Advancing Interoperability: The Need For Collaboration, Partnership, And Commitment

By Bruno Nardone and Muhammad Chebli, NextGen Healthcare

The past 10 years has seen a rapid evolution of healthcare information technology. In 2007, only a small fraction of hospitals and physician practices used EHRs; now they’re almost ubiquitous, used by more than 87 percent of doctors and more than 94 percent of hospitals. Although the capture of digital information in EHRs is nearly ubiquitous, there are still opportunities to improve health information sharing capabilities as organizations strive to advance population health and further participate in value-based care.

Initial Stages Of Interoperability

Federal government incentives like Meaningful Use — which now make up part of the Merit-based Incentive Payment System (MIPS) — have positively impacted EHRs by pushing them past point-of-care documentation and toward cross-continuum communication. With overall increases in EHR functionality have come many solutions for data sharing. Now, we’re in an era calling for information exchange technology that moves past merely meeting regulatory requirements and certifications. We need interoperable data that embodies the spirit of standards intended to facilitate straightforward, open information exchange.

Elevating Data To The Next Level

So what are the next steps for interoperability? To accelerate value-based care, organizations must be able to more easily and immediately share and interpret patient data across disparate care settings. Not only will this improve individual patient treatment, it will help organizations make greater strides in population health management by obtaining wider collection of health data.

For example, no matter the size of a practice, the likelihood is very high that information from an external data source will become critical to successful management of patients under value-based contracts. Being able to easily integrate key data sources can be the difference between achieving goals, economically or not.

Current Challenges And Opportunities

For interoperability to reach its full potential and support better clinical and financial decision-making, practice leaders should be actively looking for new interoperability features from their vendors.

One example, FHIR — Fast Health Interoperability Resources — is a standard showing early promise for breaking down connectivity barriers by providing greater clarity on interface standards between healthcare applications. When evaluating current or potential future HIT investments, practice leaders should inquire about vendors’ FHIR capabilities and future plans as a good indicator of their commitment to solutions that foster connected health.

While FHIR defines one specific approach to system integration, in general Application Programming Interfaces (APIs) should be a clear part of vendors’ solutions approach to facilitating interoperability. Practice leaders should look for a strong API strategy from their technology partners and examples of those interfaces being used in production. To cut through the hype, vendors should be able to go beyond what’s planned and share referenceable work.

Additionally, the 21^st Century Cures Act, signed into law in December of 2016, sets new guidelines for defining appropriate solutions thus assessing interoperability offerings against filter criteria for compliance. Under the law interoperability offerings must at a minimum be able to address:

1. Secure transfer. The technology allows the secure transfer of all electronically accessible health information to and from any and all health information technology, for authorized use under applicable State or Federal law.
2. Complete access to health information. The technology allows for complete access, exchange and use of all electronically accessible health information for authorized use under applicable State or Federal law — without special effort by the requestor of such health information.
3. No information blocking. The technology is not configured, set up or implemented to information block, as defined in section 3010A(d) of the law.

By better understanding the technical issues and goals surrounding interoperability, providers can start to work in partnership with their vendors to break down the barriers to information exchange — and to promote value-based care in the process.

The Role Of Physician Practice Leaders

While vendors work to facilitate greater interoperability, physician practice leaders should serve as champions for more comprehensive data exchange — for both themselves and their patients. What does that role entail? Here are few key steps for providers to consider:

• Articulate your goals. The entire industry has its eyes set on delivering higher quality care at a lower cost. As a first step toward value-based care, practices should document their clinical and financial goals, then consider what resources will be necessary to achieve desired success. This process should also include a review of how workflows will change, as well as the infrastructure and interoperability required to support the new processes.
• Determine what data you need and where the gaps are. Once goals are identified, it’s time to start thinking about how to achieve them. What data is needed? What information is already being collected and what’s missing? Are insights from the data actionable? What technology components would make them actionable? By performing a gap analysis that compares current capabilities with required elements, practices can develop a roadmap that follows manageable steps for getting from point A to point B.
• Look for a partner. Although identifying data needs may seem conceptually straightforward, the task can become overwhelming. To extract the most insights from targeted data, organizations should consider reaching out to technology partners like NextGen Healthcare to discuss value-based goals, requirements and challenges. Not only can vendors support robust gap analyses, they can also help integrate better approaches to inserting data directly into practice workflows. In some cases, solutions may not be immediately accessible because technology has not advanced as far as desired. In these situations, practices should maintain an active dialog with vendors to keep aligned on goals and explore how products can best support them.
• Embrace innovation. Organizations must also adopt a culture that is friendly to fast-changing technologies. Hesitating to evaluate unfolding technology options can hinder a practice’s efficiency and ability to meet evolving market demands. While it’s appropriate to assess the ROI of any innovation, don’t forget to consider the complementary capabilities that may arise from the adoption of new technologies. That may include, for example, shifting applications to the cloud. Cloud-based applications can bring the promise of more real-time interoperability at lower price points. They may also offer unexpected value from efficient scale, access to subject matter experts, and easier inclusion of capabilities when a practice is ready for them.
• Adopt early. Larger organizations have an opportunity to shape the interoperability for their entire community. When anchor organizations adopt and implement interoperability solutions, it can drive critical exchange partners in their community to get on board. For those organizations that haven’t yet committed to participation in a national exchange network, there is still plenty of time for participation. Organizations should take a look at the good work happening in both Carequality and the CommonWell Health Alliance.

Now Is The Time

The shift to value-based care is building momentum, and interoperability is a critical component of getting there. Access to comprehensive health data is not about just purchasing technology and considering it done; it’s about leveraging the insights gleaned from those tools to enhance patient care. Forward-thinking physician practices and vendors understand the current technology challenges, but are working together to define value-based care goals and enable the interoperability needed to accomplish them.

About The Authors

Bruno Nardone is the senior vice president of population health solutions for NextGen Healthcare. Muhammad Chebli is the senior interoperability product manager for NextGen Healthcare. Follow him on Twitter at @muhammadc.