The Challenge of Interoperability

When you deposit your paycheck, you expect your bank to process it. If you're out of town, you count on an ATM to access your money. But patients discharged from the hospital to a rehabilitation center or SNF may not experience such a seamless transition of their healthcare information.

This useful information exchange is called interoperability and it is one of the truly pressing issues facing healthcare reform. The lack of interoperability can cause serious issues for patients. For example, communication breakdowns are a key cause of medication errors. One report indicates that “an estimated 60% of medication errors occur during times of transition."¹ This puts patients at risk for poor outcomes, including re-hospitalization. Not only does interoperability enable more coordinated care, but as healthcare delivery and payment increasingly shifts to value-based care, interoperable health IT is integral to the effective communication that will help improve the quality of care, better the health of communities, and lower per capita costs. This chart shows the three levels of health information technology interoperability as defined by the Healthcare Information Management Systems Society (HIMSS) in 2013.⁴

Foundational Interoprability	Basic level of interoperability Data from one information technology system can be received by another The receiving system does not need to be able to interpret it.
Structural Interoperability	Intermediate level of interoperability Data exchanges between information technology systems can be interpreted at the data field level Clinical or operational purpose and meaning of the data is preserved.
Semantic Interoperability	Highest level of interoperability Two or more systems can exchange information 3 Exchanged information can be used Electronic exchange of patient summary information among caregivers and other authorized parties via potentially disparate electronic health record (EHR) systems

It should be noted that true interoperability is more than information exchange; it's the ability of two or more systems or components to exchange information and then use the information that has been exchanged.² The challenges to achieving semantic interoperability transcend the technical, as there are cultural, social, policy and economic barriers to data sharing. The U.S. Department of Health and Human Services in an April 2015 Report to Congress on Health Information Blocking noted that information blocking practiced by some healthcare providers and health IT developers undermines the national goal to achieve secure, appropriate and efficient sharing of electronic health information across the health care continuum. Reasons for information blocking include concerns about the liability risk of data exchange. The 2015 Nationwide Interoperability Roadmap also points out “providers may believe interoperability will jeopardize competitive advantages they gain from exclusive access to patients' health information,” and technology developers can make it “challenging for providers to extract and share data, for instance, in order to prevent providers from easily switching to a competitor's product.” Interoperability promises to be an issue at the forefront of healthcare transformation in 2016. The Medicare Access and CHIP Reauthorization Act (MACRA), signed by the President in April 2015, will take important steps toward streamlining and expanding the use of value-based payment and quality reporting programs. As it phases in, MACRA will consolidate current physician reporting programs, including the Medicare EHR Incentive Program, Physician Quality Reporting System (PQRS), and the Value Modifier into a unified Merit-Based Incentive Payment System (MIPS) and create incentives for providers to participate in eligible alternative payment models. As these programs integrate providers across care settings, they will reach a provider base that includes critical providers ineligible for the Medicare and Medicaid EHR Incentive Program, such as many post-acute care and behavioral and mental health providers. In addition, the link to value-based payment promises to incentivize providers to invest in resolving interoperability challenges in their communities.⁵ The U.S. healthcare system is evolving. Coordinating care among all of a patient's providers, as well as including the patient in their care, is pivotal to improving the quality of care. To enable interoperability, Remedy Partners has developed Episode Connect which has integrated with every major EHR and is the only enterprise software that functions as a robust operating system for managing bundled payment programs. It is imperative for providers across the healthcare continuum to consistently send and receive accurate and meaningful patient data. Otherwise we will fail to realize the benefits of interoperability: improvements in clinical decision-making and patient safety, operational process improvement, and support for value-based care. Footnotes

1. _{National Transitions of Care Coalition. Improving Transitions of Care: The Vision of the National Transitions of Care Coalition. May 2008. Available at: http://www.ntocc.org/Portals/0/PolicyPaper.pdf.}
2. _{IEEE Standard Computer Dictionary: A Compilation of IEEE Standard Computer Glossaries (New York, NY: 1990)}
3. _{Health IT in Long-term and Post Acute Care Setting, https://www.healthit.gov/sites/default/files/pdf/HIT_LTPAC_IssueBrief031513.pdf}
4. _{http://www.himss.org/library/interoperability-standards/what-is-interoperability}
5. _{The Merit-Based Incentive Payment System (MIPS) & Alternative payment Models (APM), https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html}

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