How interoperability will help unlock the value of clinical data

We’re more than 20 years into an accelerating cycle of digital transformation, with healthcare stuck in a seemingly endless state of “transforming.” Unlike other industries, healthcare clings stubbornly to stale, fragmented information architectures—systems that frustrate efforts to create the kind of information liquidity and transparency that is standard in banking, retail and other transactional industries. Data—and particularly clinical data—is becoming the currency of healthcare, and this asset is often trapped within systems that limit its access, flow and transactional value. For example, a typical health system maintains multiple applications, including EHR, lab, radiology and billing systems, and healthcare networks can engage with as many as 18 different EHR platforms. This system wide data disaggregation invites data errors, data omissions and data segregation, and threatens every healthcare stakeholder—particularly the patient. It’s an industrywide failure that continues to grow as the touchpoints of healthcare delivery expand beyond traditional care environments. Part of the solution set to healthcare data transparency lies in interoperability, defined by HIMSS as “the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of healthcare for individuals and communities.” Healthcare interoperability involves the bilateral sharing of clinical information, including medical records, laboratory results, clinical summaries, medication lists and much more. Today, health systems have established a foundational data exchange within their clinical environments, but among office-based physicians, clinical data interoperability has not gained a firm foothold. And unless every stakeholder participates, interoperability cannot realize its potential, and quality is compromised. The grand vision of healthcare interoperability is to remove the structural, technical and cultural divisions that prevent transparent clinical data exchange among every stakeholder in the care continuum. But it’s about more than the free exchange of data—interoperability impacts the way that providers deliver and patients experience care. It’s being fueled by heightened patient expectations and industry innovations including population health, value-based care, mobile applications and non-traditional care modalities. Fully deployed, clinical interoperability will increase productivity and reduce operating costs; reduce errors, improve outcomes and the patient experience. The tools of interoperability aim to establish a common data lexicon and common extraction, interpretation and delivery of relevant, actionable clinical information at the point of care, regardless of format, platform or vendor. Foremost among these tools are Fast Healthcare Interoperability Resources (FHIR), a set of HL7 sponsored standards that facilitate the exchange of health information through connected, independent systems. FHIR provides consistent data formats, elements and an application programming interface (API) to connect health information across different health systems, payers, practices, pharmacies, and consumers. Ultimately, FHIR creates a common language where any clinical system can connect and share data. Leveraging FHIR resources, the DaVinci project is a private sector initiative working to help payers and health care providers, positively impact clinical quality, cost and care management outcomes by facilitating the adoption of FHIR data standards. Likewise, The CARIN Alliance promotes the ability of consumers and their authorized caregivers to gain digital access to their health information via open APIs (APIs provide the means for disparate applications and systems to communicate with each other). Not to be outdone, CMS has created Blue Button, a system that enables all 53 million Medicare beneficiaries to view online and download their own personal health records. These and other applications will deliver a dashboard style, consolidated patient record on any connected device, and will provide a trove of research and best practice information to members of the care team, including primary care, pharmacy and payers. The full scope of the interoperability challenge is to capture, store, interpret, analyze and deliver meaningful, actionable information to the right person at the right time in the right place. To be effective, that data flow must be bi-directional between healthcare’s stakeholders—payer, provider and patient. The opportunities to improve the patient experience are enormous, but true interoperability faces some formidable challenges. A uniform patient identifier, consistent data formats, stakeholder trust, privacy and security, payer participation, cost and incentives all are hurdles that must be addressed if interoperability is to become an agent of clinical transformation. There are promising solutions. These include FHIR enablement and Use Case adoption for data standards and common communication protocols; cloud-based EMRs for a centralized, shared platform; blockchain for a National Patient Identifier; value-based care incentives to spur adoption; and open APIs to “close the loop” of data sharing. As the catalogue of these solutions evolve and expand, access, affordability and demand will drive uptake—first between payer and provider, and then between provider and patient. Potential applications range from simple scheduling and messaging—to advanced capabilities like population health, precision medicine, wellness and AI. But to reach that stage of industry adoption, here’s a snapshot of what it’s going to take. • Security and privacy. Each stakeholder in the interoperability care community must establish bulletproof security—a weak link exposes all to risk. • Infrastructure. Cost, particularly on the provider side, has proven to be one of the principle obstacles to data interoperability, but the infrastructure used to connect data sharing networks has to scalable and adaptive. • Consistent standards. Connected systems require standards like FHIR that are consistent and universally adopted. • Incentives. Interoperable systems must be co-joined with value-based incentives to spur adoption. • Leveraging the data. The true value that interoperability delivers is rich analytics—AI, population health, virtual health and patient generated health data sourced from healthcare’s ever-expanding touchpoints. The most promising—and elusive opportunity to leverage health data via interoperability—the social determinants of health is a riddle yet to be solved. With the current emphasis on value-based care, more and more healthcare organizations are beginning to see the need to treat the whole patient and not just their episodes of care. According to the National Academy of Science, medical care only accounts for from 10 percent to 20 percent of health outcomes, whereas social determinants account for 80 percent to 90 percent of outcomes. SDOH encompasses a large swath of factors including where someone lives, education level, social support, income, access to technologies, public safety in their neighborhood and more. For now at least, the capture, normalization and exchange of this often unstructured and non-standardized data, garnered from a wide array of sources beyond the boundaries of healthcare, is limited. A brief example: There is no standard data-driven intervention methodology to impact the recurrence of a patient that is continually returning to the emergency department because he or she is homeless, hungry, unemployed, mentally unstable or any combination of environmental factors. There is a huge opportunity to impact healthcare of populations via SDOH, but the systematic documentation and aggregation of SDOH data in EMRs is limited because of a variety of factors, including the following. An incomplete understanding of the value and catalogue of SDOH data for clinical care and population health management. The ability to capture SDOH data in unstructured and non-standardized formats, which adds layers of complexity to the aggregation, distillation and interpretation of the data regardless of the source. Gaps in and overlap between non-standardized codes and terminologies. It’s still the early days for interoperability in healthcare, and much remains to be done to bridge the cultural, financial and technical issues that are woven into the fabric of care. But looking ahead, through capabilities like ubiquitous clinical data interoperability, there will be a seismic industry shift from treatment to proactive intervention. Driven by greater data connectivity; interoperable and open, secure platforms; consumer engagement, and a wellspring of industry innovation, the collective assets of healthcare will pivot towards wellness, prevention and proactive intervention. The insights that will be derived from AI and predictive analytics will fundamentally recast the patient experience. It’s perhaps not the “Amazon” experience that healthcare consumers would like, but a far greater connected, continual, personalized care relationship between providers and patients where “healthcare” is replaced by “health.”