Interoperability: Challenges & Solutions

 Saba Khan

                                      

In the context of modern healthcare, what is interoperability and why is it important?

In today’s modern era, use of information technology has become the back bone of health care. Health Information Exchange (HIE) makes it possible for the health care providers to access and share the electronic medical record of a patient securely which enables them to avoid errors and duplicate testing, along with improving the diagnosis (US Department of Health and Human Services, 2014). All of that is not possible without interoperability, which connects the various stake holders in providing health care.

In health care, interoperability is defined as, “The ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged” (HIMSS, 2010). The three levels of health information technology interoperability are as follows (NCVHS, 2000):-

i.        ‘Foundational interoperability’, means that the data from one IT system is exchanged to another, without the ability/necessity of the other IT system for data interpretation.

ii.      ‘Structural interoperability’, defines the format of data exchange to ensure that the data exchanged between two IT systems is unaltered and can be interpreted.

iii.    ‘Semantic interoperability’, makes it possible for the exchanged data from one or more sources to be interpreted and used accordingly.

Similarly, health information can be exchanged in three forms i.e. direct exchange, query based exchange and consumer medicated exchange (US Department of Health and Human Services, 2014). Direct exchange of health information occur when the information regarding a patient is sent for specialist advice or sending data to public health organizations for quality check (US Department of Health and Human Services, 2014)

Query based exchange of information helps service providers to gain information regarding the past history of a patient, which in turn helps them to plan further management of the patient by avoiding repetition of investigations and treatment errors (US Department of Health and Human Services, 2014). Similarly consumer mediated exchange of health information enables patients to have access to their own health records, which empowers them to manage their own health by correcting any errors or billing information and health monitoring (Williams et al, 2012)

Interoperability in modern health care, not only saves time and money (HIMSS, 2009), but also ensures secure and reliable exchange of information, which in turn benefits the patients and helps the service providers to function effectively.

 

What are the key challenges to achieving system interoperability?

According to Patricia B. Wise, vice president of the Healthcare Information and Management Systems Society (HIMSS) the “biggest barrier” encountered by the modern health systems is the lack of semantic interoperability (Marboury, 2016), due to the socioeconomic, cultural and policy barriers encountered in data sharing (Shah, 2016).

The Office of the National Coordinator of Health IT (ONC), reports that an in-office EHR system costs $33,000 and a software as a service (SaaS) system costs $26,000, with an annual maintenance costs up to $4,000 for in-office systems, and $8,000 for SaaS, which is not cost effective, making interoperability systems unaffordable (Marboury, 2016).

Electronic Health Record (EHR) can be compared to a bank account, which can be accessed from anywhere via a paycheque or an ATM, but unfortunately that is not the case with a patient’s health record (Shah, 2016). According to National Transition of Care Coalition, 2008, 60% of errors in medication take place during transition caused by interruption in communication, which may result in patients’ re-hospitalization (Shah, 2016). The reason is the variety of EHRs and EHR interfaces which do not interrelate, resulting in interoperability failure (Marboury, 2016).

Interoperability is not only about Health Information Exchanges (HIEs) and Electronic Records (ERs), but it is evolving around health care plans addressing practical needs of the patients, which is evident from the increasing gap between the public and the private HIEs e.g. the Black Book Research in April 2016 which included 2300 payers, reported that, 90% of the payers were abandoning public HIEs to work with regions/states via private HIEs to get more patient oriented services (Marboury, 2016). The differences between the public and private EHR interfaces and policies become a challenge for interoperability.

According to Savage, Chief privacy officer, Office of the National Coordinator (ONC) for Health IT and Brookes, ONC privacy analyst, Health Insurance Portability and Accountability Act (HIPAA) to safe guard the privacy of a patient, is not a challenge for interoperability (Snell, 2017). The 2015 Nationwide roadmap highlighted that interoperability may compromise the providers’ monetary benefits from their sole access to the patient’s health records; hence they are reluctant to share data (Shah, 2016). On the contrary patients assume that their information is shared amongst healthcare providers (Snell, 2017).

The president of EHR Workflow, Inc., Charles Webster, who is also a medical informatics marketing/work flow technology expert, says that the staff involved in the data exchange process is equally important and organizations/platforms interconnected with each other must make sure that along with the availability of data, the staff is trained and the workflow is smooth, for interoperability to function (Marboury, 2016).

