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Aiming for Interoperability in Health IT

Black Book survey identifies challenges to exchanging patient health information.

Black Book's annual survey of healthcare IT leaders reflects what many of us know from experience, which is that interoperability efforts still have a long way to go.

Black Book recently released findings from its survey of hospital and health system executives, physician administrators and payer organization IT leaders, aimed at identifying interoperability trends and understanding the challenges of exchanging patient information in the current healthcare environment.

Of the more than 2,000 provider HIE users and 2,300 payer HIE users surveyed, a majority of respondents admitted to lagging behind in interoperability growth. In fact, 40% of the hospitals surveyed said that they are "still in the planning and catch up stages of sending sharing secure, relevant data."

This is concerning, as we know that patient information is only as valuable as our ability to access it at the point of need.

As I have written previously, the secure electronic exchange and management of patient health data is critical for providers to effectively manage the volume and complexity of information now surrounding patient care. Getting the right information to the right people at the right time is more important than ever to facilitate faster response times, smoother transitions and better outcomes for patients.

Delayed Progress

EHR HIE interoperability While Black Book's survey found consensus on the delayed pace of progress, the reasons for the delay are not as clear.

Of those lagging behind, more than half blamed the lack of headway on EHR vendors and health data blocking, while 20% pointed to insufficient monitoring of interoperability from government agencies.

Only 17% cited an organizational lack of funding and/or executive support as reasons for the delay. Due to the frustrations of HIE and interoperability, 63% of hospitals reported plans to replace their current HIE with a more advanced system or middleware alternative.

"The misalignment of requirements and protocols has hampered all the stakeholders' interoperability efforts," said Doug Brown, Managing Partner of Black Book. "This disorder is ushering in a new replacement revolution, this time for those HIEs failing to meet the expectations of their users, payers and providers alike". 

Although interoperability remains a challenge, EHR adoption has continued to increase, with nearly 97% of hospitals now using a certified EHR system according to the Office of the National Coordinator for Health IT. Ninety percent of these vendors - including Epic, Cerner and McKesson - recently signed an industry-wide pledge, committing to improve interoperability across all EHRs and healthcare systems.

Announced by Department of Health and Human Services (HHS) Secretary Sylvia M. Burwell at this year's HIMSS conference, the pledge is made up of three parts- 1) improving consumer access to health data, 2) eliminating intentional data blocking and 3) implementing federal standards for health data interoperability. In addition to the EHR vendors that signed the pledge, five of the nation's largest health systems and numerous professional organizations such as HIMSS and AHIMA also joined the agreement.

"The future of the nation's health delivery system is one where electronic health information is unlocked and shared securely, yet seamlessly, to put patients at the center of their own care," said Karen B. DeSalvo, M.D., M.P.H., M.Sc., national coordinator for health information technology. "The broad agreement by leaders in health and health IT across the nation brings us much closer to our vision for a truly learning, connected health system."

Steps in the Right Direction

This commitment is a step in the right direction for advancing interoperability, as is the increased involvement of payers noted in Black Book's recent survey. Until recently, payers have been mostly absent from the development of HIEs, as data sharing has traditionally been seen as primarily a benefit to providers. In the recent survey, however, 88% of hospitals and 95% of payers said that secure data exchanges create a more collaborative, trusting relationship between providers and payers.

HIE and interoperability are now seen as a joint effort between providers and payers where all parties hold an equal share in development. A significant number of hospitals reported plans to participate in private HIEs that involve collaboration among payers and providers. This cooperative arrangement supports better connectivity and the ability to integrate clinical and financial information, giving both parties access to needed data.

EHR HIE interoperability"Value based care, payer participation in private HIEs, patient locator systems and analytics will be the real forces that push interoperability ahead next," said Doug Brown of Black Book.

In the meantime, healthcare providers must do all they can to be prepared while remaining agile in the shifting healthcare landscape. Cost-effective, flexible solutions that offer the ability to capture and share needed data among stakeholders will place hospitals at the forefront of the interoperability movement.

"The challenge of turning silos of medical and financial information into a linked, complete, accurate secure lifetime medical record is still tenuous," added Brown.

As this work of structured clinical data exchange and EHR interoperability continues, hospitals need the interim ability to manage unstructured content and share it between systems and stakeholders. Solutions that facilitate the secure, auditable exchange of data in its current state-whether paper, image, electronic document, fax or voice - give hospitals the ability to safely manage and share unstructured data often stored outside the EHR.

Disconnected data from sources such as ancillary systems, paper files and even verbal exchanges is captured, tied to the patient record and integrated with existing systems for a more complete picture of patient health data exchanged across the continuum of care. Workflow is then supported with tools to automatically and securely share records between systems and team members, eliminating time consuming and error-prone processes for greater efficiency, accuracy and consistency.

While there is no magic bullet for interoperability success, the industry presses on with more optimism than we have seen in the past. Ninety-one percent of payers and 74% of providers now believe that a robust, meaningful national HIE will be achievable by 2020. With continued development of standards, growth in technology and collaboration among stakeholders, the right pieces are in place to reach that goal.

Resources

Benton, Lindy. "Secure and Accessible Healthcare Data," Advance for Health Information Professionals. Feb. 16, 2016. http://health-information.advanceweb.com/Features/Articles/Secure-and-Accessible-Healthcare-Data.aspx

"EHR Adoption Growing Despite Industry Challenges, ONC Reports," https://ehrintelligence.com/news/ehr-adoption-growing-despite-industry-challenges-onc-reports

Heath, Sara. "Are EHR Vendors Culpable for Lacking HIE, Interoperability?" Health IT Interoperability. April 7, 2016. http://healthitinteroperability.com/news/are-ehr-vendors-culpable-for-lacking-hie-interoperability

"HHS Interoperability Pledge Gains Major Support at HIMSS 2016," https://ehrintelligence.com/news/hhs-interoperability-pledge-gains-major-support-at-himss-2016

"Payers Accelerate Private HIE Executions; Providers Judge HIE Replacements, Middleware and FHIR Options, 2016 Black Book Interoperability Survey," Black Book Rankings. April 7, 2016. https://blackbookmarketresearch.newswire.com/news/payers-accelerate-private-hie-executions-providers-judge-hie-9866842

Lindy Benton is CEO and President of Vyne™, the industry leader in secure health information exchange and electronic healthcare communication management. Vyne's proven solutions connect disconnected data to close gaps in documentation and improve the continuum of care through a more complete and fully accessible patient record. Outcomes include improved financial strength, operational performance and patient experience for medical and dental providers and payers. For more information, visit vynecorp.com.

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I think it is pretty interesting that such a large percentage of hospitals are opting for a change "Due to the frustrations of HIE and interoperability, 63% of hospitals reported plans to replace their current HIE with a more advanced system or middleware alternative." It seems like most HIEs were poorly conceived as sustainability was not ensured without continued funding and interoperability was still limited to only those within the HIE. Think about how many have failed. It was not a complete solution to the interoperability problem. Middleware, on the other hand, in conjunction with HIEs that support the financial interests of their constituent providers offers a long term solution that meet both the business and technical challenges inherent to healthcare interoperability. Middleware solves a lot of the problems.

Monika Vainius,  Executive Vice PresidentSeptember 07, 2016
Tampa, FL




     

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