[{"innerBlocks":[],"name":"core\/freeform","postId":1398,"blockType":{"name":"core\/freeform","keywords":[],"attributes":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"providesContext":[],"usesContext":[],"selectors":[],"supports":{"className":false,"customClassName":false,"reusable":false},"styles":[],"variations":[],"apiVersion":3,"title":"Classic","description":"Use the classic WordPress editor.","category":"text"},"originalContent":"Now that most providers have implemented an electronic health or medical record system to comply with federal Meaningful Use requirements, the government has turned its attention in healthcare technology to interoperability. In fact, last April, the Centers for Medicare and Medicaid Services renamed the program\u2014it\u2019s now Promoting Interoperability.

It makes sense to shift the attention to data exchange, experts say. \u201cThere\u2019s no need to measure things people are already doing universally,\u201d says David Harlow, a lawyer and consultant who specializes in healthcare business and regulatory issues.

But those experts also say it\u2019s not so universal to actually use the data within EHR and EMR systems\u2014along with other sources such as patient portals, connected devices, sensors and apps\u2014to deliver meaningful and actionable data to improve outcomes across the care continuum and at the point of care for populations of patients. Although there are hurdles to overcome, the industry\u2014driven by new regulations, incentives and the shift to value-based care\u2014is definitely moving in that direction.

The technology is advancing rapidly, so we\u2019ll have the capability to do things in healthcare that we couldn\u2019t do five years ago with our EMRs and our HIEs,\u201d says Brian Ahier, a board member of the not-for-profit Sequoia Project, which works to advance the implementation of secure, interoperable nationwide health information exchange. \u201cI think 2019 is going to be a good year for interoperability.\u201d

In addition to the Promoting Interoperability program, the final rule of the government\u2019s 21st Century Cures Act, a law signed by President Obama and supported by the Trump Administration, was expected to emerge near the start of the New Year. The Cures Act is designed to speed medical advancements, in part by penalizing egregious information blocking, although regulators haven\u2019t established specific penalties for such interference with the free flow of information.

They\u2019re coming, though--along with other government interoperability programs that are on horizon--and the industry must get ready. \u201cAt this stage of the game, we have the tools that allow for widespread availability of information in the data-blocking context, so provider to provider and \u2026 to the patient, it should be universal at this point\u2014but it\u2019s not,\u201d Harlow says.

Incentives needed<\/b>
Another regulation pushing the industry toward interoperability is the Medicare Access and CHIP Reauthorization Act of 2015 [MACRA], which empowered CMS to create alternative payment models, such as accountable care organizations. The shift from fee-for-service to pay-for-quality gives payers and providers a financial incentive to share data.

\u201cThe Obama administration and the Trump administration don\u2019t have a whole lot in common,\u201d Ahier says. \u201cIn policy perspectives there\u2019s a pretty big chasm between them. But not in this regard. They\u2019re all in on value-based care.\u201d

The industry can\u2019t achieve the vision of value-based care without interoperable health IT, Harlow adds. \u201cIt\u2019s just not going to happen.\u201d

While data may flow freely within large organizations, a surge of mergers and acquisitions has left providers with a variety of systems that don\u2019t necessarily talk to each other, creating \u201ca potential interoperability problem that\u2019s going to work against you in terms of value-based care management,\u201d Harlow says. \u201cThe financial relationships in the value-based care models need to accommodate the idea that providers inside and outside those walls may need to work together.\u201d

\u201cBut until those financial incentives are firmly in place, the business disincentives to interoperability and data sharing linger,\u201d says Wen Dombrowski, MD, a physician informaticist and chief convergence officer at Catalaize, a consulting firm that advises healthcare organizations, technology companies and investors on innovation and emerging technologies. \u201cLarge health systems competing for market share in the same region struggle to make a business case for sharing the data they\u2019ve gathered.

