Incentives to Adopt Interoperable Healthcare Systems

The cost of implementing interoperability can be significant, however, the federal government provides incentives for healthcare providers to implement technologiesat their practices. This includes implementing an EHR system and adopting health information technology (HIT) standards. The Centers for Medicare and Medicaid Services (CMS) offers incentives via their Promoting Interoperability Programs, previously the Meaningful Use Program. The government has also been promoting interoperable healthcare systems that allow patients access to their health information regardless of the technology or system utilized by the provider.

Interoperable Healthcare Systems Lead to Better Patient Care

Some hesitancy remains around implementing interoperable systems because sometimes it entails learning a new system and incurringadditional resources and expenses. However, interoperability allows providers to share data seamlessly and efficiently which can lead to better patient care. Additionally, it permits patients access to their health information regardless of the system utilized, giving patients more control over their healthcare and enabling them to make more informed decisions about their treatment. This allows for more continuity of care and better outcomes overall because all providers involved in a patient’s care have access to the same accurate information about that patient’s medical history and current condition. This means fewer mistakes due to miscommunication between doctors, nurses, and other healthcare professionals,which leads to reduced cost of care.

Robust Infrastructure Makes Interoperability Possible

Interoperability needs an infrastructure that provides a dynamic framework for privacy, security, identification, authentication, and authorization for transferring information from one EHR to another. With advances in technology, adoption, and implementation of application programming interfaces (APIs) that are FHIR-enabled by the HL7 standard enablessecure connectivity between EHRs, healthcare applications, and portals.

The Unified Data Access Protocol (UDAP) provides a way to exchange data between disparate systems. UDAP is a web-based application that allows authorized users to access and exchange healthcare data regardless of the system or technology being used. UDAP uses secure sockets layer (SSL) encryption to protect patient information during transmission.

AssureCare’s President and CEO, Yousuf Ahmad, believes, “we will see an impetus towards building open, connected communities of health. This means transferring information from one EHR to another will no longer be a pain point—rather the adoption of application programming interface (APIs) will enable electronic records to inculcate data from disparate systems and devices in real-time.”

How to Get Started

Implementing an interoperable healthcare system can seem like a daunting task, but with the right amount of planning and dedication from all levels within your organization the process can be made smooth. Here are a few tips to make implementation easier:

• Get organized: Take inventory of all systems in place including hardware, software, databases, etc. Make sure everything is up-to-date and working properly before proceeding with implementation plans. If anything needs to be upgraded or replaced, do so before moving forward.
• Define your goals: What are you hoping to achieve with an interoperable healthcare system? Improved quality of care? Increased patient satisfaction? Reduced costs? Once you have clear goals defined it will be easier to develop implementation plans that meet your specific needs.
• Create a plan: Once you have defined your goals and know what systems need to be in place for interoperability, create a plan detailing how these systems will work together. This plan should include timelines, responsibilities, and budget information. Be sure to involve all stakeholders (providers, IT staff, patients, etc.) in the development process so everyone is on the same page.
• Execute the plan: Implementing a healthcare interoperability system is no small task, but with communication and collaboration it will be successful resulting in organizational improvements.

Interoperability has become the reality for healthcare organizations and providers. 2022 will be a year for widespread implementation as interoperability becomes the key to both progression and success in the industry. Contact us today to learn more about our interoperable, robust provider services including an EHR, Practice Management System, and Revenue Cycle Management.

Let’s understand how it works

Connected data sharing relies on these three things:

First, we need an Interface

• This enables two separate systems to exchange data. It establishes the endpoints for shared information.

Second, we need Integration

• Integration connects multiple interfaces that support business process automation within an organization, making sure that they work cohesively as a whole system.

Third, we need Interoperability 

• While integration enables disparate systems to communicate with each other, interoperability uses these integrated connections to exchange data.
• Interoperability is the process of exchanging and interpreting data between computerized systems and software applications across organizational boundaries.
• Information systems talk to each other using a single, shared language without adding complexity.
• Interoperability enables computer systems to transmit data with increasing sophistication across four key levels.

Four Key Levels of Interoperability

FOUNDATIONAL: Establishes the inter-connectivity requirements needed to securely exchange data between systems.

STRUCTURAL: Defines the format, syntax, and organization of data exchange, including at the data field level for interpretation.

SEMANTIC: Allows for common underlying models and codification of data, providing shared understanding and meaning.

