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 The Challenges Of Interoperability

HHS urges vendors and providers to work on health information technology systems that can talk to one another.

 

 
Doc DeVoreThe Healthcare Information Management and Systems Society (HIMSS) held its annual meeting Feb. 29-March 4 in Las Vegas. At HIMSS 2016, many leading health information technology (HIT) vendors and providers made an interoperability pledge that was acknowledged by U.S. Department of Health and Human Services Secretary Sylvia Mathews Burwell.
 
The Centers for Medicare & Medicaid Services defines interoperability as the ability of two or more systems or components to exchange information and use the information that has been exchanged. The pledge represents a commitment to three things: consumer access, transparency/no blocking, and standards. Vendors and providers promising to work together to achieve meaningful interoperability is definitely a step in the right direction; getting it done is the challenge.

The Next Step

To understand the progress that has been made and the challenges that remain, it is helpful to use the three core elements of interoperability—payload, transport, transaction—as a frame of reference.

With respect to payload—the data that will be exchanged—there are standards in place. The HL7-ordained Continuity of Care Document and Consolidated Clinical Document Architecture (C-CDA) definitions provide a comprehensive care summary. Health Level-7, or HL7, refers to a set of international standards for transfer of clinical and administrative data between software applications used by various health care providers. The vision of the Office of the National Coordinator for Health Information Technology (ONC)—the agency at the forefront of the administration’s HIT efforts—for the use of the C-CDA begins to describe the common content that providers should share to manage care longitudinally.

That being said, challenges remain. First, there is a need for a common code set. If one system is using LOINC codes for laboratory results and other clinical observations and another is using SNOMED, translation is required before the information can actually be used. Logical Observation Identifiers Names and Codes (LOINC) is a database and universal standard for identifying medical laboratory observations, while the Systematized Nomenclature of Medicine (SNOMED) is a broader systematic, computer-processable collection of medical terms to provide codes for anatomy, diseases, findings, procedures, microorganisms, substances, and so forth.

Second, while the C-CDA is comprehensive, it may contain more information than is needed for a specific workflow. Defining the essential clinical workflows involved in a transition of care and the small subset of truly valuable data points within the care summary will require focused collaboration between provider clinicians and health information technology (HIT) vendors across all health care sectors.

ONC Lends A Hand

As for transporting the data from one system/provider to another, historically this has been done through one-on-one interfaces that are complex and difficult to maintain. As electronic health records (EHRs) became more widely used, it became obvious that HIT vendors would not create an interoperability standard on their own, so ONC initiated the Direct Project to develop standards to facilitate interoperability.

Direct Messaging is based on standards for encrypted email as a basis for communication and private/public key infrastructure to authenticate recipients who view encrypted information. While the current workflows supported by Direct Messaging are simple, even though how they have been implemented by EHR vendors varies, they are low-cost and easy to use. Providers that don’t have a Direct address should get one as it will prepare them for the interoperability that will come as more systems adopt a standards-based information exchange.

Biggest Hurdle

The third element of interoperability, transaction or consumption of the data, is where the real challenges exist. Despite agreement on the payload and transport mechanism, HIT vendors have to agree on standards in order to request data from and provide information to other systems. To begin developing transport standards, key use cases must be defined; for example, transitions of care or requests for medical records from a physician’s office.

Many HIT vendors have implemented Admission, Discharge, and Transfer (ADT) feeds, but providing a clinician with a true longitudinal view of a resident’s health is going to take more than that. Standard “calls” based on use cases, GetChart or WriteOrder need to be developed along with open Application Programming Interfaces to facilitate the sending and consumption of data.

While technical challenges are interesting problems to solve, achieving meaningful interoperability will require health care partners to develop trust in each other’s clinical practices and standard of care. Unfortunately, today there is a pervasive attitude of distrust that results in the care setting receiving the resident starting from scratch because they don’t trust what happened in the discharging care setting.

This is where organizations like HIMSS can help advance interoperability by facilitating conversations and collaboration to lay the foundation for trusting partnerships that in the end can deliver integrated care and better outcomes for seniors.
 
Doc Devore is the director of clinical informatics and industry relations with MatrixCare.
 
Sponsored by MatrixCare
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