Healthcare Interoperability: Misconceptions, Challenges, and Progress

Healthcare interoperability is a topic that’s both buzzworthy and a sore point for the industry. For decades, the healthcare ecosystem has tried to overcome interoperability woes. Since the wide-scale adoption and deployment of EHRs and health information systems, interoperability has always been a priority. Achieving it has been elusive and complicated, leading to misconceptions, challenges, and progress. 

Healthcare Interoperability Misconceptions

Misconceptions occur in every industry, and when you mix in technology, things tend to become more ambiguous. Let’s clear up some misconceptions about interoperability.

Interoperability Is Hard Because of Disparate Systems

Getting systems to “talk” to one another isn’t really the issue with interoperability. Although there are issues with API standardization. Drawing a line between one system to the next doesn’t require tech geniuses. The challenge comes from a lack of resources, namely time, money, and people

When most healthcare organizations approach interoperability, they do so reactively. Instead, they should look at interoperability as another layer to their systems. By doing this, the barriers that exist are more surmountable. 

FHIR Is the Standard

Fast Healthcare Interoperability Resources (FHIR) is a standard for exchanging healthcare information digitally. It’s relatively new, and even though it’s a standard, not everyone is using it. Further, it doesn’t solve every interoperability issue.

However, FHIR Release 4 is now normative, no longer in draft form. Additionally, the new interoperability rule declares it the standard for APIs. These two elements make its adoption likely to increase, but challenges will persist as the standard matures.

Interoperability Is Only an EHR Problem

EHRs are an integral part of the interoperability environment, but it’s only one piece. The technology piece of EHR interoperability isn’t really the problem. It’s an operational one in the big picture, as there are multiple roadblocks in looking at the system. 

First, there is the need for interoperability within a healthcare system, which is the least complex. Considerations of the different types of system are necessary because healthcare doesn’t just EHRs. The long list of health information systems includes pharmacy software, decision support, revenue cycle management, eMARs, business intelligence, and more. In theory, all these systems should be interoperable to improve continuity of care.

Second, information exchange must occur outside of an organization. This could include public health, payers, other providers, and other players. The complexity dials up a notch. 

Third, there is the emerging need to share and access data from IoT (Internet of Things) medical devices. Now, the interoperability equation becomes intertwined with hardware, operating systems, and communication protocols, all of which may not be compatible. This data is often unstructured as well, so aggregating and making it useful is another concern.

Healthcare Interoperability Challenges

In looking at the misconceptions, we’ve uncovered many of the challenges of interoperability in healthcare. There are more than what we’ve already touched upon. 

Patient Identification Inconsistencies

The healthcare system does not currently have a universal way to identify patients. Patient identification is by name, date of birth, or Social Security number. These identifiers are stored differently in platforms, which is an impediment. HIMSS and CHIME have advocated for a national patient identifier. Lack of conformity on this drive interoperability disconnection.

Information Exchange Standards

As noted, FHIR is a standard, not the standard. Applications used in healthcare do not follow one standard for data formats, meaning data sharing is difficult. Data conversions must be employed most of the time to match formatting and fields, so there are extra steps necessary to allow these systems to exchange data accurately.

Measurement and Analysis Issues

Healthcare needs to be able to measure the effectiveness of their systems, something nearly impossible without interoperability. When platforms cannot speak to each other, it becomes very difficult to quantify costs, error rates, outcomes, and other important metrics. We do not know or deeply understand the impact of interoperability delays and failures. 

A comprehensive way to collect and analyze data could drive many benefits for patients individually and public healthcare initiatives. The potential for better outcomes and care along with lower costs is there—interoperability can make it a reality.

Information Blocking

The new HHS rule attempts to take this challenge head-on, with clarification and requirements. Payers and other stakeholders have often engaged in information blocking for a variety of reasons. The rule seeks to eliminate most instances of this; however, there are eight categories of exceptions. It’s not perfect, but it’s a good start.

Healthcare Interoperability Progress

Interoperability progress is happening, albeit sometimes very slowly. And many organizations see it as a priority. According to the Center for Connected Medicine survey, 60% of respondents said interoperability objectives are a priority.

So how far have we come? These are some milestones that demonstrate progress.

• FHIR standards: They aren’t fully deployed but create a starting point.
• New interoperability rule: The focus of the rule has been patient accessibility and will force some advancement to an interoperable healthcare world. However, there is still some time before all parties must comply, and enforcement is still murky.
• Interoperable data liaisons: There are data management companies that specialize in helping disparate systems talk to one another. That’s a big part of what we do!
• Industry leaders are behind interoperability: Organizations like HIMSS, as well as associations that represent providers, are all on-board and pushing for this to happen, realizing the benefits for all stakeholders and patients.
• Realization of the value of data: Healthcare organizations understand the importance of their patient data and how it can drive better outcomes. This wasn’t always the case, and it’s clear this movement is firm within the industry.

Interoperability Is Feasible, But Far from Easy

In thinking about interoperability outside of the healthcare context, most of them time APIs and integrations are prevalent. Unfortunately, that’s now healthcare works—the data has different provisions for security and compliance. There are also fundamental design challenges. EHRs and other systems aren’t necessarily built to share. 

It’s not like anyone is really fighting interoperability. It’s just that everyone’s not quite on the same page—competing priorities and cautiousness about the process exist. How will the industry come together to resolve a problem that’s been happening for decades? We’ll all learn a lot once the interoperability rule is officially active. 

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