ORGANIZATIONAL: Includes governance, policy, social, legal, and organizational considerations to facilitate the secure and seamless flow and use of data, both within and between organizations.

Achieving interoperability within the healthcare system makes it possible to use a consistent standard of language in data exchange across the entire healthcare continuum. It will reduce errors of communication between care providers, payers, and the wider healthcare marketplace, resulting in increased productivity, better patient outcomes, and reduced cost.

Interested in learning more about how iPatientCare can help you start your journey towards interoperability?

To continue with the advancement in productivity, quality, and financial sustainability interoperability in telemedicine plays a very significant role.

What is Interoperability in Telemedicine?

Utilizing telemedicine is not only about getting on a video call consultation with patients. Interoperability in telemedicine enhances the care delivery model by seamlessly integrating with other digital devices to ensure real-time data management during ongoing virtual consultations. Within the healthcare ecosystem, interoperability is a step forward in standardizing care across the continuum and providing access to the right information at the right time, irrespective of the patient’s care setting.

Why is it important to choose a telemedicine solution with robust interoperability?

Usually smaller or rural practitioners pass on high-risk patients to larger healthcare systems. Here interoperable telemedicine solutions play a very important role in sharing patient records directly to the larger healthcare system during a telehealth visit. This automated and seamless data transfer between referring and consulting providers saves time and maintains continuity of care for patients. Also, the patient record is automatically updated with the summarized results of the. Without interoperable telehealth, the whole process would be inefficient and would involve manual entries that follow longer time durations and risk of transcription errors.

How has the current demand for telemedicine impacted interoperability?

The COVID-19 pandemic has accelerated the use of telemedicine solutions worldwide. At this point it’s not about how virtual visits are getting conducted, it’s about the patient experience during the virtual visit. Therefore, it becomes critical to look at the overall integration of respective services and how they seamlessly integrate to develop an effective virtual care delivery model.

Issues with clinical systems that are not interoperable with your virtual care systems

• Access to relevant patient data during a virtual consultation
• Lower patient engagement
• Unnecessary steps or clicks
• Inability to coordinate care
• Siloed telehealth-related data
• Burdensome patient experience

These are just a few examples of how a lack of interoperability within telemedicine can impact patient care.

If you are planning to deploy or switch to a robust Virtual Care Platform, receive a live demonstration of digital healthcare solutions provided by iPatientCare and ready your practice with the best.

Earlier attempts to improve interoperability have failed because EHRs used to produce non-standardized, and disparate data. But today, there is a widespread adoption of EHR, with almost 98 percent of health systems using a government-certified EHR. Each of it has its own set of technical specifications, clinical terminologies, and even unique customizations that allows true interoperability and data sharing across systems.

But despite these impressive steps, there are still major operational inefficiencies in sharing and accessing healthcare data. Inefficiency in exchanging healthcare data leads to communication gaps and overlaps between healthcare systems. The costs of inefficient health data exchange can have far more serious consequences, including

• Missing patient information can lead to poorer patient outcomes, sometimes it can even get worse.
• Healthcare providers spending much time on entering or searching for patient data don’t have as sufficient time to deliver proper care
• Operational inefficiencies lead to increased cost of healthcare

Barriers of Healthcare Interoperability

Today’s EMR/EHR systems and the lack of interoperability between the systems generate tremendous amounts of data, but lacks is data analytics and integration. An increase in the number of providers, systems, data sources, and the records collected a huge amount of disparate low-quality data. Which becomes a major contributor to providers discontent and burnout.

Adding to that, the explosion of data from the new technology and online connect —such as wearables, mobile phones, and genomics has intensified the level of problems in interoperability.

Misperceptions about interoperability and insights behind each one

Interoperability is an EHR’s problem

EHR is just a piece of the puzzle, the real challenges of interoperability are three distinct tiers within the healthcare industry that highlight the less-technical barriers to interoperability.

• The first interoperability tier is the organizational level of healthcare, which impacts the exchange of information within the existing systems.
• The second tier is the community level of healthcare, where the complexity of interoperability becomes even more extravagant. Here, the exchange of information extends between different organizations.
• The final and the third tier is the growing number of hardware platforms, operating systems, and communication systems connected to health and healthcare devices — such as “smart” consumer products, personal fitness apps, and sophisticated implantable medical devices.

