultimately do not serve the patient well. Interoperability is meant to remove the silos and allow all health care participants to communicate and share data among each other, safely and securely.
How interoperability could impact health care
Interoperability is expected to improve consumer engagement, improve health outcomes and decrease costs of delivering health care. By enabling the safe and secure access to people’s personal health information, new tools and products will be developed that serve information to users in new ways. It is expected to result in new apps that people can use that make health care more convenient, easier to navigate and with more support. We are at a similar point in time to the precipice we stood on when the iPhone or iPad first came to market. The industry wasn’t exactly sure how these products and capabilities would be adopted, but ultimately they led to many of the great advances in technology and many of the productivity apps we depend on today.
Key terms for reference
Before jumping into some examples and what interoperability will mean for health care, there are a few key terms that are particularly important to be familiar with alongside any discussion of interoperability in health care.
- FHIR®: Fast Healthcare Interoperability Resources is a standard from HL7® for exchanging health care information electronically. FHIR solutions are built from a set of modular components called “resources.” These resources can easily be assembled into working systems that solve real-world clinical and administrative problems at a fraction of the price of existing alternatives. FHIR is suitable for use in a wide variety of contexts – mobile phone apps, cloud communications, EHR-based data sharing, server communication in large institutional health care providers, and much more.
- SMART on FHIR: Substitutable Medical Applications and Reusable Technologies (SMART) project aimed to create a platform on which developers could make health care applications that could run interoperably across different health IT systems leveraging the FHIR standards. SMART on FHIR is a set of open specifications to integrate apps with Electronic Health Records, portals, Health Information Exchanges, and other Health IT systems.
- The CARIN Alliance: The CARIN Alliance is a non-partisan, multi-sector alliance co-founded by David Blumenthal, David Brailer, Aneesh Chopra, and Mike Leavitt. The Alliance is led by distinguished risk-bearing providers, payers, consumers, pharmaceutical companies, consumer platform companies, health IT companies, and consumer-advocates who are working collaboratively with other stakeholders in government to overcome barriers in advancing consumer-directed exchange across the U.S.
- The Da Vinci Project: Interoperability challenges have limited many stakeholders in the health care community from achieving better care at lower cost. The dual challenges of data standardization and easy information access are compromising the ability of both payers and providers to create efficient care delivery solutions and effective care management models. The goal of the Da Vinci project is to help payers and providers to positively impact clinical, quality, cost and care management outcomes.
Interoperability examples today
- Cerner Corporation and Geisinger Health System are using FHIR to expand population health management capabilities and create specialty-specific applications that break down data siloes.
- Epic Systems, the Mayo Clinic, and IBM Watson Health are leveraging FHIR as the basis for a new clinical decision support model that includes real-time data access for providers at the point of care.
- Private industry interoperability efforts like the Healthcare Services Platform Consortium (HSPC) are making FHIR the centerpiece of their work to create an EHR-agnostic “marketplace” for apps that allow data to flow freely across disparate systems.
- The CommonWell Alliance, Carequality, and the Sequoia Project are also exploring FHIR’s potential for creating seamless data exchange.
- Da Vinci Project use cases:
- Streamlining preauthorization is a particularly high-value use case. “It’s an anathema for clinicians,” noted HL7 International CEO Charles Jaffe, MD, PhD . “Clinicians do their best to get preauthorized for every prescription or procedure, but the rules may be different for every payer, and they don’t even know the criteria upon which that authorization is judged.”
- “When they care for the patient in the normal course of events, FHIR can enable a preauthorization algorithm to simply say ‘yes, you can do that’ or ‘no, you haven’t met these five criteria yet.’ The burden and frustration of preauthorization is solved inherently.”
- Participants in the project will be examining a number of other use cases, as well, including medication reconciliation and data exchange to support HEDIS and STARS ratings.
- Streamlining preauthorization is a particularly high-value use case. “It’s an anathema for clinicians,” noted HL7 International CEO Charles Jaffe, MD, PhD . “Clinicians do their best to get preauthorized for every prescription or procedure, but the rules may be different for every payer, and they don’t even know the criteria upon which that authorization is judged.”
Why all the buzz right now if interoperability initiatives are already taking place?
To expedite the interoperability process beyond the examples above and move it industry-wide, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) have finalized some new rules. These rules would require health care data to be formatted in a specific way so it can be easily shared and safely secured, encourages the adoption of standardized application programming interfaces (APIs), restricts or eliminates data access from being blocked and focuses strongly on the patient’s ability to access their health information. There are also elements that make health care data more readily portable as you navigate your health care journey. These rules apply to health plans who support Medicaid, Medicare or offer Qualified Health Plans on the national exchange, however the intent is that broader adoption will be encouraged for those health plans that offer commercial products as well. This standardization and the effort to meet the requirements to do so are the subject of much debate today.
In summary, interoperability is about standardizing health care data, making it safely and securely available to patients and their providers and encouraging innovation to flourish in the health care industry. While adoption is slowly occurring in some segments, it is also being supported by the federal government with new rules which require covered government plans to comply by January 1, 2021.