\u201cIt\u2019s reasonable to make enough money to keep the doors open, keep all the nurses employed and things like that\u2014I understand the rationale behind it,\u201d Dombrowski says. \u201cBut as long as we\u2019re locked into a profit-driven kind of economic structure, I don\u2019t think interoperability will progress much, regardless of what CMS, ONC and other bodies promote and regardless of all the statements and promises. Fundamentally, if there\u2019s not an overwhelming incentive for healthcare organizations and vendors to be interoperable, then it\u2019s not going to happen.\u201d

And until healthcare does decide it wants to share, \u201cachieving the clinical, research and practical benefits is going to be stunted,\u201d Dombrowski says. \u201cBecause there are already elegant data management tools and AI algorithms developed, a lot of products and solutions are already possible. No one has to invent these per se. But the fact is, if the data is not easily accessible in a fairly real-time manner, then the projects that organizations can do are limited in terms of the promise and magic of predictive analytics and machine learning.\u201d

Value-based care<\/b>
Rob Barras, vice president of health solutions at CTG, an IT advisory and services company, says ideally healthcare organizations would want to share data for altruistic reasons\u2014to improve clinical care\u2014but realistically, the potential of data sharing to optimize value-based care agreements is ultimately what will drive interoperability.

\u201cYou cannot make decisions about a population until you have the data you need,\u201d especially at the point of care, Barras says. \u201cThat\u2019s the real value of integrating all that data in one place: so we can understand the health of the population as opposed to the individual.\u201d

The biggest barrier right now, he adds, is that most organizations are just beginning to understand the requirements of value-based care. And IT leaders, in particular, still need help determining how to use technology to make it happen. \u201cIf IT doesn\u2019t understand it, if the CIO doesn\u2019t understand it, what are the chances the chief nursing officer or the VP of population health understands it?\u201d Barras says. \u201cThere are still a lot of heads in the sand that we\u2019re living in a fee-for-service world.\u201d

Ahier agrees, but says lack of understanding and denial won\u2019t cut it much longer. \u201cProviders stuck in fee-for-service or transitioning into these new payment care delivery models have one foot on the dock and one on the rowboat, and the rowboat is going out to sea. They\u2019re not going to let you get back on the dock,\u201d he says. \u201cThat\u2019s where I see the most complicating factors for the boots-on-the-ground, in-the-trenches folks; the informaticists, the physicians, the nurses, the clinicians of all stripes who are caring for patients in the value-based realm.

\u201cFortunately,\u201d he adds, \u201cthere\u2019s a lot of great technology that can help them do that.\u201d

But the technical issue is currently being solved at the minimal dataset level, according to Harlow. \u201cIt should be solved at a broader level and that should enable value-based care,\u201d he says.

\u201cInteroperability is not an end in itself. It drives better value-based care along a number of dimensions. It\u2019s about provider payments, it\u2019s about outcomes and it\u2019s about care management\u2014the process of care. Along all those different dimensions there should be incentives to provider organizations to up the ante on interoperability.\u201d

Some larger EHR companies, including Epic, are working toward those goals by creating interoperability functions within their own systems. And then there are companies, such as Cerner, that offer care coordination solutions.

But a market is also emerging for purpose-built, vendor-agnostic solutions, mainly from small companies that are focused on care coordination and sharing data across the care continuum, such as CareCentrix And PatientPing.

These companies \u201coffer very important capabilities, which enable the entire healthcare network to stay connected with each other,\u201d says Koustav Chatterjee, a Frost & Sullivan healthcare industry consultant and analyst. \u201cAs patients come in with more complicated conditions, it becomes increasingly difficult for the payer and provider to offer that holistic, evidence-based clinical judgment to that patient at the point of care. And that\u2019s why they don\u2019t have any other option but to reach out to ... specialist healthcare IT vendors who are offering the bandwidth and capabilities so that everyone wins.\u201d

The market, he adds, \u201cis perfectly poised to aid the next revolution of healthcare IT\u201d and the move toward interoperability.