Vast use of FHIR

Fast Healthcare Interoperability Resource (FHIR) is the latest healthcare data standard that has created a false hype. Though it will be useful in many areas of innovation emerging in the industry, but that doesn’t mean everyone is using FHIR. It is not the power button to boost and solve all interoperability issues. FHIR it is still a young standard. The health IT industry is still working out the most strategic places to implement FHIR. As new applications come to market and new use cases are tested and rolled-out, FHIR will surely gain real momentum in terms of actual implementations.

Healthcare Interoperability is hard

The biggest interoperability barrier for most organizations is not a lack of solutions, but a lack of resources in terms of time, money, and people. Changing the way organizations prioritize and think about interoperability will help them move from their current circumstances to a place where information exchange is effortless. If hospitals and health systems can think of the long-term benefits of implementing interoperability, they’ll be less likely to run into issues down the road.

Solutions to seamless Interoperability

Interoperability means more than basic connectivity. It must ensure effective, secure, and frictionless data exchange for and among all stakeholders. Providers just have to choose healthcare IT solutions that manage seamless interoperability and provide easy access to the most accurate patient information possible. With patients carrying an increasing share of the healthcare cost burden, providers should focus on interoperability solutions that must play serious on empowering providers and patients with timely access to their data, so they can make better decisions with the lowest burden on their pockets.

Emerging technologies that improves healthcare interoperability

• Direct Secure Messaging – Direct Secure Messaging is simply a direct message. It is a digital point-to-point solution. Similar to a fax or an email, providers can use Direct Secure Messaging for sending data to other providers who are in need. It is generally used for the provider to provider or patient to provider communication and even for public health reporting. Direct Secure Messaging is an effective way to increase interoperability among the various organizations in a patient’s range of care.
• Query-based Exchange – Query-based exchange allows organizations to share and access each other’s patient health information according to a reciprocal agreement. Member organizations sign an agreement promising to use the network’s data responsibly and ethically, and in line with HIPAA and other relevant laws, and they are given access to all of the network’s collective data.
• Healthcare APIs – APIs can help a provider or other healthcare organization unite its various systems and allow data to flow between them—regardless of the data’s format or source. APIs promise to aid in the interoperability of health data exchange across many disparate systems.

Conclusion

With only a few clicks, individuals can access their banking information or explore shopping options or travel access, then why not healthcare information? Healthcare providers and clinicians could gain access to more health information on patients’ medical conditions from other providers to improve on today’s coordinated care. Patients could also more easily obtain and aggregate their data, enabling them to successfully engage in personal care.

iPatientCare’s interoperability, Enterprise Integration Adaptors (EIA) enable you to begin with the real power of EHR interoperability by facilitating standards-based data exchange with other EHR systems, health information exchanges (HIEs), labs, pharmacies, payers, immunization and disease registries, and public health agencies. All these exchanges between healthcare information systems happen accurately and securely within the existing workflow.

To feel the power of true interoperability with iPatientCare’s interoperability. Here is the demo.

Along with technology and strategy, effective collaboration of public health authorities with private health care providers, laboratories, and community-based organizations, plays a successful role in delivering care. Synchronizing all three to conduct medical testing, effective contact tracing, and quickly distinguishing new patterns of COVID-19 expansion will help in identifying new ways to improve all of these activities. Improving these factors is crucial as the world begins to open shortly.

Here are some of the immediate possible ways to improve interoperability and exchange of key data, which will enable public health programs to work more effectively with private health care providers, clinical laboratories, and other critical partners in COVID-19 containment efforts.

•   Improvement in Commercial Lab Reporting

Lab reporting of positive COVID-19 patients is a cornerstone of public health surveillance. However, many of these laboratory results are missing with essential data, including basic patient address or zip code, which is the least basic information used to identify the infection clusters, disease hotspots, and contact cases to complete the investigations, and match patient information, to build supportive care quality network.

Firstly, there is an opportunity to use existing systems to improve the flow of key data to public health. Just by adding ‘ask at order entry’ fields to capture key demographics will ensure the bridge between electronic health records, laboratory information management systems, and commercial laboratories. These will also support the public health response to prioritize solutions that has broad applicability to all data sources.

On the other hand, more scalable solution that allows labs to use application programming interface (API) to request providers for the patient’s commonly missing data elements such as, race/ethnicity, phone number, address, medical record number + DOB or payer + subscriber number — either directly to provider EMRs or through Health Information Exchanges (HIEs).

