Improving the interoperability of health information technology is one of the biggest, overarching goals in health care today. Significant barriers and challenges remain for system-wide interoperability. However, progress is emerging across partners where there is a clear business value and practical view toward innovation. Here are some interoperability trends that demonstrate that data exchange happens when there is clear operational value to organizations.
1. FHIR. The Fast Healthcare Interoperability Resource seems to be everywhere these days. FHIR will be finalized as a standard by HL7 toward the end of this year. Widely deployed in draft standard format across electronic health records, vendors and providers, FHIR provides normalized data formats and elements and application programming interface(s) for exchanging data with EHRs. FHIR differs from previous standards because it uses existing, common, modern, web-based suites of API technology.
FHIR enables stakeholders to share data from different sources in a single, consistent format. With this flexibility, users can more easily and quickly exchange clinical data from different providers and sites of care. Work to date has primarily focused on provider-to-consumer or provider-to-provider data exchange but is positioned to expand to include other types of data exchange. As providers continue to merge into integrated delivery networks, for example, it will be imperative for them to seamlessly exchange patient data among disparate sites of care and with such other partners as health plans and pharmacy benefit managers. The ability to combine and exchange patient-specific benefit details and requirements with clinical data will be needed to fuel the transition to value-based reimbursement. In this environment, payers and providers must have benefit details and clinical data to impact patient outcomes and measure performance, ultimately to determine shared savings.
2. The Da Vinci Project. Da Vinci is driving a multistakeholder initiative to promote and accelerate use of FHIR for the specific data exchange needed for value-based care delivery. Project participants believe FHIR is well positioned to bridge interoperability gaps across the many disparate systems used today to exchange clinical and administrative data between payers and providers and providers and providers. The Da Vinci founders include a diverse body of stakeholders across a mix of payers, providers and vendors, with experience across the specific value-based care business challenges, emerging FHIR use cases and agile solutions development.
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Implementation guides for two initial FHIR use cases — 30-day medication reconciliation and coverage requirements discovery — were recently balloted at HL7. Both guides and reference implementation materials are available on confluence.hl7.org. More information about Da Vinci is available here.
3. Taking an axe to the fax. Eliminating fax transactions has become the latest call to arms, spurred by the Centers for Medicare and Medicaid Services. Seema Verma, who heads the agency, got everyone’s attention when she challenged developers to “help us make every doctor’s office in America a fax-free zone by 2020.” Despite everyone’s best efforts, faxes still are still widely used in most physician practices — especially for dealing with prior authorizations. Although no details were announced, CMS is sure to leverage its position as the largest payer to exert influence. Medicare is often a driver for change, with commercial payers following suit. This should help hasten the adoption of electronic prior authorization and computerization of specialty medication prescriptions.
4. Improving patients’ access to their data. Promoting consumer involvement in their care remains a key (and elusive) health goal. It is contingent, to a large extent, on giving patients access to their data in order to make informed decisions and share information with caregivers. This was nearly impossible in the world of paper medical records, but significant progress has been made to give patients immediate, digital access to their records. Two examples stand out.
- One personal health record initiative that is receiving positive feedback is CMS’ Bluebutton 2.0. This API enables Medicare beneficiaries to download their claims data. According to CMS, what’s needed next are consumer-friendly ways for beneficiaries to share their data with select providers and researchers. CMS is seeking developers, and 600 or so have already expressed interest.
The first BlueButton was highly touted but did not gain much traction. The outlook may be better for version 2.0: technology has improved, and the vast majority of beneficiaries now have smart phones and/or access the Internet. On the other hand, you can lead Medicare beneficiaries to an application but you can’t necessarily make them use it. First, they must understand the information they are given. Let’s face it — understanding claims data can be challenging for those of us in the health care business, much less for the layperson. Apps are needed to translate Medicare claims data into meaningful information that beneficiaries can understand and act upon. In addition, beneficiaries still must be educated about the availability of BlueButton 2.0 and how to use it. As research from McKinsey pointed out, awareness increases the use of technology-enabled consumer health care tools.
On the private side, Apple shot out of the gate with its Health Record. This uses FHIR to aggregate patient records from EHRs into an iPhone app. It’s too soon to tell how this is working out. Apple Health may have to overcome the same health literacy barrier as BlueButton 2.0 to be successful. Not everyone can afford a pricey new iPhone, and many consumers may not want to have their personal health information in the hands of their favorite mobile software vendor.
On the other hand, Apple’s new app could be a game changer on the technical side. The app is touted to be adept at reconciling the disparate code sets and uncodified data among the hundreds of different EHRs available in the market. This issue has plagued the industry for a long time; if Apple has truly solved the problem, it could eliminate a huge interoperability barrier. The app has innovatively addressed another long-standing problem: patient identification. Patients assume responsibility for curating their own data in the app by identifying themselves through the EHR patient portal’s logon. Thus, a separate patient identifier is not needed.
Patients traditionally have not been motivated to access provider portals, so usage is low where functionality is low. It remains to be seen whether the Apple Health Record can overcome this potential adoption barrier.
5. Big business is weighing in. Major corporations are taking more than a little interest in interoperability. Apple is the poster child, having filed over 50 patents that will enable the iPhone to be used as a medical device to track patient health. Other technology giants are jumping on the interoperability bandwagon. Amazon, Google, Microsoft, IBM, Salesforce and Oracle recently pledged to remove the barriers of interoperability using open standards, cloud computing, APIs and artificial intelligence. There is some skepticism about whether all this big-time corporate muscle can make things happen. After all, Microsoft and Google have been down this road before with little success but it could be a different ballgame today. Technology has advanced, and demand is driving adoption. Plus, these corporate giants need to address interoperability to help make good on their significant and growing investments in digital and mobile health.
6. Mandatory PDMP use. The states and federal government are actively seeking ways of addressing the opioid epidemic. One is the mandatory consultation by providers of prescription drug monitoring programs, which are statewide databases of controlled substance prescriptions. The trend for requiring prescribers to review the PDMP before “writing” electronic prescriptions for controlled substances began in 2012. It started off slowly and has been picking up speed in the past year. So far, prescribers are mandated — or soon will be required — to query the PDMP for at least some Schedule II drugs in 41 states. However, details vary greatly, including differences in current and future effective dates as well as the Schedule II drugs that are covered by the legislation. This creates challenges for EHR developers. An additional challenge has been the need for interoperability of PDMPs among the states. This gradually is being resolved as industry develops standards and infrastructure. What’s needed next are ways to provide actionable data and integrate them within clinician work flows.
While other industry efforts to advance interoperability exist and have value, these six are worth watching in 2019.
Date: November 7, 2018