Still, healthcare leaders, especially CFOs, are often hesitant to spend money on additional value-based services. They think the EHR \u201cshould be able to do everything,\u201d including coordinating care and reporting quality metrics, Chatterjee says. But because every payer has a different set of guidelines and protocols, \u201cit\u2019s literally impossible for an EHR to perform all those activities for that complex patient population.\u201d

In some ways, the barriers to interoperability aren\u2019t technical at all. There are plenty of tools and data sources to mine, including sensors, connected medical devices, patient apps and wearables,that are improving care quality right now.

Sensors, in particular, hold tremendous promise for the healthcare industry, which can benefit from auto industry expertise in this area.

\u201cThere\u2019s a lot of applicability in terms of what\u2019s being developed on the technological front with self-driving cars,\u201d Dombrowski says. \u201cIt\u2019s an example of where you\u2019re taking a large amount of data from many sensor sources and AI algorithms analyze it in real time\u2014instantly\u2014and it generates a recommendation or action that has life or death consequences; it has a high level of criticality.\u201d

And in the auto industry\u2014as in the healthcare industry\u2014technology that creates more responsive algorithms is key \u201cso it doesn\u2019t take two minutes to analyze and react to what happened two minutes ago,\u201d she adds.

Other non-technical approaches that can move data-sharing forward include data governance; better trained, more efficient IT departments; and input from patients\u2014an important group that\u2019s sometimes overlooked in the interoperability conversation.

While government incentives and the natural course of technological advances have largely eliminated the paper silo, these efforts have created a digital data silo, says Ahier.

Data governance\u2019s role<\/b>
Data governance is one way to break down the walls.

Getting a handle on data is key to interoperability because the way electronic information is gathered and reported can vary widely. The definition of length of stay at one hospital may be different at another, for example, or the way clinicians record blood pressure readings may differ from site to site. Such variations\u2014and the fact that the industry is unlikely to ever agree on one system or one set of recording methods\u2014are part of the reason many organizations struggle to adopt analytics tools.

\u201cYou\u2019re not going to break down all those silos, so then what?\u201d Barras says. \u201cData governance is the \u2018then what.\u2019 \u201d

With value-based care, organizations often struggle to identify who \u201cowns\u201d the process of gathering and sharing data, Barras explains. Some think it\u2019s the chief medical officer, the vice president of quality or the population health director. But the correct answer is \u201call of the above\u201d and more. \u201cThat\u2019s what a strong governance platform will provide\u2014that clarity that we all own it,\u201d Barras says, noting that the time to put data governance in place \u201cis now.\u201d

Many organizations are spending a lot of money on interoperability systems, data warehousing and data analytics, Dombrowski says. \u201cFrankly speaking, all that cost could have been prevented if there was cleaner, interoperable data upfront.\u201d

IT staff\u2019s role<\/b>
Another challenge is recruiting experienced IT staff who can build upon industry best practices and who are adept at semantic interoperability and data mapping that help achieve higher levels of information exchange, for example.

\u201cA lot of organizations are trying to reinvent the wheel,\u201d Dombrowski says. \u201cThey might have either junior teams or experienced teams, and they are trying to build things from scratch.\u201d

That\u2019s costly and time-consuming, she says.

\u201cIt takes a lot of effort, and if the team is not experienced, software and data exchange systems could be built or set up incorrectly. We see that over and over again, where the technical system \u2026 is a little off.\u201d

For example, errors may be present in the patient portal, even if the information is correct in the medical records. \u201cIf they can\u2019t even get my first name correct, then how do I know these labs are mine? This is such a basic example of interoperability,\u201d she says.

Semantic interoperability, too, is a big challenge in healthcare, where vital stats like blood pressure readings can be reported in different formats not only from one system to another but from one department to another, she adds.

Because information exchange is about more than just moving piles of data from point A to point B, data mapping is a critical IT skill. \u201cIt\u2019s not as simple as just dumping all the data into one database. That data still might not be able to talk to each other,\u201d Dombrowski says.

Providers must have teams in place that not only understand these barriers to interoperability but also have the ability to solve them.