• Enhancement in Case Investigations with Clinical Data

Case investigations often starts with attempting to locate clinical data for the patient’s course of illness, additional conditions, and demographics. This is currently categorized as a burdensome and a difficult process concerning the COVID-19 epidemic, because most of the health departments have to rely on manual queries, and some have been requesting logins to individual hospital EHRs even when they are interoperable.

Over the past few years, national interoperability networks have well emerged to accelerate secure clinical data exchange between providers trusted electronic framework. Interoperable networks sharing required data, enables direct support to the treatment of patients.

iPatientCare’s trusted framework primarily provide standards and governance for data exchange.

•  Enhance Use of the National Syndromic Surveillance Program (NSSP)

Syndromic surveillance method supports the detection of individual and population health indicators that are available before confirmed diagnoses are made. It provides valuable insights into tracking the COVID-19 outbreak.

There are few challenges with data-sharing agreements, governing the flow of syndromic surveillance data between state and federal health officials. Therefore, there have been parallel federal efforts – “national coronavirus surveillance systems” which tracks the flow of patients in emergency departments from private-sector databases, resulting in duplication of efforts and data inconsistencies within state and local health officials.

There are also several technical changes to the Syndromic Surveillance that will improve the accuracy and consistency of reported data. Good implementation of technical changes will enable fresh start for Syndromic Surveillance messaging standard. Afterward, it could be rolled out to all vendors as part of the Promoting Interoperability program.

However, enhancements to NSSP will allow a single system to be used to track multiple types of healthcare events now and in the future. Using a single, consistent system will effectively improve the epidemiological capacity.

Bringing federal, state, and local lawmakers on the same page to improve data exchange and interoperability, will help us get through the current crisis of coronavirus and prepare us better for the next one.

If you are also struggling to enable your technology framework with interoperability standards to communicate, exchange data, and use the information, then you must have a look at iPatientCare’s easy and secure Interoperability software.

Despite the growth in Electronic Health Record (EHR) and technology adoption in healthcare organizations, hospitals, and clinics, there is a huge communication gap between the systems. Therefore, these systems continue to contribute to data silos that make interoperability a significant challenge, and hence care coordination drops off the slide without even getting noticed.

Shifting healthcare systems towards coordinated care settings and tying them together under one communication channel, where one system can seamlessly exchange data with another, under full privacy and security, is the hardest part of the healthcare ecosystem.

Let’s see how we can streamline interoperability to drive care coordination.

Point-to-point integration:

• Point to point integration links the sender system directly with the receiver, via a specialized interface code provided by the vendor.
• Point to point integration simply implies that a transient message sent from a data source such as a cloud computing EHR hosting center, to a data recipient such as an e-prescribing gateway, a healthcare information exchange, or payer.
• The language of each message sent, won’t be affected when it reaches to the receiver.

Challenges with point to point integration:

• It does not work for complex scenarios such as an emergency department requesting for the lifetime clinical record of a person from all the places their data exists in the country.
• Auditing the clinical records between two organizations based on transient messages is more challenging
• Recreating a damaged clinical record by replaying transient messages from an interface engine is harder.
• Since each connection requires its own set of codes, point to point integration becomes quite expensive and the security of information is also a considerable challenge.

Application programming interface (API):

• Information exchange is more organized than point-to-point connections.
• API binds together different systems to allow secure data exchange that doesn’t rely on static, document-based exchange.
• API likely uses different languages, so one system can’t fully consume and use information from another system.
• Using open API providers and patients can collect, analysis and access healthcare information and make updates.
• Using the right tools, providers can interact with each other and can access critical information at the point of care.
• Open APIs can help providers to have easy and efficient access to a particular clinical data that supports their decision making with more informed choices.

Challenges with API development:

• As time passes, API becomes more and more inefficient until they are not allowed to merge with newer technologies.
• The shortage of API developers, without a vibrant developer crafting APIs is difficult.
• The lack of effective tools for designing, testing, and monitoring APIs.
• API development requires constant feedback and reviewing.

Fast Healthcare Interoperability Resources (FHIR):

• FHIR is a data standard designed to encourage patient data portability and accessibility.
• FHIR uses universally structured data to assist in automated clinical decision support and machine-based processing.
• Several trends are driving the adoption of FHIR in healthcare, most significant of them is a need for real-time access to clinical data via APIs.
•  FHIR is a simplified but powerful reinvention of CCDA, HL7 v3, and HL7 v2.
• FHIR works on the same web technology as social media, e-commerce websites and search engines, so sharing data scattered across multiple systems, in real-time isn’t difficult.
• FHIR doesn’t have to undergo any modifications for any information-exchange protocol- REST, HL7, or CCDA.

