Interoperability - Next Steps


Interoperability - Next Steps

Friday, March 18th, 2016 - 9:59
Friday, March 18, 2016 - 09:38
The holy grail of interoperability would involve moving information seamlessly from one system to another, and allowing the receiving system to treat the incoming data as native to its system.

In one of my previous posts, I referenced the Standards and Interoperability (S&I) Framework, which enables healthcare stakeholders to create standards, specifications, and implementation guidelines that facilitate effective healthcare information exchange.   This will facilitate the adoption of interoperable standards.

The holy grail of interoperability would involve moving information seamlessly from one system to another, and allowing the receiving system to treat the incoming data as native to its system-- information that is both human and machine readable, for which the meaning from the originating system remains intact. This information exchange enables the use of data and documents to provide comprehensive care to patients by exposing relevant information, allowing computations and analytics, and driving the best clinical decision support practices available. Currently, variability in the sharing of data and documents strains the march toward interoperability within the healthcare ecosystem.  Other industries (e.g., banking, cell phone), enjoy the benefits of interoperability based on shared standards and use, which allow a relatively fluid exchange of data and documents between stakeholders in these industries.

The evolving maturation of healthcare interoperability also points to some key barriers. The federal healthcare delivery systems at the Veterans Health Administration and the Department of Defense already share a significant amount of information, albeit at a lower level of interoperability. At a higher level, semantic interoperability involves standardized data structure and coding to support unambiguous shared meaning and automated interpretation.

In a report to Congress, HHS’ Office of the National Coordinator for Health IT (ONC) cited 5 barriers to healthcare interoperability. The first 4 are either in progress of being resolved or do not present a material barrier for the Federal Healthcare Delivery System (DoD, VA, IHS, PHS, NCI and so on).

Past HITPC Recommendations to Promote Interoperability

We frame our summary of past HITPC recommendations in the following categories of barriers to interoperability:

  • Lack of universal adoption of standards-based EHR systems
  • Impact on providers’ day-to-day workflow
  • Complex privacy and security challenges associated with widespread health information exchange
  • Need for synchronous collective action among multiple stakeholders
  • Weak or misaligned incentives

Though agencies are not yet highly interoperable at the semantic level, they are funded as well as mandated by statute to share information that ensures the seamless integration of health data among DoD, VA, and private health care providers. For example, the service treatment record is provided by DoD to VA to support disability evaluations and determination of disability benefits; the Joint Legacy Viewer (JLV) allows a read-only view of much of the available clinical data between the agencies, as well as many purchased care providers in Tricare.

VHA and DoD buy about 50% to 70% of the care provided to their beneficiaries from the commercial healthcare sector. In linking purchased care payments to the electronic exchange of health information between agencies and providers, the federal healthcare system has a serious lever to move toward interoperability. Doing so can create robust information exchanges between the federal and commercial healthcare sectors, which could forge an interoperability template going forward –as the payment incentives shift from the traditional fee for service model, and to a health model focused on value and driven by healthy outcomes.

All of this rests on the ability to share useable and readable health information amongst disparate systems.  In the end, leveraging the incentives and capabilities that exist today in the Federal delivery system, healthcare stakeholders can lead to transformation in the national healthcare ecosystem, and lay the foundation to make the vision of interoperability a reality on a national level.

Image courtesy of pandpstock001 at