Interoperability in healthcare for better patient care and efficacy

- Panchalee Thakur

The case for data interoperability in healthcare has long been established for its wide-ranging benefits - improved patient safety, quality care, streamlined business and administrative processes, and simplified reporting. While regulatory mandates initially prompted organizations on the path to interoperability, today, other compelling factors such as the ability to make smarter decisions based on data and changing patients’ expectations are helping drive adoption. The regulatory environment continues to evolve after the publication of the first set of Fast Healthcare Interoperability Resources (FHIR) in 2013. FHIR is a protocol developed by the standards development body, Health Level 7 (HL7), for exchanging Electronic Health Records (EHR). A notable regulatory mandate in the US is the Cures Act, which came into effect in 2016, “to accelerate the discovery, development, and delivery of 21st century cures, and for other purposes”.

In May 2020, the Office of the National Coordinator for Health Information Technology (ONC) and the Department of Health and Human Services (HHS) released the 21st Century Cures Act: Interoperability, Information Blocking, and the ONC Health IT Certification Program Final Rule to implement certain provisions of the Cures Act including conditions and maintenance of certification requirements for health IT developers under the ONC Health IT Certification Program, the voluntary certification of health IT for use by paediatric health care providers, and reasonable and necessary activities that do not constitute information blocking. The implementation of these provisions was aimed at advancing interoperability and supporting the access, exchange, and use of electronic health information. The rule also finalized certain modifications to the 2015 Edition health IT certification criteria and program to advance interoperability, enhance health IT certification, and reduce burden and costs.

In June 2023, the HHS Office of Inspector General (OIG) issued the final rule for implementing information blocking penalties in accordance with the Cures Act.

In December 2023, ONC's HTI-1 final rule implemented provisions of the 21st Century Cures Act and made updates to the ONC Health IT Certification Program with new and updated standards, implementation specifications, and certification criteria. Provisions in the HTI-1 final rule “advance interoperability, improve transparency, and support the access, exchange, and use of electronic health information”. Key aspects of the final rule include introducing algorithm transparency, adopting United States Core Data for Interoperability (USCDI) Version 3 as a new baseline standard, enhancing information blocking requirements, and implementing new interoperability-focused reporting metrics for certified health IT. These key provisions of the Act are helping achieve interoperability and patient-centricity in US healthcare.

In June 2023, the HHS Office of Inspector General (OIG) issued the final rule for implementing information blocking penalties in accordance with the Cures Act.

Against this fast-evolving regulatory landscape, Healthcare Organizations (HCO) are making interoperability centerstage. A Forrester report reveals that 42% of “modern and future-fit HCOs” accord “critical priority” to data interoperability and unlocking the value of data. While 33% of organizations focus on reducing costs, a higher number (40%) cite improving customer experience as their top business objective along with revenue growth — something that interoperability makes possible.

Interoperability allows HCOs to enhance patient care and efficiency, yielding numerous benefits:

  • Reduces the reliance on manual health records, mitigating duplicate health checks
  • Improves the accuracy, completeness, and timely access of patient data, enabling better medication management
  • Lowers the cost and time required for treatment
  • Increases patient participation in the care journey
  • Enhances coordination and organization of patient information
  • Reduces medical errors and ensures continuity of care
  • Improves communication between health professionals and patients
  • Fuels medical research with access to large-scale healthcare data
  • Drives success in telehealth and patient monitoring
  • Enables population health data aggregation and analysis, providing data analytics and better visibility for HCOs to implement targeted interventions in community health programs

New use cases for data interoperability in healthcare are emerging. These include access to information on mobile apps, digitized diagnostic reports, and clinical decision support systems. Other applications for healthcare data interoperability are appointment booking via chatbots or apps, online admission and discharge notifications, claims verification and processing, and seamless exchange of data between payers.

Addressing challenges in healthcare modernization and interoperability

The adoption of healthcare interoperability is driven by efficient and cost-effective healthcare delivery, government initiatives, regulations promoting patient care and safety, the rise of new medical technologies, and the increased adoption of EHR. However, implementation remains challenging, with 70% of healthcare providers continuing to exchange medical information over fax. However, initiatives for healthcare modernization are growing, particularly with the Centers of Medicare and Medicaid Services (CMS) calling for an end to fax in US healthcare.

Composable architecture to adapt better and faster

In a 2022 Statista survey, close to a quarter (23%) of global healthcare leaders reported that limited technology infrastructure was a major barrier to effective data utilization in their organization. A composable healthcare strategy emphasizing interoperability offers a solution for reusing existing IT system functionalities and adding newer capabilities in a modular manner. Gartner recommends utilizing Interoperable Application Ecosystems (IAE) as a practical medium to achieve composable healthcare and orchestrate successful digital transformation.