Challenges with FHIR:

• If different versions of FHIR are implemented in different systems, the two systems aren’t actually interoperable at all.
• When EHR vendors don’t implement all available FHIR APIs – or if they don’t implement the entire API, then it results in inconsistency. These inconsistencies undermine the goal of achieving interoperability.

Direct Secure Messaging:

• Direct secure messaging is a digital messaging tool similar to email.
• It is used to communicate pharmacy prescriptions, referrals, admissions, discharges, transfers, automated push-event notifications, and even messaging directly to patients.

Challenges with Direct Secure Messaging:

• Many people find Direct Secure Messaging complicated and not user-friendly.
• Sending a message requires a unique Direct address and knowing your recipient’s address and therefore – providers, insurers, and labs aren’t direct users.

The best of the above-mentioned technologies promotes interoperability by connecting the entire healthcare ecosystem. Providers can send, receive, find, and access patient’s data to coordinate continuous care.

If you are here looking for data interoperability software to improve easy and secure data exchange with other providers, laboratories, pharmacies, immunization/disease registries, and many more then you must have a demo of iPatientCare’s Interoperability software.

According to HIMSS, interoperability is about the extent to which systems and devices can exchange health data electronically, so that a user understands the health information and can use it in their treatment and operation decisions. Health information exchange ultimately involves the exchange of all the health-related data, which includes medical records, laboratory results, clinical summaries, medication lists, and much more. Nowadays, Hospitals and clinicians are already doing a great job of using Electronic Health Records to make interoperability more convenient, but still, there are many gaps in the system which need to be filled. So that every doctor and healthcare providers would have access to the required information at the point of care. Lack of certain information at a point of care will need to spend more time on obtaining the information rather than patient care.

This blog will help you get a few important advice on how healthcare interoperability works best for doctors and healthcare providers and how they can implement it for better patient care management.

Stages for implementing interoperability technology

For interoperability, exchange of data needs to be done in a way that it can also be understood by an end-user. So, practically, interoperability is the ability to make unrelated technological systems and diverse organizations work together and exchange data for real-time use. There are three stages of health information technology interoperability that correlate with data-exchange opportunities:

1) Foundational Interoperability: It enables one information system to exchange data with another information system. It is not required that the receiving system posses the ability to interpret the data. The receiving machine can store the document, and the receiving clinician can read the document, however, it cannot further process the information contained within the document on its own. The recipient of the document would need to open it and manually enter the updates to the medication.

2) Structural Interoperability: At an intermediate level, structural interoperability defines the uniform movement of healthcare data from one system to another. This has to do with standards that govern the format of messages being sent from one system to another, that the operational or clinical purpose and meaning of the data are preserved and unaltered in the receiving system. It ensures that the data exchanges between IT systems can be interpreted at the data field level (as in a database of patient records). It requires both the sending and the receiving machine using an accepted data standard. For example – If the patient’s discharge medication list has been transmitted, then the receiving machine will recognize every individual element such as medication name, dosage, frequency, etc. The receiving machine can then populate the appropriate data elements in the patient’s current medication list.

3) Semantic interoperability: It is one of the highest levels of interoperability at this level. In which, two or more systems or elements can exchange and use the data. The receiving IT systems can interpret the data and use it to achieve outcomes such as improved quality, safety, efficiency, and efficacy of healthcare delivery.

What problems interoperability can solve for your practice

• Identifying Patients: Currently, the biggest problem is, How are patients identified? There is no consistent way of identifying a patient across the healthcare spectrum. With the adoption of interoperability, the time consumption in identifying patients can be reduced and healthcare providers can identify patients by their name, date of birth, and Social Security number(if possible), on their fingertips.
• Standards for Sending, Receiving and Managing Information Between Health Systems: Currently, it is difficult to simply share information from one EHR software to another. The adoption and use of health data standards by enabling interoperability between different electronic health record systems can connect the whole healthcare spectrum.
• Measurement, Analysis, and Improvement: “you can’t improve what you can’t measure” Therefore, it becomes difficult to quantify costs, error rate, and other issues that are observed when healthcare systems do not communicate in meaningful ways. Interoperability brings in point to point communication within the system. It helps to analyze problem areas and make changes or even monitor how those changes can improve the quality of care and patient outcomes.
• Information Blocking By Vendors: A lack of shared data in healthcare is a problem. Information blocking — EHR vendor or some of the technology companies charge fees for transmitting data outside the system. Encouraging the interoperability of electronic health records and patient access to health data can discourage information blocking.

