Achieving Health Care Interoperability

Health care interoperability is defined as the “ability for different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.”[i] At PatientPing, interoperability is at the core of what we do. Our mission is to help transform our country's health care system by empowering providers to more seamlessly coordinate care with one another. We do this by providing real-time notifications to providers when their patients receive care anywhere.

In partnering with providers across the full care continuum, including acute, post-acute, long-term care, and community-based providers, we have found there to be three consistent challenges relating to interoperability. In this post, we describe the challenges facing the health care system today, and propose both technological and policy-based solutions to help overcome them:

Challenge 1: Legacy IT infrastructure and clinical workflows that do not assume interoperability
Existing IT infrastructure was adopted and implemented in siloes without requirements for interoperability in place. As interoperability efforts have evolved, many emergent solutions have focused on simply routing data into already crowded provider interfaces, as opposed to intelligently aggregating and harmonizing data from multiple systems so that it can easily be consumed into provider workflows.

Take, for example, ADT notifications and direct messaging. If we were to simply route ADT messages between systems and pass it through to existing direct messaging endpoints, we could say that we have achieved system interoperability. We would argue, though, that this comes at the cost of the provider user, whom we’ve inevitably over-flooded with a tangle of individual messages which they then have to read, contextualize, and sequence, in order to determine which action to take. This ultimately negates the value of inter-system connectivity. True interoperability entails more than the ability to share data—the real value comes in actually using that exchanged data to drive better patient outcomes.

Challenge 2: Lack of complete financial incentives to engage providers and advance interoperability
Much progress has been made to move toward value-based care and engage providers to enhance care quality for their patients, but there is still room for improvement. Due to conflicting incentive design across care models and payers, many providers are left with one foot in volume-based care and the other in value-based care.

In addition, there continues to be an emphasis on process vs. outcome-based performance metrics among many value-based programs. With the launch of more value-based programs, some with overlapping and other non-overlapping metrics, providers are often left confused and distracted, focused on checking requirement boxes instead of on what really matters, which is, of course, delivering higher value care to their patients. 

Challenge 3: Limited access to real-time, actionable, information about when and where patients receive care
Providers often rely on claims data to understand their patients' utilization trends. Claims data is inherently delayed, leaving providers with directional insight but no ability to make timely interventions to improve patient care or iteratively measure the impact of actions they do take. Many providers have focused on trying to obtain real-time data about when and where their patients receive care through costly, time-consuming, and inefficient manual efforts, resulting in unintended siloes and missed opportunities for providers to collaborate and deliver the highest value care to their patients.

Proposed Solutions:
We have found that when solutions aimed at addressing real business needs are adopted by engaged providers, many interoperability challenges can be overcome.

Providers that are evaluated annually on outcome-based metrics and have large volumes of patients do not have time to wait for retrospective claims data to be processed before they can take action. Those who are participating in alternative payment models with aligned metrics are most engaged in championing the type of behavior change required to achieve true interoperability.

Technology solutions that focus on delivering real business value to providers under alternative payment models have a better chance at being adopted into existing provider workflows. Many solutions risk trying to address too many interoperability use cases at once, ultimately resulting in additional layers of complexity and lack of provider adoption. For example, at PatientPing we are starting by focusing on an actionable, simple use case: Where is my patient? 

Providers should focus on adopting best-in-class technology solutions that are proven to add business value, and have the expectation that vendors will work together to offer a seamless provider experience.

On the policy side, we have found that policies that use consistent outcome-based metrics to fully align incentives for providers across care models and payers will incentivize providers to not just passively consume data, but also act on this data in a way that truly transforms how they think about and care for their patients.

With solutions like these, we hope that the challenges discussed above can be resolved, making it easier to achieve true provider interoperability and result in more seamlessly coordinated care for patients.

 

[i] HIMSS. http://www.himss.org/library/interoperability-standards/what-is-interoperability