Patient participation<\/b>
Ironically, another ingredient missing from the data-sharing mix is the very reason healthcare needs to do a better job of interoperability: the patient.

Even government regulations have shifted away from broad patient participation, Harlow says, amid complaints from clinicians that patient engagement in healthcare data is out of their control.

\u201cI still hear many stories from people who can\u2019t get access to their records,\u201d he says. \u201cIt\u2019s surprising that it\u2019s still this difficult. The rules are clear, but there are institutional practices in place, and some of them are still at odds with the rules.\u2026The idea that the patient controls the distribution of information seems to be lost on a lot of people.\u201d

HIPAA, he adds, ends up being used as an excuse not to share records.

Dombrowski also advocates for a patient-centric approach.

\u201cA lot of the discussion about interoperability centers around transmission of EHR records,\u201d she says. \u201cA lot of it is about interoperability of the whole EHR or a small subset, such as a discharge summary or problem list. As a clinician, having that basic summary is useful, but it\u2019s not sufficient to capture the whole narrative about a patient and what\u2019s happened over time.\u201d

Especially for patients with complex medical cases, interoperability needs to go \u201cmuch further,\u201d she adds.

Although the concept of patient-generated health data is gaining traction, solutions to harness it don\u2019t always make sense. \u201cMost patient portals are dead ends,\u201d Dombrowski says. \u201cThe information that patients enter doesn\u2019t always go into the EHR or get pushed back to the doctor. If you\u2019re a patient who is really bored, you can type your information into a computer \u2026 but it has no impact.

\u201cI would go beyond what you can document in the portal and actually get the patient-centered health data in the form of many different apps,\u201d she adds. That includes basic health apps such as those that track pain or fertility to fitness apps and trackers.

Bottom line, to treat populations of patients, providers must make decisions based on information about those populations. And that requires interoperable data sharing.

\u201cOnce all stakeholders understand that you can\u2019t make decisions about a population you\u2019re trying to manage with only parts of the data,\u201d Barras says, the healthcare industry will find ways to overcome any remaining barriers to interoperability.","saveContent":"Now that most providers have implemented an electronic health or medical record system to comply with federal Meaningful Use requirements, the government has turned its attention in healthcare technology to interoperability. In fact, last April, the Centers for Medicare and Medicaid Services renamed the program\u2014it\u2019s now Promoting Interoperability.

It makes sense to shift the attention to data exchange, experts say. \u201cThere\u2019s no need to measure things people are already doing universally,\u201d says David Harlow, a lawyer and consultant who specializes in healthcare business and regulatory issues.

But those experts also say it\u2019s not so universal to actually use the data within EHR and EMR systems\u2014along with other sources such as patient portals, connected devices, sensors and apps\u2014to deliver meaningful and actionable data to improve outcomes across the care continuum and at the point of care for populations of patients. Although there are hurdles to overcome, the industry\u2014driven by new regulations, incentives and the shift to value-based care\u2014is definitely moving in that direction.

The technology is advancing rapidly, so we\u2019ll have the capability to do things in healthcare that we couldn\u2019t do five years ago with our EMRs and our HIEs,\u201d says Brian Ahier, a board member of the not-for-profit Sequoia Project, which works to advance the implementation of secure, interoperable nationwide health information exchange. \u201cI think 2019 is going to be a good year for interoperability.\u201d

In addition to the Promoting Interoperability program, the final rule of the government\u2019s 21st Century Cures Act, a law signed by President Obama and supported by the Trump Administration, was expected to emerge near the start of the New Year. The Cures Act is designed to speed medical advancements, in part by penalizing egregious information blocking, although regulators haven\u2019t established specific penalties for such interference with the free flow of information.

They\u2019re coming, though--along with other government interoperability programs that are on horizon--and the industry must get ready. \u201cAt this stage of the game, we have the tools that allow for widespread availability of information in the data-blocking context, so provider to provider and \u2026 to the patient, it should be universal at this point\u2014but it\u2019s not,\u201d Harlow says.