What problems interoperability can solve for patients

• Patient safety: Interoperability enables safer transitions of data. By adopting advanced interoperability, to capture and process data across the systems, healthcare providers can prevent errors due to missing or incomplete patient data.
• Improves patient experiences and coordination of care: Supporting strong care coordination and teamwork amongst providers is a core aspect of improving the patient experience. It’s hard to feel safe or have a positive experience when multiple providers are taking care of a patient, therefore patient wants their providers to be on the same page during a point of consultation.
• Cost reduction and higher productivity: Interoperability gives organizations the opportunity to save time on patient encounters by getting the right data to the patient, the provider and affiliate at the right time, every time. So it helps providers to minimize the cost behind collecting, analyzing, and processing data every time for the same patient and hence it directly benefits patients to save time and reduce cost.
• Patient privacy and security: To fully access data from anywhere around the corner privacy and security are the primary care and regulatory issues to consider. By promoting interoperability patients can better identify users, track their access and more effectively manage access rights.

Why Health Information Exchange is important for interoperability?

In addition to the interoperability of systems and devices, health information exchange (HIE) is another important component of effective Healthcare IT. The HIE has been divided into several categories such as sending, receiving, finding, and integrating. It’s not enough just to send data, it needs to be received, found easily and get integrated into an electronic health record. It is like a chain of activity, if any of the links get missing then the overall healthcare productivity suffers.

HIE is a pivotal step in moving the technological support to exchange data in a manner that preserves the meaning of the data, harmonizes with the clinician’s workflow and increases the patient-centric approach.

Related Article: What is your approach to Interoperability?

EHR adoption and increasing focus on reducing healthcare costs are some of the factors driving the health information exchange market globally. Countries across various regions are focusing on developing a better and safe infrastructure for health information exchange

Different Types of Health Information Exchange Data?

Currently, there are three basic HIE forms used to exchange data

• Directed Exchange: Sending and receiving information between healthcare providers to support coordinated care.
• Query Based Exchange: One healthcare provider can request patient-related information from other providers.
• Consumer Mediated Exchange: Patients can control the use of their health information among different healthcare providers.

Benefits of Health Information Exchange

When technology is evolving constantly and options for exchanging health information are increasing, Here are a few benefits of health information exchange.

• Minimizes errors: As the data is safely stored in a database and exchanged through a digital channel HIE helps in reducing medical and medication errors.
• Provides efficiency: HIE saves data in digital format which eliminates the risk of losing any information.
• Acts as a support tool: HIE system acts as a support tool for healthcare providers offering clinical decision support for better treatment and effective care.
• Case study: Transformative healthcare network built on open communication and collaboration. It provides the caregiver with clinical decision making support.
• Improve public health reporting and monitoring: Simplifying the data exchange and process improves health reporting and monitoring.
• Eliminates Testing, Improve healthcare quality and outcomes: The HIE system can eliminate unnecessary and redundant testing for healthcare providers, thereby improving the quality and outcome of healthcare delivery.
• Reduce health-related costs: Effective HIE systems can reduce health-related costs as it provides personal patients data digitally.

How HIE needs to serve healthcare providers

Health Information Exchange (HIE) needs to provide a framework for disparate clinical systems to interact with one another. It should provide a community Portal that facilitates a holistic view of a patient’s record captured at various healthcare information systems like ambulatory clinics, hospital systems, and/or updated by patients. It typically serves the following customers:

• Physicians within a community network
• Consumers to view and control access to their health record
• Hospitals and Health Systems to connect with their affiliated physicians
• Public health Agencies and Registries to view the summary of the patient population.

Where Is interoperability Headed?

In near future, If we manage to bring interoperability as a primary requirement to our healthcare system then, we can expect it to become more consumer-driven, where patients expect more connectivity from EHR to other devices, apps, and other technological tools. We can also expect to see healthcare IT departments bringing in advance tools to make better use of data from multiple sources for greater efficiency and patient outcomes.

