To put it politely, there are still many opportunities for all healthcare players to more fully exchange information. In 2016, some of the largest healthcare systems and a variety of health IT companies agreed to sign the interoperability pledge. The pledge is one part of “A Way to Connect Health and Care for the Nation,” according to the Office of the National Coordinator for Health IT.
Six months after the pledge was unveiled, the companies that provide 90 percent of electronic health records used by hospitals nationwide as well as the top five largest healthcare systems in the country agreed to implement these three core commitments:
Patient access: To help patients easily and securely access their electronic health information, send it to any desired location, learn how their information can be shared and used, and be assured that this information will be effectively and safely used to benefit their health and that of their community.
Transparency: To help providers share individuals’ health information for care with other providers and their patients whenever permitted by law, and not block electronic health information (defined as knowingly and unreasonably interfering with information sharing).
Standards: To implement federally recognized, national interoperability standards, policies, guidance, and practices for electronic health information, and adopt best practices including those related to privacy and security.
There are some workable interoperability initiatives emerging, but the Devil is in the details, and there are a lot of details. It will likely take more than one “killer app” to break the technology logjam that’s dogging data-driven, value-based care.
Moving to FHIR
One element of CMS’ EHR incentive program is spurring interest and development in HL7 technology known as Fast Healthcare Interoperability Resources (FHIR) and other application programming interfaces (APIs). According to CMS, requiring certified EHR software to support these APIs enables the development of “bridges” across systems for increased data access.
FHIR development is not confined to new patient data access options; it’s also being used for applications that enhance clinician workflow and decision support. These developments are good news because federal data shows that 75 percent of office-based physicians use certified EHR technology, but provider dissatisfaction with EHRs is common, with several factors (including siloed information) driving that vexation.
The true cost of care coordination
Another dissatisfaction driver is cost. The price tag for EHR systems exceeds buyers’ spending expectations by 37 percent, according to a report from software research firm Capterra. The final yearly tab for EHR software averages nearly $118,000, about $32,000 more than anticipated, reported 400 physicians, nurses, and administrators surveyed for the report.
Even offices that spend less on their EHRs are struggling with the burden of implementing care coordination strategies that further stretch their finances, increase their workload, and possibly impede their ability to care for patients. They report that care coordination is a major difficulty because of interoperability issues.
EHR interoperability is still elusive for many healthcare providers as they revamp their systems or replace them with systems that can merge clinical documentation with revenue cycle management. Last year, Black Book Rankings surveys showed that providers aiming to maximize meaningful use, tackle population health management, and shift opportunities for value-based reimbursement are seeking integrated, interoperable clinical and practice management technologies.
Whether systems are cloud- or server-based, integration across the organization is crucial for improving revenue cycle management. Another recent survey showed 86 percent of smaller healthcare providers aim to transition to a single, integrated practice management and EHR suite by 2017. Ninety-two percent of providers surveyed are considering practice management and revenue cycle management systems that are deeply integrated with the clinical EHR.
Big data, still a hot topic in healthcare, also depends on interoperable systems. Access to big data could be vital for small and midsized practices that are part of an accountable care organization or a patient-centered medical home.
Small practices can benefit from access to the information that’s accruing exponentially, but only if their systems can speak the same language and share data. The pledge might keep this concept top of mind for vendors as they work to develop the capabilities that will be demanded of their software in the near future.
