On The Road To Connected Care: The Promise Of Interoperability
By Rakesh Mathew, program manager, HealthShare Exchange of Southeastern Pennsylvania
Consider this scenario: Felecia Martin described the moment she learned she was pregnant as the happiest of her life. But soon after the 33-year-old gave birth, a routine postpartum exam revealed a suspicious lump in her breast that turned out to be an aggressive form of breast cancer.
What followed was a whirlwind of visits to numerous providers — obstetricians, surgeons, radiologists, and oncologists. This left her confused about her treatment options and frustrated about having to share the same information repeatedly with different providers who didn’t have a way to communicate effectively, nor easy access to Felecia’s complete medical record. She was exhausted, stressed out, and worried.
Then, soon after her diagnosis, a fall sent her to the emergency room of a major university medical center with an injury to her wrist. Because the hospital she went to did not have access to her full medical records, the ER doctor was unaware of Felecia’s very recent cancer diagnosis — and so was unable to ask her whether she had arranged cancer care yet. He treated her wrist and sent her home.
Felecia chose her local hospital for care, undergoing conventional treatment for her triple-negative breast cancer, but without adequate access or referral to clinical trials of advanced treatments for her particular type of tumor. Traditional surgery and chemotherapy ultimately failed and Felecia succumbed to cancer, leaving behind her infant daughter.
A Model For Connected Care
Although we live in a hyper-connected world, Felecia’s hypothetical story remains all too common in healthcare. The issue generally isn’t one of the competency of care. Rather, it’s the fragmented, disconnected, siloed nature of patient/provider encounters. The worry, stress, and frustration Felecia experienced during her care journey — and ultimately her failure to obtain the most advanced or optimal available treatment for her particular disease — illustrate the need to achieve true interoperability that supports integrated data and seamless coordination across multiple health systems and providers.
The good news: the ongoing shift to value-based care has accelerated the technological transformation needed to drive quality-focused, patient-centered care emphasizing, among other things, the role of health information technology and clinical data interoperability. With the help of technology partners, organizations such as HealthShare Exchange (HSX) are leading this transformation.
In less than four years of operation, HSX has made significant strides connecting most of approximately 15,000 providers and 50-some hospitals, health systems, and insurers in the Delaware Valley region. Healthshare Exchange has done it by moving beyond the previous model in which health information sharing occurred primarily within individual hospital health systems and failed to take advantage of data from healthcare plans.
Until the recent past, patient clinical records have resided in multiple, separate systems with challenging access that requires physicians to add extra, time-consuming steps to their workflows in order to locate, and retrieve the intersystem data they need to make informed care decisions. Often, this involves outdated technology such as faxing. Further steps are then required to upload the patient’s shared medical records, once the encounter is complete.
HSX instead uses a technology stack powered by NextGen Healthcare’s Mirth Connect that houses a central electronic data repository (CDR) containing patient medical history information from multiple entities. It does so within an environment that supports a variety of interfaces, such as EHRs and secure messaging, as well as services that retrieve claims-based data from insurers — all of which will contribute to personalized/precision medicine matching and connected health for consumer education and coaching.
This operational infrastructure enables real-time integration of patient data across separate — even competing — health systems and practices, with data feedback to and from the payer as well. In addition, data is available within a provider’s existing, daily, hour-to-hour workflow. This means at the point of care the provider can instantly pull the patient’s record from the CDR. When the encounter is complete, the patient’s records update automatically.
The Human Story Of Interoperability
While sharing our fictitious patient Felecia’s story during the HIMSS17 Interoperability Showcase in Orlando earlier this year, we conducted a “time travel” experiment to see what this young woman’s story might look like in 2020, a time when HSX envisions a fully interoperable, connected care environment across the healthcare ecosystem.
During her routine postpartum exam, Felecia’s doctor discovers a suspicious lump in her breast. When a diagnosis of breast cancer is confirmed, her medical record is instantly updated with all clinical data and test results. At every office visit afterward, the multiple providers she consults about treatment options already have access to her updated medical records, including clinical history and test results. Felecia is confident doctors have the information they need. Furthermore, her office visits trigger notifications and reminders from providers and payers on her connected health app that keep her informed and engaged. Her stress level is reduced and her care experience greatly improves.
During the emergency room visit for her fall, her doctor accesses her clinical history and notes her recent cancer diagnosis; as a result, he suggests a consultation with a leader in precision-medicine-centered oncology. Based on the results of genetic testing and molecular analysis of her cancer, the specialist recommends a new immunotherapy drug as a more effective treatment option than traditional chemotherapy.
Not only does Felecia’s wrist heal, but her cancer goes away. Thanks to the connected nature of her care journey, her cancer is in complete remission and she is a healthy, happy mother of a young child.
Felecia’s story is a reminder that even though interoperability is technically about system interactions, it’s really all about human interactions. As health IT professionals, our focus shouldn’t just be on interoperability itself, but on its promise: dramatic improvement in the quality of the patient experience and more informed, efficient care decisions that lead to better, healthier outcomes.
About The Author
Rakesh Mathew is a program manager for HealthShare Exchange of Southeastern Pennsylvania. At HealthShare Exchange, Rakesh oversees the technical implementation staff, serving as the Philadelphia-regional health information exchange’s interoperability expert. Rakesh has an undergraduate degree in Electrical and Electronics Engineering from Anna University, India; an MBA degree in Management of Technology from the New Jersey Institute of Technology, and an MS degree in Environmental Engineering from NJIT. You can follow him on Twitter at @rakesh_hsxsepa.