The U.S. healthcare industry has marked several milestones as it pushes towards industry-wide interoperability. But the journey has not been without setbacks. Despite the progress made towards making it easier to share medical records between clinicians at hospitals and health systems, there are still significant gaps that inhibit how to measure and quantify how successful interoperability is around the country.
A webinar, sponsored by Surescripts, sought to highlight the findings of a report commissioned by the Healthcare Leadership Council — Opportunities for Private Sector Measures to Inform and Advance Interoperability Policy. The conversation fleshed out progress made on interoperability, recommendations on how best to measure and quantify interoperability, and a near term outlook on next steps. It also addressed the legacy of the HITECH Act provisions and the impact of the 21st Century Cures Act.
Among the panelists are:
- Tom Skelton, CEO, Surescripts
- Judy Faulkner, Founder and CEO, Epic
- Mary Grealy, President, Healthcare Leadership Council
- A. Jay Holmgren, Assistant Professor of Medicine with University of California — San Francisco Medical School, and author of the Healthcare Leadership Council-commissioned report
Stephanie Baum, Director of Special Projects at MedCity News, is the moderator.
Faulkner recommended a change in how we measure and quantify interoperability from the number of patient records shared to the number of patients for which information is successfully shared. That shift would not only offer a more practical approach to assessing how widespread and effective interoperability is, but could also offer insight into communities and patient populations where interoperability needs improvement.
One talking point sought to contextualize the impact of the HITECH Act and the Meaningful Use requirements contained within it. Although it led to a rapid transformation of paper-based patient medical records to digital, the consensus among panelists is that it also slowed interoperability. Holmgren highlighted some pros and cons of the Meaningful Use provisions of the Act, observing that it led to slower interoperability growth than had been hoped for.
“I think if you had looked at the 2008 plan, do you expect in 2022 to be publishing papers that about 50% of hospitals report they regularly exchange data electronically? I’m pretty sure that they would say no. I’m pretty sure they’d hope to get a lot more broad interoperability and data exchange before that. So in one way, it was wildly successful. Just looking at the state of the U.S. healthcare system compared to other countries, we have digitized our system, which is necessary, but not sufficient. Where we’ve moved slower is moving that data across different silos.”
Grealy, Healthcare Leadership Council President, highlighted the importance of the work of the Office of the National Coordinator for Health IT in advancing interoperability.
“I think the Trusted Exchange Framework and Common Agreement (TEFCA) certainly has really moved us in the right direction. I think we were finding that there were some good regional health information exchanges, but we really needed to ramp that up and expand it. Some of the Carequality and Commonwell initiatives are really important examples of private sector collaboration. I know both Tom and Judy are pretty active with those organizations. I think it really highlights the importance of the private sector stepping in, taking responsibility, trying to drive this change, but we really can’t do it without a partner like the office of the Office of the National Coordinator.”
Skelton, while highlighting some of the progress Surescripts has made with e-prescribing, also addressed the inherent challenges that interoperability has created. Making sensitive patient data more easily accessible has also increased the need to develop ways to better safeguard the data as well as easily correct that data when there are errors.
“The most accurate data in any setting is data that is being used regularly and as a vital part of a workflow. As long as that’s happening, then the data tends to get corrected quickly or noticed quickly. If a lot of data is moving around, then it’s being swept into a closet somewhere online. It could actually end up in a situation where the quality of that data doesn’t really get the view it should get, and we could end up in a situation where [it is] proliferated across health systems. And so we do have to be careful about this. They are legitimate risks. Being an optimist, I believe that industry is being exceptionally diligent here and will continue to be, but I do think the risk is real and I think it’s something we need to recognize and accept.”
Faulkner highlighted some of the interoperability efforts undertaken by Epic, including Care Everywhere and, more recently, Share Everywhere for patients who have access to its patient portal MyChart. She also offered a few takeaways from the discussion.
“I think we need to celebrate our success, that has really changed the whole country and even the world because of interoperability, there’s been a lot that’s been accomplished. Secondly, I think we really have to focus on those left behind who can’t afford it, and don’t have the human power to do it. We have to figure out what we do with those institutions. My daughter was recently injured and had to go to two different hospitals. One had no interoperability and it felt like the light switch was turned off. The other had, and then the light switch got turned on and it was a striking comparison. Third, and this is just for those who use My Chart: learn about Share Everywhere — you might have to use it sometime.”
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Photo: LeoWolfert, Getty Images