The Challenges of Achieving Interoperability
Throughout healthcare, facilities and organizations are coming to terms with the nuances and challenges inherent in their journey to achieve interoperability. Prompted further by the industrywide shift to a value-based model of care, it’s more crucial than in years past for an enterprise to quickly reach interoperability.
A 2017 survey on health information technology purchasing intentions, conducted by TechTarget and the College of Healthcare Information Management Executives, revealed that 36 percent of healthcare IT (HIT) respondents said that interoperability and data exchange were the main factors driving technology buying decisions at their respective organizations. Fifty-three percent of respondents also cited “improving the quality of patient care” as the top reason for making those changes in 2017, a significant jump from 44 percent in 2016.
Kent Petty, chief information officer for HealthTrust, defines interoperability as the ability to make the right data available to the right people at the right time.
“Data is really the currency of healthcare and the currency of HealthTrust; it’s the way we bring cost, quality and outcomes together,” Petty explains. “We need large amounts of data in order to make decisions about the right cost for the right quality outcome, whether it’s in supply chain asset tracking, or in pharmaceutical or product tracking. We have to have an engine driving the analytics to provide the best care to the patient.”
Most HIT professionals would agree on the benefits that interoperability can afford both patients and providers. Aside from an overall improvement in the comprehensive and efficient care of patients, interoperability can also streamline patient care transitions across different organizations; reduce operational and administrative waste across a facility’s enterprise; assist in providing essential data for population health initiatives; reduce wait times and delays between insurance providers; and improve communication and response times between patients and clinicians.
Conversely, a lack of interoperability within an enterprise can be damaging to a facility and to patients. According to the National Transitions of Care Coalition, communication breakdowns are a leading cause of medication errors, with “an estimated 60 percent of medication errors occur[ing] during times of transition.”
In addition to putting patients at risk, communication breakdowns and the absence of an interoperable system will also directly affect the bottom line for hospitals and healthcare organizations as delivery and payments continue to shift to value-based care.
“In value-based care, it’s incredibly important to put knowledge in the right place, and interoperability enables that,” Petty says.
According to Petty, the shift to interoperability is similar to banking’s transition to ATM technology, which is now so ubiquitous it’s barely noticed. “Originally, if you walked up to an ATM and wanted to get money out of your account, you had to do it at your bank,” Petty explains. “As ATMs started exchanging information about how much money you had in your account, that changed. Even if you had all your money at Bank A, you could go to Bank B and get your money out of that ATM machine.”
Now, fast forward to the present. “You can go to an ATM in France today and take out money,” Petty continues. “The machine can access your funds, do a security check and an exchange rate simultaneously—that whole system is interoperability. That’s the kind of migration we’re seeing in healthcare. We were interfacing, then we were integrating, and now we’re moving to interoperability.”
The Journey to Compassionate Care
Despite this upswing in investment and the need to transition away from the traditional fee-for-service model, achieving interoperability remains elusive. That’s in part because the drive to become interoperable has exposed communication gaps and data-sharing inefficiencies some organizations were either unaware of or had previously chosen to ignore.
Plus, integration overhauls or HIT adoptions are disruptive to those who work within them, not to mention costly and time-intensive. Additionally, legacy patient data systems might not possess the technical capability to interact with next-generation technology that interoperable operations demand.
A larger challenge is that few, if any, roadmaps exist to guide the industry along the path toward achieving interoperability. Bridging the gap between data silos and connecting relevant data sources is complex and cumbersome work, and inconsistent interoperable standards between suppliers, regulators and providers do little to drive the progress onward.
According to a February 2018 article in Health Management Technology, provider and supplier inertia is a major roadblock. “Providers have long been the gatekeepers of patient content, and old habits die hard,” the article reads. “Many have yet to find adequate motivation to liberate health data so that it can be freely exchanged with patients and other providers.”
Petty realizes there’s still work to be done. “We still need to get interoperable standards to a place where everyone can agree on a standard exchange of information,” he notes. “We have very inconsistent standards between suppliers, which might be a paradox we can’t solve, but we need to continue to focus on the benefits of sharing this information. Rising to the challenge of interoperability means focusing on what it can do to improve the treatment of the patient.”
Though achieving a broad adoption of standards is critical, variations in state adoption rules can also be a constraint. Stronger patient matching technologies and more widespread trust among healthcare stakeholders looking to embrace the patient-first vision of care enabled by interoperability are also needed.
Challenges aside, what exactly does achieving interoperability look like? According to Petty, beauty is in the eye of the beholder.
“You know you’ve achieved it when you have the right information to do what you’re charged to do,” Petty says. “If you’re in emergency care, interoperability needs to enable patient identification. For supply chain, interoperability needs to be able to tell me if we have a drug shortage in this part of the U.S. If so, we need to be able to look at sourcing elsewhere.”
“We need to strive for the benefits of compassionate care,” he continues. “Having a lot of data can help you make the right decisions.”
The Office of the National Coordinator (ONC) for Health Information Technology has created a 10-year plan for advancing healthcare interoperability. Download the ONC’s Shared Nationwide Interoperability Roadmap.
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