Incentives needed<\/b>
Another regulation pushing the industry toward interoperability is the Medicare Access and CHIP Reauthorization Act of 2015 [MACRA], which empowered CMS to create alternative payment models, such as accountable care organizations. The shift from fee-for-service to pay-for-quality gives payers and providers a financial incentive to share data.

\u201cThe Obama administration and the Trump administration don\u2019t have a whole lot in common,\u201d Ahier says. \u201cIn policy perspectives there\u2019s a pretty big chasm between them. But not in this regard. They\u2019re all in on value-based care.\u201d

The industry can\u2019t achieve the vision of value-based care without interoperable health IT, Harlow adds. \u201cIt\u2019s just not going to happen.\u201d

While data may flow freely within large organizations, a surge of mergers and acquisitions has left providers with a variety of systems that don\u2019t necessarily talk to each other, creating \u201ca potential interoperability problem that\u2019s going to work against you in terms of value-based care management,\u201d Harlow says. \u201cThe financial relationships in the value-based care models need to accommodate the idea that providers inside and outside those walls may need to work together.\u201d

\u201cBut until those financial incentives are firmly in place, the business disincentives to interoperability and data sharing linger,\u201d says Wen Dombrowski, MD, a physician informaticist and chief convergence officer at Catalaize, a consulting firm that advises healthcare organizations, technology companies and investors on innovation and emerging technologies. \u201cLarge health systems competing for market share in the same region struggle to make a business case for sharing the data they\u2019ve gathered.

\u201cIt\u2019s reasonable to make enough money to keep the doors open, keep all the nurses employed and things like that\u2014I understand the rationale behind it,\u201d Dombrowski says. \u201cBut as long as we\u2019re locked into a profit-driven kind of economic structure, I don\u2019t think interoperability will progress much, regardless of what CMS, ONC and other bodies promote and regardless of all the statements and promises. Fundamentally, if there\u2019s not an overwhelming incentive for healthcare organizations and vendors to be interoperable, then it\u2019s not going to happen.\u201d

And until healthcare does decide it wants to share, \u201cachieving the clinical, research and practical benefits is going to be stunted,\u201d Dombrowski says. \u201cBecause there are already elegant data management tools and AI algorithms developed, a lot of products and solutions are already possible. No one has to invent these per se. But the fact is, if the data is not easily accessible in a fairly real-time manner, then the projects that organizations can do are limited in terms of the promise and magic of predictive analytics and machine learning.\u201d

Value-based care<\/b>
Rob Barras, vice president of health solutions at CTG, an IT advisory and services company, says ideally healthcare organizations would want to share data for altruistic reasons\u2014to improve clinical care\u2014but realistically, the potential of data sharing to optimize value-based care agreements is ultimately what will drive interoperability.

\u201cYou cannot make decisions about a population until you have the data you need,\u201d especially at the point of care, Barras says. \u201cThat\u2019s the real value of integrating all that data in one place: so we can understand the health of the population as opposed to the individual.\u201d

The biggest barrier right now, he adds, is that most organizations are just beginning to understand the requirements of value-based care. And IT leaders, in particular, still need help determining how to use technology to make it happen. \u201cIf IT doesn\u2019t understand it, if the CIO doesn\u2019t understand it, what are the chances the chief nursing officer or the VP of population health understands it?\u201d Barras says. \u201cThere are still a lot of heads in the sand that we\u2019re living in a fee-for-service world.\u201d

Ahier agrees, but says lack of understanding and denial won\u2019t cut it much longer. \u201cProviders stuck in fee-for-service or transitioning into these new payment care delivery models have one foot on the dock and one on the rowboat, and the rowboat is going out to sea. They\u2019re not going to let you get back on the dock,\u201d he says. \u201cThat\u2019s where I see the most complicating factors for the boots-on-the-ground, in-the-trenches folks; the informaticists, the physicians, the nurses, the clinicians of all stripes who are caring for patients in the value-based realm.

