Posts Tagged: data sharing

Healthcare Interoperability: Misconceptions, Challenges, and Progress

healthcare interoperability

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

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

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. 

Questions about interoperability? Find out how we can help

Healthcare Data Management: Interoperability, Portability, and Accessibility Challenges

healthcare data management

Healthcare data management is complex, and not something most organizations have the expertise or bandwidth to handle on their own. Most stakeholders understand the opportunities of leveraging such an asset but aren’t sure how. They struggle with interoperability, portability, and accessibility. The healthcare system is ripe with challenges that leave many entities unable to use their data for the greater good optimally. 

So, what are the biggest challenges and possibilities? As a healthcare data management company with over two decades of experience, we’re happy to share our ideas.

Interoperability Remains at an Impasse

The healthcare community at large, and its regulators, are certainly trying to make headway here. The new interoperability and information blocking rule from HHS tackles this head-on. The focus of the new rules is to allow patients more access to their medical records. The rules also express the need to eliminate information blocking. However, the enforceability of this is still up in the air. 

We’ve seen lots of interoperability issues in our years of working on over 27,000 data management projects. Moving PHI isn’t a straightforward process. There have been many efforts to drive standardization in EHRs, mostly through FHIR (Fast Healthcare Interoperability Resources), which should “simplify implementation without sacrificing information integrity). 

However, there are different versions of FHIR so that systems could be technically “standardizing,” but there’s still incompatibility. Additional inconsistencies include EHRs not using all available FHIR APIs. The interoperability rule does address the need for FHIR APIs to improve data sharing. Most EHRs have adopted FHIR, but the new interoperability rule moves to make FHIR Release 4 the standard. 

What’s the biggest roadblock? Health information systems aren’t “open.” They are designed to integrate, like many SaaS platforms. Healthcare data, it’s just different. 

Portability Isn’t Easy

In many cases, a business can quickly move databases around. For example, if you move to new CRM software, you’ll migrate your customer data to a new platform. It’s usually not a heavy lift—maybe a little light data cleaning or purging.

Unfortunately, in healthcare data management, portability is a huge pain point. You can’t just move to a new EHR or decision support system by copying and pasting. It requires a data conversion to make sure the information is securely sent, and that field matching is as accurate as possible.

Beyond moving from one software to another, many healthcare organizations also need the capability to data share across their different systems. Again, not an easy road, even for IT experts. What typically occurs is that systems don’t sync, and implementations that don’t launch on time. 

Access to Data Shouldn’t Be a Roadblock 

The third concern that you may be dealing with in healthcare data management is accessibility. Can you access your data when and how you need it? While you may have no issues with reviewing and analyzing data in your current EHR or pharmacy system, what about legacy records? 

Often, organizations will keep a legacy system running to store their old records. Storage is necessary to comply with medical record retention requirements, but using an old system is not the best user experience. It’s hard to find what you need, and you’re paying every month to retain access. 

The easiest answer to universal, compliant, and easy accessibility is data archiving. Choosing a web-based system that allows you to store documents, data, and images ensures regulatory adherence while boosting ease of use and reducing costs. 

Healthcare Data Management Made Easy with InfoWerks

Our goal is to promote interoperability, portability, and accessibility for every area of the healthcare ecosystem. Our experience and healthcare-centric approach to data management have made us the choice for thousands of organizations. Get in touch today to see how we can help.

Will the New Information Blocking Rule Really Improve Healthcare Data Sharing?

information blocking rule

In March, HHS published the ONC’s new interoperability and information blocking rule. These new rules are meant to help implement certain provisions of the 21st Century Cures Act. The objective is to improve patient access to their healthcare data and prohibit information blocking among providers, payers, and other stakeholders. Looking at the components of the information blocking rule, many are asking if it will really impact healthcare data sharing?

What Does the Information Blocking Rule Define and Clarify?

Even though interoperability and data sharing have been essential in healthcare for some time, it’s never been an easy road. Healthcare data is complex and requires privacy and security provisions. Payers and health systems have been guilty of “information blocking,” restricting what they share and with whom. 

The rule seeks to eliminate some aspects of blocking and hold accountable IT developers and EHR vendors as a condition of certification. The Final Rule on information blocking seeks to support Section 4004 of the Cures Act. This section created new federal penalties to deter against information blocking. 

The new rule clarifies the definition of information blocking as “the intentional withholding of patient health information either from provider to provider or provider to patient.” It also establishes who is subject to this rule. It also finalizes any exceptions to information blocking with eight categories that involve preventing patient harm, security concerns, infeasibility, and reasonability. 

This part of the rule was to go into effect on June 30, 2020. But due to COVID-19, it’s not effective until November 2, 2020. 

Who Is Impacted by Information Blocking?

The rule includes EHR developers, health information exchanges and networks, and providers. Providers are described as “covered actors.” EHR vendors now face new certification rules for compliance. 

Providers would be subject to sanction if they knowingly engage in information blocking that interferes or prevents data access. The term healthcare provider is very broad and includes hospitals, surgical centers, labs, pharmacies, long-term care facilities, and individual practitioners.

What Is the Enforcement?

If a provider is accused of information blocking, the OIG will investigate such complaints. Should a violation occur, the provider would not be subject to the $1 million per violation, as noted in Section 4004. Congress has directed the OIG to refer violations to the appropriate agency to be subject to appropriate disincentives using authorities under applicable Federal law, as the Secretary sets forth through notice and comment rulemaking.”

However, HHS has not identified which agencies should be involved or what the disincentive is. Thus, enforcement and penalties are still up in the air. The OCR, which enforces HIPAA, could be a probable agency. CMS could also act as an enforcer and has already stated it will begin to publish providers that do not list or update contact information, per the interoperability and information blocking rule. 

Will the Rule Improve Data Sharing?

information blocking

Interoperability has been hard to achieve because platforms like EHRs do not allow for outside accessibility, per their design. This practice protects businesses but harms patient care and public health in general. 

So now, it’s like completely changing a business model. On top of this transformation, the ONC has defined a framework on how EHR vendors can reach the new certification requirements but not how to do it. There is much dysfunction in the world of healthcare data, and EHR vendors and others have voiced concerns about privacy issues that go along with enforcing these rules.

The rules are not perfect by any means. The objective behind them is clear—accessibility and portability—that can then improve care models and possibly reduce healthcare costs. For example, if a patient’s records were accessible across the board, then it could minimize lab tests or imaging being duplicated. Without specific standards in place for data sharing, the effort and investment may not be feasible. 

Is the Rule and Empty Promise?

Because there are so many unknowns regarding how to do it and how to enforce it, it may seem like an empty promise right now. Paradigm shifts involve much change, and that won’t happen rapidly. On top of this, add the COVID-19 pandemic, which has its own data sharing woes

For this to work and equally benefit providers, payers, patients, and software vendors, data sharing must be consistent and structured. No matter what role you play in the information blocking rule, it’s likely you need a partner that deeply understands how to convert and migrate PHI between applications. That’s exactly what we know how to do. Find out more about how we can be your data liaison.