 

What are the key features of the solutions to overcome the challenges?

The goals of ‘interoperability road map’ released in 2015 by the Department of Health and Human Services (HHS) Office of the National Coordinator for Health IT (ONC), include improvement in data sharing, inclusion of new sources of data and a learning health system that focuses on patients (Snell, 2015). It also highlighted that the challenges to interoperability can be overcome by improving consumer access, encouraging health information exchange and following recognized IT standards (Marboury, 2016).

The health systems lack the interfaces which can interact with the growing number of data sources, says Leroy Jones, CEO of GSI Health, a cloud-based healthcare software company (Marboury, 2016). Consumer access can be improved by developing a single platform for patients, payers and providers to get all the information which is stored in various databases e.g. Episode Connect developed by Remedy partners, has integrated various EHRs, where consumers can manage their payment programs and monitor their health progress (Shah, 2016).

Universal IT standards should be followed by all the providers in public and private sector, for various electronic health systems to become interoperable (Marboury, 2016) e.g. the United States Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) 2015, will combine Medicare EHR Incentive Program, Physician Quality Reporting System (PQRS) and the Value Modifier into one Merit-Based Incentive Payment System (MIPS) (MIPS & APM, 2015). This integration of various programs will ensure smooth health information exchange by giving incentives to the providers (MIPS & APM, 2015).

The purpose of interoperability is to provide effective healthcare, by gathering all the stakeholders under one umbrella. The main challenge for interoperability is problems with data sharing that can be solved by introducing policies which ensure data privacy and access.

 References

 Fig.  Interoperability and its stake holders in modern health care (Source: US Department of Health and Information Services, 2014)

Healthcare Information & Management Systems Society (HIMSS) (2010). Dictionary of Healthcare Information Technology Terms, Acronyms and Organizations, 2nd Edition, 2010, Appendix B, p190, original source: Wikipedia. Available online at: http://www.himss.org/library/interoperability-standards/what-is-interoperability . Accessed on [29/09/2017]

Healthcare Information and Management Systems Society (HIMSS) (2009). ‘Evaluating  a Potential HIE Oppurtunity’. HIMSS Guide to Participating in HIE. 2009 November. Available online at:  http://www.himss.org/file/1305286/download?token=5WnvInuM . Accessed on [29/09/2017]

Institute of Electrical and Electronics Engineers (1990). IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries. New York, NY: 1990. 

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National Committee on Vital and Health Statistics (NCVHS) (2000). Report on Uniform Data Standards for Patient Medical Record Information, July 6, 2000, pp. 21-22. 

National Transitions of Care Coalition (2008). Improving Transitions of Care: The Vision of the National Transitions of Care Coalition. May 2008. Available online at: http://www.ntocc.org/Portals/0/PolicyPaper.pdf  Accessed on [30/09/2016]

Shah, S (2016). The Challenge of Interoperability. Available online at: http://www.modernhealthcare.com/article/20160713/SPONSORED/160719952. Accessed on [29/09/2017]

Snell, E (2017). ‘Data Security Considerations in Healthcare Interoperability’. Health IT Securit, Features. Available online at:https://healthitsecurity.com/features/data-security-considerations-in-healthcare-interoperability. Accessed on [05/11/2017]

Snell, E (2015). ‘Final ONC Roadmap Highlights Health Data Privacy, Security’. Health IT Security, Cybersecurity news. Available online at:https://healthitsecurity.com/news/final-onc-roadmap-highlights-health-data-privacy-security . Accessed on [05/11/2017]

The Merit-Based Incentive Payment System (MIPS) & Alternative payment Models (APM) (2015). Available online at: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html . Accessed on [30/09/2017]

US Department of Health and Human Services (2014). What is HIE? Available online from:  https://www.healthit.gov/providers-professionals/health-information-exchange/what-hie . Accessed [29/09/2017]

Williams, C, Mostashari, F, Mertz, K, Hogin, E, & Atwal, P (2012). ‘From The Office Of The National Coordinator: The Strategy For Advancing The Exchange Of Health Information’. Health Affairs, 31, no.3 (2012):527-536.