Why leveraging interoperability is key to closing care gaps
As healthcare evolves, optimizing information exchange will help close care gaps and ensuring all patients receive coordinated, high-quality care.
Care gaps, or lapses in the coordination of services, are unfortunately a common reality of the healthcare system in the U.S. These gaps significantly impact quality metrics and revenue, often leading to poorer patient outcomes and increased healthcare costs.
A study published in the National Library of Medicine found that one-third of US respondents experienced at least one care gap, and 10 percent experienced poor primary care conditions, characterized by experiencing three or more gaps.
Closing these gaps is crucial for improving overall patient care and outcomes, but healthcare providers aren’t always aware of every gap that exists for their patients. Care gaps happen for a variety of reasons; for example, when patients see multiple providers and patient information is not exchanged properly or when a patient misses a recommended screening or because of system inefficiencies.
The consequences of these gaps can include duplicate tests, incorrect prescription guidelines, care delays, patient frustration, wasted provider time and, ultimately, worse health outcomes for patients. Maximizing health systems interoperability – how well different systems work together on behalf of the patient without extra effort – is essential for minimizing gaps in care.
It’s no secret that healthcare has an interoperability problem. The inability of different health information systems to communicate and share data seamlessly has long been a barrier to providing optimal patient care. This fragmentation leads to inefficiencies, increased costs, and gaps in patient care that can have serious consequences.
However, improvements are possible. By leveraging advanced technologies and fostering greater collaboration among healthcare stakeholders, we can bridge these gaps and create a more connected, efficient and patient-centered healthcare system.
Interoperability and patient outcomes
There are several ways that interoperability can play a role in reducing workloads and improving patient outcomes.
Reducing administrative burden. One of the primary benefits of interoperability is the reduction of administrative burden on clinical staff. When health information systems are interoperable, data can be shared and accessed easily across different platforms. When healthcare providers do not need to manually input or transfer patient information, the risk of error is reduced and their valuable time is saved.
For instance, test results and medical records can be automatically updated and shared between primary care providers and specialists, ensuring that all parties have the most current information.
Using an automated solution like a gap alert, which can be embedded within a provider’s electronic health records system workflow, can notify providers of potential care gaps during pre-visit planning or the actual patient visit. This solution improves communication between payers and providers and reduces the need for manual operations.
Faster results. Interoperability facilitates quicker and more efficient access to patient data, which can significantly reduce the likelihood of errors. For example, if a patient's medical history, test results and current medications are readily available to all healthcare providers involved in their care, it reduces the risk of redundant tests and conflicting treatments. This not only enhances the accuracy of diagnoses and treatment plans but also speeds up the decision-making process, minimizing delays and leading to faster patient care.
By having immediate access to comprehensive patient data, healthcare providers can make informed decisions more quickly, reducing the time patients spend waiting for diagnoses and treatments. This can be particularly crucial in emergency situations, in which every second counts. Using tools to automate the chart retrieval process is one way to ensure that clinical data is shared efficiently and securely, thus speeding up the availability of critical patient information.
Enhancing patient safety. Patient safety is significantly improved through interoperability. When healthcare providers have access to comprehensive and up-to-date patient information, they can make more informed decisions. This reduces the risk of adverse drug interactions, incorrect dosages and other medical errors. Additionally, interoperability enables better coordination of care, confirming that all healthcare providers involved in a patient's treatment are aware of each other's actions and recommendations.
For example, if a patient is seeing multiple specialists, interoperability ensures that each specialist is aware of the treatments and medications prescribed by the others. This coordination helps prevent harmful drug interactions and ensures that all aspects of the patient's care are aligned. Effective information exchange between payers and providers, where clinical data and insights are shared, can have a significant impact on the quality of care delivered.
Mitigating extra costs. A recent report estimates that plans and providers fail to collect more than $26 billion in revenue because they fail to address and report the closure of gaps in care. Interoperability can help mitigate extra costs associated with redundant tests, unnecessary treatments, and administrative inefficiencies.
By streamlining the flow of information and reducing the need for manual data entry and verification, healthcare organizations can operate more efficiently and cost-effectively. This not only benefits healthcare providers but also reduces the financial burden on patients and the overall healthcare system.
Improving patient engagement. Interoperability empowers patients by giving them easier access to their own health information. When patients can view their medical records, test results and treatment plans through patient portals or mobile apps, they are more likely to be engaged in their own care. This increased engagement can lead to better adherence to treatment plans, more informed decision-making and, ultimately, better health outcomes.
When patients are actively involved in their healthcare, they are more likely to follow through with recommended treatments and screenings. This proactive approach can lead to early detection of potential health issues and more effective management of chronic conditions.
Addressing care gaps can be achieved through improved interoperability, enhancing patient care and outcomes. By reducing administrative burdens, speeding up access to accurate information, enhancing patient safety, mitigating extra costs and improving patient engagement, interoperability can transform the healthcare experience for both providers and patients.
As the healthcare system continues to evolve, prioritizing interoperability will be key to closing care gaps and ensuring that all patients receive coordinated, high-quality, value-based care.
Jay Bhattacharyya is the senior vice president and general manager for Veradigm’s payer business unit. Prior to the creation of Veradigm, Bhattacharyya served as vice president of finance at Allscripts for more than a decade.