Interoperability in Healthcare Delivers Critical Health Information at the Point of Care
“Interoperability” is a distracting word that means very different things to different people. To healthcare IT staff, it may mean developing and deploying interfaces that move health information. To health system executives, it may mean proving the value of the expensive information systems they purchased—demonstrating how these systems communicate with each other and external information systems. To clinicians, it may mean easily getting the information they need, when they need it (at the point of care).
Given the technical complexities of interoperability, national standards regarding interoperability, and voluminous national plans to promote interoperability, it’s no surprise health systems are struggling to make progress in this area.
Interoperability, the process of freely exchanging healthcare information among electronic systems, boils down to delivering the highest-quality, most effective, and most efficient care to patients. That’s it. To accomplish this, clinicians must have the best information available at the point of care when making diagnosis and treatment decisions, and communicating them to patients.
Interoperability for interoperability’s sake is a sure path toward more waste in healthcare. Instead, health systems must pursue interoperability that serves patients and enhances their care.
How National Policy Impacts Interoperability in Healthcare
The 21st Century Cures Act’s view of interoperability (outlined in a previous article) focuses on patient care. It defines information-blocking practices that may be at odds with interoperability, prohibiting any practice by a vendor or provider that is, “likely to interfere with, prevent, or materially discourage access, exchange, or use of electronic health information.”
This standard is broad and will be refined in regulations the Office of Inspector General (OIG) will write. The Act doesn’t say anything about providing the right information to the clinician at the right time at the point of care. This is an example of a comprehensive use case that may be addressed by OIG and the healthcare industry in carrying out the national policy articulated in the Act.
EHR Integration: An Important Interoperability Use Case
Healthcare analytics vendors and third party information vendors know that their solutions are most effective when they are available to clinicians using the EHR at the point of care. Clinicians spend enough time managing the EHR interface; they don’t have time to work with multiple interfaces to get the information they need.
According to Dale Sanders, Health Catalyst Executive Vice President, Product Development, “Physicians are 15 times more likely to change their ordering and treatment protocols if presented with substantiating data at the point of care versus presented with that same data in a clinical process improvement meeting.” That is why analytics developers are so intent on making the insights from their tools available at the point of care.
For example, health systems with advanced analytic capabilities can, based on the analysis of data in their enterprise data warehouse (EDW) and predictive analytics, produce a worklist that identifies patients at highest risk for sepsis, central line-associated bloodstream infection (CLABSI), and other conditions. Although the EHR can’t typically produce this prioritized worklist, the EHR interface can make it available to clinicians at the point of care, enabling them to take appropriate, immediate action for high-risk patients. This is just one of many examples of the utility of integrating analytic tools with the EHR interface—an integration that often doesn’t happen due to several common objections.
Common EHR Integration Objections
The technology and information exchange standards required for EHR integration are available and work well. Among the widely used standards are APIs with FHIR, SMART on FHIR, and CDS hooks. However, there are a few common objections to EHR integration that should be addressed:
Objection: “HIT vendors want to integrate too many tools with the EHR, making the integration hard to manage.” -EHR Vendors
This is a legitimate concern if the EHR vendor was required to facilitate access to anyone who asked, but it needn’t be the case. Healthcare users can have the decision-making authority and control over which third party tools are available through the EHR interface, and will naturally limit them to the most critical and commonly used in patient care. They do not want to be inundated with useless information, and will manage access accordingly. Some EHR vendors are creating functionality and processes to enable integration with third party vendors without creating an undue technical burden for themselves.
Objection: “Integration requires EHR access to test and configure the interface; we’re worried we don’t have permission from our EHR vendors to grant this access.” -Health Systems
Only limited, temporary access is required to configure an interface to enable the availability of worklists and alerts. This limited access shouldn’t raise any credible IP concerns. No software code access is required and protections can be put in place to assure an EHR vendor that code will not be accessed and user interface layouts will not be misused. Policymakers should consider a “safe harbor” rule allowing health systems to manage access to/configuration of third party tools without fear of violating contracts.
Other objections involve sourcing data from EHRs as well as other clinical systems; objections that are quickly dissipating with the assistance of the national policy mandate on interoperability and better cooperation among industry participants, including third party organizations with a mission to promote the exchange of electronic healthcare information. Industry participants, federal and state governments, and non-governmental organizations are making progress on eliminating barriers and addressing objections, but more work, on a much shorter timeline, is required.
Hopefully, lingering objections will turn into unqualified support as the industry increasingly understands how important the flow of information is to effective care coordination, and improving treatment and diagnosis.
Amidst Distractions, Keep Interoperability’s Top Goal in Mind: Improving Patient Care
Too often, health systems are distracted by the technical or administrative processes that facilitate interoperability in healthcare and lose sight of its top goal: improving patient care by making the best information available at the point of care.
The industry is making progress, but not fast enough. Health systems need to understand the myriad use cases of interoperability’s utility, including providing critical analytic insights at the point of care through the EHR interface.
Fortunately, there’s hope for the industry’s speedier progression toward interoperability, with a national mandate that eliminates interoperability barriers in a way that respects the concerns of all involved parties and focuses on what matters—patients and providing them with the most effective healthcare.
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