Understanding Business Dynamics Of Interoperability

By Greg Bengel, contributing writer

As EHR adoption rises, providers are beginning to shift their focus from technological concerns to business concerns to ensure the success of interoperability

Health IT Outcomes recently took a look a look at interoperability in the article “Fixing the EHR Interoperability Mess.” We reported that more than 80 percent of eligible hospitals and 50 percent of doctors were poised and ready to leverage EHR systems by the end of 2013. However, “The fact is, EHR adoption will do little good if the systems don’t ultimately share patient data with one another.”

An interoperability blog post on CommonWell Community takes a look at the business model for interoperability in healthcare. According to the blog post, “Much of the recent discussion around making interoperability a widespread success has shifted from technical standards and capabilities to business dynamics.”

In support for this claim the blog post points us to the August HHS report Principles and Strategy for Accelerating Health Information Exchange and Advancing Interoperability, which states that “Both providers and their vendors do not yet have a business imperative to electronically share person-level health information across providers and settings of care that exceeds the cost of doing so.” The post also points us to an eHealth Initiative survey of over 100 established HIEs, in which the HIEs ranked “developing a sustainable business model” and “competitive positioning in the marketplace” as a bigger challenge than “addressing technical barriers.”

So, given the need for a business model for interoperability, the post asks, “How can providers – and EHR suppliers for that matter – embrace the return on investment of data exchange?” One possible approach is taken from the HHS report linked to above: “A natural lifecycle of incentives followed by payment adjustments and conditions of participation in Medicare and Medicaid programs as HIE becomes an established enabler of patient-centered care delivery.” The post quotes the report further, which calls this strategy an evolution from “incentive and reward structures to ultimately considering HIE a standard business practice for providers.”

The blog post also argues that “the business case for incentives and payment based on a level of interoperability is growing.” In particular, it lists factors that lead to what it calls “a growing business case.”

• The U.S. House Energy & Commerce Committee proposal to refurbish fee-for-for-service (FFS) into a payment program scored by means of care coordination
• The fact that consulting firm Sg2 predicts a three percent decline in hospital admissions countered by a 17 percent growth in outpatient services throughout the next five years. And similarly, that the Congressional Budget Office lowered its projections for future Medicare spending.
• A Rand Corp study, which says consumers seeking care at drugstore clinics rose from 1.5 to nearly 6 million visits from 2007 to 2009. “This demonstrates another need for expanded interoperability on multiple levels,” says the post, “as these widespread and accessible clinics seek data exchange within their networks and to the external primary care physicians the store chains point out are still needed by their walk-in customers.”

“With ever-improved data exchange standards and consensus — and ever-increasing incentive programs — providers should come to understand that implementing data exchange offers a defined ROI,” the post reads. “On the health IT side, offering integration over interfaces and exchange points matching data sets with the addition of analysis creates desirable solutions. And I would expect that collaborations such as the CommonWell Health Alliance send providers the message that the greater good of population health and sustainability are in the business plans of the supply side as health IT strives to solve common issues such as patient consent models that can streamline provider exchange. Put simply, sharing is caring!”