A simple Google search for “interoperability medical records” generates a staggering 4.3 million returns, with content spanning the past 10 years. The prospect of interoperability anticipates a new era of streamlined health care delivery, one where providers have ubiquitous, easy access to data that dramatically enhances the quality of care, reduces costs, and improves countless lives.
Still, building systems that are truly interoperable has taken much longer than anyone anticipated. Thanks to the efforts of CommonWell and Carequality, we have reached a time where it is possible for providers to access some information across venues of care. However, the usability of that data is still quite variable, particularly in the post-acute arena, where care is delivered in the home, and in other facilities outside the hospital setting.
The question post-acute leaders should be asking isn't just how to integrate, but rather before they integrate, what is the usability of the data they are sending. This is a subtle but important shift in the way we approach interoperability that moves us beyond our current focus of “just get connected.”
This is why the health care information technology (HIT) industry is obligated to do better by delivering on meaningful and consistent data exchanges that enable providers to make effective use of the data received. Providers and patients demand more. The onus is on HIT providers to pioneer this next-level interoperability across post-acute care.
While 2018 delivered some notable milestones in data exchange that drew the health care industry closer to achieving interoperability, it failed to see true industry-wide integration. From new partnerships and pledges, to forums and innovation, the year was filled with interoperability building blocks. That is why leaders continue to spend so much time thinking and talking about the significant disconnects across our health system – disconnects that will continue to impact patient care outcomes if not resolved.
Goals that were once wishful thinking for interoperability in post-acute care are now slowly being realized through the integration of new technologies and industry standards. Look no further than CMS, which recently changed the name of their Meaningful Use program to “Promoting Interoperability.” Further, CMS's website highlights a variety of post-acute pilot programs that are beginning to demonstrate more advanced levels of interoperability.
The Healthcare Information and Management Systems Society (HIMSS) has developed a definition of interoperability, which the organization describes as “the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.” In addition, they have created a three-tiered model, which offers distinct levels of interoperability: foundational, structural, and semantic.
The highest level of interoperability is achieved at the semantic level — when two or more systems can actually use the information that has been exchanged. In order to use the information safely and effectively, it must be normalized, meaning the data must use a standardized vocabulary, so the information system can interpret the data.
Historically, post-acute electronic medical records have not been built to enable structured data capture. The reasons for this are many, but the most practical reason is because the vast majority of medical records were modeled after paper systems. They allowed clinicians to capture what they normally wrote on paper, in an electronic format. Most of the narrative documentation that surrounds patient care has been captured in what is known as “free text” fields, which can present a significant challenge in reaching interoperability.
Striving for Integrated Care
Achieving true integrated care will require health information technology partners who can realize the highest level of interoperability while placing the least burden on clinicians. Recently, CMS announced their new Data Element Library designed to create a comprehensive, electronic, distributable, and centralized resource of their assessment instrument content. By standardizing the assessment and response content, providers can now consume, through their electronic medical record providers, semantic-level information about the patient as they move across care settings. This is a significant step toward enabling HIT companies to support providers with timely and relevant patient information across transitions in care.
For 2019 and beyond, technology partners that focus on making post-acute patient care data more usable in a connected world will help providers realize the true promise of interoperability and integrated care.