\u201cFortunately,\u201d he adds, \u201cthere\u2019s a lot of great technology that can help them do that.\u201d

But the technical issue is currently being solved at the minimal dataset level, according to Harlow. \u201cIt should be solved at a broader level and that should enable value-based care,\u201d he says.

\u201cInteroperability is not an end in itself. It drives better value-based care along a number of dimensions. It\u2019s about provider payments, it\u2019s about outcomes and it\u2019s about care management\u2014the process of care. Along all those different dimensions there should be incentives to provider organizations to up the ante on interoperability.\u201d

Some larger EHR companies, including Epic, are working toward those goals by creating interoperability functions within their own systems. And then there are companies, such as Cerner, that offer care coordination solutions.

But a market is also emerging for purpose-built, vendor-agnostic solutions, mainly from small companies that are focused on care coordination and sharing data across the care continuum, such as CareCentrix And PatientPing.

These companies \u201coffer very important capabilities, which enable the entire healthcare network to stay connected with each other,\u201d says Koustav Chatterjee, a Frost & Sullivan healthcare industry consultant and analyst. \u201cAs patients come in with more complicated conditions, it becomes increasingly difficult for the payer and provider to offer that holistic, evidence-based clinical judgment to that patient at the point of care. And that\u2019s why they don\u2019t have any other option but to reach out to ... specialist healthcare IT vendors who are offering the bandwidth and capabilities so that everyone wins.\u201d

The market, he adds, \u201cis perfectly poised to aid the next revolution of healthcare IT\u201d and the move toward interoperability.

Still, healthcare leaders, especially CFOs, are often hesitant to spend money on additional value-based services. They think the EHR \u201cshould be able to do everything,\u201d including coordinating care and reporting quality metrics, Chatterjee says. But because every payer has a different set of guidelines and protocols, \u201cit\u2019s literally impossible for an EHR to perform all those activities for that complex patient population.\u201d

In some ways, the barriers to interoperability aren\u2019t technical at all. There are plenty of tools and data sources to mine, including sensors, connected medical devices, patient apps and wearables,that are improving care quality right now.

Sensors, in particular, hold tremendous promise for the healthcare industry, which can benefit from auto industry expertise in this area.

\u201cThere\u2019s a lot of applicability in terms of what\u2019s being developed on the technological front with self-driving cars,\u201d Dombrowski says. \u201cIt\u2019s an example of where you\u2019re taking a large amount of data from many sensor sources and AI algorithms analyze it in real time\u2014instantly\u2014and it generates a recommendation or action that has life or death consequences; it has a high level of criticality.\u201d

And in the auto industry\u2014as in the healthcare industry\u2014technology that creates more responsive algorithms is key \u201cso it doesn\u2019t take two minutes to analyze and react to what happened two minutes ago,\u201d she adds.

Other non-technical approaches that can move data-sharing forward include data governance; better trained, more efficient IT departments; and input from patients\u2014an important group that\u2019s sometimes overlooked in the interoperability conversation.

While government incentives and the natural course of technological advances have largely eliminated the paper silo, these efforts have created a digital data silo, says Ahier.

Data governance\u2019s role<\/b>
Data governance is one way to break down the walls.

Getting a handle on data is key to interoperability because the way electronic information is gathered and reported can vary widely. The definition of length of stay at one hospital may be different at another, for example, or the way clinicians record blood pressure readings may differ from site to site. Such variations\u2014and the fact that the industry is unlikely to ever agree on one system or one set of recording methods\u2014are part of the reason many organizations struggle to adopt analytics tools.