Hybrid cloud-based solutions, partnerships to transition from legacy systems

According to a 2021 Healthcare Information and Management Systems Society (HIMSS) survey, 73% of healthcare providers continue to use legacy information systems. Outdated systems result in slower processes, increased errors, difficulties in adapting to the demands of a modern healthcare ecosystem, and compliance gaps. For an effective transition to interoperability, organizations can leverage hybrid cloud-based solutions to modernize their data management capabilities. This transformation not only streamlines the integration of new applications and programs but also ensures a continuous flow of data during system updates. Healthcare providers can further enhance this transition by educating stakeholders on the importance of interoperability and its associated tools and collaborating with industry experts and vendors to ensure a smooth transition from outdated legacy systems to deep interoperability.

Audits, analytics, standards, and metrics for data quality

A 2020 JAMA Network study found that 20% of patients identified errors in their EHR data. Moreover, as per a recent survey by HIMSS and Patient ID, HCOs devote 109.6 hours on average every week to tackle patient identification issues. Over a third of the surveyed organizations indicated a yearly expenditure of over $1 million on identification resolution. To address this issue, a standardized approach to identity management is crucial. Improving the quality of healthcare data requires organizations to audit data management practices, follow industry-approved standards, integrate analytics, choose relevant metrics, and provide ongoing staff training on data management solutions.

Government funds and pay-as-you-go models to lower costs

The transition to healthcare interoperable systems from traditional workflows involves high upfront costs. According to Global Market Insights, an HCO’s initial installation costs for software development and infrastructure can exceed $60,000 in the first year. Organizations must explore their eligibility for government grants aimed at modernizing health record systems. Moreover, pay-as-you-go models from cloud vendors can help mitigate financial barriers and facilitate long-term savings. A trusted IT services partner can help identify an affordable means to modernize and utilize cloud resources by thoroughly assessing organizational workloads, inefficiencies, cost-benefit analysis and developing a phased plan for cloud adoption.

Asset tracking and use of APIs to improve cybersecurity

Ensuring the security of patient data is a top concern, with “more than 82.6 million healthcare records being exposed or impermissibly disclosed” between January 1, 2023 and October 31, 2023, in the US, according to the HIPAA Journal. According to a Forrester report, cybersecurity vendors observe that health systems often underestimate the number of connected devices on their networks. To address this concern, HCOs are turning to automation, specifically asset tracking, to accurately identify all connected devices and mitigate potential threats. Streamlining and standardizing codes through APIs can enhance the efficiency and safety of health data exchange, paving the way for process improvements and innovation.

Compliance with local data standards

A key challenge in enhancing interoperability involves the standardization of terminology and the normalization of data to align with new standards. Acknowledging the significance of interoperability standards in digital health transformation, the World Health Organization (WHO) and HL7 entered into a Project Collaboration Agreement to promote the global adoption of open interoperability standards. HCOs must be prepared to adhere to local, national, and global interoperability standards as they evolve.

Overcoming data management issues

Approximately 50% of the survey respondents from US hospitals and health systems in a Statista survey cited managing unstructured data as the primary obstacle to enhancing interoperability and providing a connected care experience. Smart hospitals can address silos and consolidate data into a readily digestible and standardized format, resulting in improved data generation and insights, according to a Forrester report on the key takeaways from HIMSS23 conference.

Interoperability kit for Healthcare Information Exchange

According to Forrester, a revamped ecosystem calls for reframed partnerships that focus on working together to enhance care coordination and patient experiences. Collaborating with a strategic partner can greatly help HCOs maximize value from interoperability in line with global and local compliance standards – all in a cost-effective manner.

At Torry Harris, we are committed to creating future-fit organizations in healthcare through interoperability. Our Interoperability Kit for Digital Healthcare Data Exchange streamlines the adoption of FHIR-compliant APIs and optimizes the value derived from data exchange. Through our FHIR and healthcare ecosystem enablement services, we help clients achieve new revenue by owning and operating a healthcare/pharma digital marketplace, and enable interoperability by standardizing API-enabled IT assets for FHIR/HL7 compliance. Moreover, we help build a partner network ecosystem by accelerating integration with third parties such as diagnostic labs, insurance providers, wearable providers, and pharmacies through FHIR-compliant starter kits to streamline, automate and augment care.

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About the author

Panchalee Thakur

Independent Consultant