This article by Ambra Health CEO, Morris Panner, originally appeared in Forbes on April 22, 2019.
Many patients receive care from a village of health care providers — who might know nothing about what the other villagers are doing. Digital data silos keep providers in the dark, hindering their ability to dispense the care that is called for by new business models that value quality over quantity. They also stymie patients’ efforts to manage their own health care. It’s no wonder the government, the technology industry, and the health care sector have been trying to improve interoperability — the ability to seamlessly exchange and use electronic information across systems, vendor platforms, medical devices, apps, and other technologies.
“The current lack of interoperability can compromise patient safety, undermine care quality and outcomes, contribute to clinician fatigue and waste billions of dollars a year,” said Milton Johnson, formerly of HCA. For instance, if the cardiologist cannot see the records from the patient’s primary-care visit, she might order the same kidney function tests the patient underwent last week, subjecting him to unnecessary testing.
A Way To Go
A 2018 survey of hospitals about their use of information technology showed room for improvement. Only 59% of hospitals reported sometimes or often using electronic information when treating patients. Just 41% said they could send, receive, find and integrate digital health information from outside sources into their own information systems.
Hospitals that seldom or never used information from outside providers cited roadblocks to doing so. About half said the information was not always available when needed. Nearly a third blamed its format, and 55% found it hard to incorporate into their own electronic health records (EHRs). When trying to send or receive information, they faced problems such as inadequate technology on either end of the exchange, different vendor platforms, trouble matching patients across systems, difficulty finding providers’ addresses and the cost.
“Health information networks and their participants often treat individuals’ electronic health information as an asset that can be restricted to obtain or maintain competitive advantage,” said a report to Congress, from the Office of the National Coordinator for Health Information Technology (ONC), last year. Yet, the situation may be improving. The survey found that interoperability increased from 2014 to 2017.
Seeing The Full Clinical Picture
Evidence that interoperability enhances clinical outcomes hails from the world of maternity care. Labor and delivery centers were having trouble planning their staffing because they had no way to predict when patients would show up or what services they might need. Furthermore, obstetricians who treated mothers after childbirth lacked records on complications that arose during labor and delivery.
To address these problems, a hospital and its community partners developed a system that enabled maternity-care providers to routinely share and integrate specific kinds of information in near-real time. The initiative curbed trips to the emergency department after childbirth and cut costs for medications used to treat complications. Information from the obstetrics clinics enabled labor and delivery centers to anticipate patients’ needs and manage staffing plans accordingly.
Preventing Medical Mistakes
“When medical devices don’t talk, patients lose,” wrote physicians Michael Johns and William Stead for the Center for Medical Interoperability. A 2015 nurses survey, commissioned by the Gary and Mary West Health Institute, supports that claim. Half the responding nurses said that a lack of device interoperability had contributed to a medical mistake they had seen. When devices cannot exchange data, nurses must manually enter it — a situation ripe for transposing numbers or making some other mistake.
Connecting medical devices will boost patient safety across the care continuum — from hospitals to patients’ homes, says a white paper from the Medical Device Plug-and-Play Interoperability Program. Ideally, devices should work with a computer system, other devices, and other technologies as soon as they are connected, without special effort from their users.
Aiding Public Health Efforts
The benefits of interoperability may go beyond sterile medical spaces to the public health arena. It could even ease the opioid crisis. A network of state prescription databases that tracks the use of controlled substances helps doctors and pharmacists know when their patients seek addictive or abused drugs across state lines.
Infectious diseases and environmental health threats cross state lines, too. If states could easily share information about them, they could detect them sooner and respond more strategically.
Curing The Data Deficit
“To achieve nationwide interoperability that truly improves patient care, two things are required: collaboration across the health care industry and the will to take real action,” said Jitin Asnaani of CommonWell Health Alliance (an organization my company participates in) in a press release. In that spirit, CommonWell recently announced a joint effort with Carequality to spur data-sharing. In a nutshell, Carequality provides a framework, including technical standards and rules, which CommonWell implements so that its network members can share data with the Carequality network. The setup works with most of the leading EHR vendors.
Another approach revolves around the patient-centered data home. When, say, an Atlanta resident seeks treatment in Austin, the Strategic Health Information Exchange Collaborative (SHIEC), which my company also participates in, alerts the health-information exchange back home. That gives her usual providers a chance to swap records with the distant health exchange, enabling care coordination across borders. The consortium’s website says it has alerted providers to 3 million treatment episodes.
More changes may be coming. When Congress passed the 21st Century Cures Act in 2016, it included provisions to advance interoperability. Last February, the Centers for Medicare and Medicaid Services, along with the ONC, proposed rules to implement those provisions. They include setting technical standards for information exchange, publicly exposing providers who block information-sharing and improving patients’ access to their records. According to a HIT Infrastructure story, the new rules could mark a turning point for making health care interoperable on a larger scale.