\u201cYou\u2019re not going to break down all those silos, so then what?\u201d Barras says. \u201cData governance is the \u2018then what.\u2019 \u201d

With value-based care, organizations often struggle to identify who \u201cowns\u201d the process of gathering and sharing data, Barras explains. Some think it\u2019s the chief medical officer, the vice president of quality or the population health director. But the correct answer is \u201call of the above\u201d and more. \u201cThat\u2019s what a strong governance platform will provide\u2014that clarity that we all own it,\u201d Barras says, noting that the time to put data governance in place \u201cis now.\u201d

Many organizations are spending a lot of money on interoperability systems, data warehousing and data analytics, Dombrowski says. \u201cFrankly speaking, all that cost could have been prevented if there was cleaner, interoperable data upfront.\u201d

IT staff\u2019s role<\/b>
Another challenge is recruiting experienced IT staff who can build upon industry best practices and who are adept at semantic interoperability and data mapping that help achieve higher levels of information exchange, for example.

\u201cA lot of organizations are trying to reinvent the wheel,\u201d Dombrowski says. \u201cThey might have either junior teams or experienced teams, and they are trying to build things from scratch.\u201d

That\u2019s costly and time-consuming, she says.

\u201cIt takes a lot of effort, and if the team is not experienced, software and data exchange systems could be built or set up incorrectly. We see that over and over again, where the technical system \u2026 is a little off.\u201d

For example, errors may be present in the patient portal, even if the information is correct in the medical records. \u201cIf they can\u2019t even get my first name correct, then how do I know these labs are mine? This is such a basic example of interoperability,\u201d she says.

Semantic interoperability, too, is a big challenge in healthcare, where vital stats like blood pressure readings can be reported in different formats not only from one system to another but from one department to another, she adds.

Because information exchange is about more than just moving piles of data from point A to point B, data mapping is a critical IT skill. \u201cIt\u2019s not as simple as just dumping all the data into one database. That data still might not be able to talk to each other,\u201d Dombrowski says.

Providers must have teams in place that not only understand these barriers to interoperability but also have the ability to solve them.

Patient participation<\/b>
Ironically, another ingredient missing from the data-sharing mix is the very reason healthcare needs to do a better job of interoperability: the patient.

Even government regulations have shifted away from broad patient participation, Harlow says, amid complaints from clinicians that patient engagement in healthcare data is out of their control.

\u201cI still hear many stories from people who can\u2019t get access to their records,\u201d he says. \u201cIt\u2019s surprising that it\u2019s still this difficult. The rules are clear, but there are institutional practices in place, and some of them are still at odds with the rules.\u2026The idea that the patient controls the distribution of information seems to be lost on a lot of people.\u201d

HIPAA, he adds, ends up being used as an excuse not to share records.

Dombrowski also advocates for a patient-centric approach.

\u201cA lot of the discussion about interoperability centers around transmission of EHR records,\u201d she says. \u201cA lot of it is about interoperability of the whole EHR or a small subset, such as a discharge summary or problem list. As a clinician, having that basic summary is useful, but it\u2019s not sufficient to capture the whole narrative about a patient and what\u2019s happened over time.\u201d

Especially for patients with complex medical cases, interoperability needs to go \u201cmuch further,\u201d she adds.

Although the concept of patient-generated health data is gaining traction, solutions to harness it don\u2019t always make sense. \u201cMost patient portals are dead ends,\u201d Dombrowski says. \u201cThe information that patients enter doesn\u2019t always go into the EHR or get pushed back to the doctor. If you\u2019re a patient who is really bored, you can type your information into a computer \u2026 but it has no impact.

\u201cI would go beyond what you can document in the portal and actually get the patient-centered health data in the form of many different apps,\u201d she adds. That includes basic health apps such as those that track pain or fertility to fitness apps and trackers.

Bottom line, to treat populations of patients, providers must make decisions based on information about those populations. And that requires interoperable data sharing.

\u201cOnce all stakeholders understand that you can\u2019t make decisions about a population you\u2019re trying to manage with only parts of the data,\u201d Barras says, the healthcare industry will find ways to overcome any remaining barriers to interoperability.","order":0,"get_parent":{},"attributes":[],"attributesType":{"content":{"type":"string","source":"raw"},"lock":{"type":"object"}},"dynamicContent":""}]

The push for interoperability gains new urgency in 2019

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