Conclusion

In a nutshell, modern healthcare is being driven by information, documents are stored in EHR systems and organized for exchange. Every healthcare facility needs to adopt interoperability to be truly effective. Medical practices using interoperability for them have already proven how beneficial it is to have full data records at their fingertips.

Incorporating technologies into healthcare is also no small task, there are great challenges ahead, so every healthcare provider needs to have a bottom-up approach while selecting their healthcare IT tools. iPatientCare as a digital healthcare software development partner strongly believes in the potential it has to offer for widely solving the problem and challenges faced by healthcare providers to adopt interoperability.

iPatientCare Enterprise Integration Adaptors (EIA) enable you to exploit the real power of EHR interoperability by facilitating standards-based data exchange with other EHR systems, health information exchanges (HIEs), labs, pharmacies, payers, immunization and disease registries, and public health agencies. All these exchanges between healthcare information systems happen accurately and securely within the existing workflow. The EIA enhances the quality of care by delivering timely and accurate information, critical for your patients’ health.

Earlier this year, two offices of the US Department of Health and Human Services (HHS) – the Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator for Health IT (ONC) aimed at promoting Health Data Exchange through Information Blocking Rule & the Interoperability Rule (collectively referred to as the Proposed Rules).

Goal For Information Blocking Rule

The proposed separate but related rules place a strong focus on improving the ability of health care providers to transmit patient health information to each other (patients and clinicians) in an interoperable format. This advancement of rules aimed to support “seamless and secure access, exchange, and use of electronic health information (EHI)” be made available at no cost, and which could go into effect in 2020.

“These proposed rules strive to bring the nation’s healthcare system one step closer to a point where patients and clinicians have the access they need to all of a patient’s health information, helping them in making better choices about care and treatment,” said HHS Secretary Alex Azar.

An Overview of the Proposed Rules – Information Sharing and Interoperability

CMS Proposed Rule –

• The proposed rule from CMS enables the healthcare delivery system to support the MyHealthEData initiative and would help increase the seamless sharing of healthcare data, reduce the burden on patients, providers, researchers, and innovators.
• CMS finalized regulations requirements will only be imposed on hospitals and health care providers that are having an electronic health record (EHR).
• CMS would also require these health care providers and plans to implement open data sharing technologies to support transitions of care.
• CMS proposes a patient’s easy access to their information, and that information follows them on their healthcare journey. The smooth transition of care can reduce burden, and eliminate redundant procedures and testing thus giving clinicians the time to focus on improving care coordination and, ultimately, health outcomes.
• The CMS rule also proposes to publicly report providers or hospitals that participate in “information blocking,” Making this information publicly available may incentivize providers and clinicians to refrain from such practices.

ONC Proposed Rule –

• ONC’s proposed rule helps ensure that patients can electronically access their electronic health information at no cost. It will provide secure and more immediate access to health information for patients and their healthcare providers.
• The ONC Proposed Rule announces the information blocking provisions of the 21st Century Cures Act and listed seven “reasonable and necessary activities” that do not constitute information blocking. Seven “Allowed” Activities (Proposed) identified in the ONC Notice of proposed rulemaking (NPRM) where sharing information can be withheld, or fees charged that would not be considered information blocking:
• Preventing harm to patients or other individuals
• Promoting privacy
• Promoting security
• Recovering costs reasonably incurred to make the API technology available
• Infeasible requests for data
• License conditions that the data discloser or API technology supplier imposes on the app developer and which are reasonable and non-discriminatory.
• The proposed rule asks the healthcare industry to adopt new tools allowing more choice in care treatment, such as Application Programming Interfaces (APIs), to help allow individuals to securely and easily access structured electronic health information (EHI) using smartphone applications.
• The proposal empowers the HHS Office of Inspector General to investigate claims of information blocking and to issue civil monetary penalties up to $1,000,000 per violation.
• Policies in the proposed CMS and ONC rules align to advance interoperability in several important ways. Together, these proposed rules address both technical and healthcare industry factors that become a hurdle to the interoperability of healthcare information and limit a patient’s ability to access essential health-related data.

Challenges to Healthcare Interoperability, according to ONC

• Technical – Lack of interoperability access in current EHR
• Financial – Costs of developing, implementing and optimizing health IT.
• Trust – Leakage of information
• Administrative Requirements – Continuously changing Federal documentation and administrative requirements.
• Reporting Requirements – Federal reporting requirements

The Consequences Of Implementing Information Sharing And Interoperability Rule On Healthcare Providers and Hospitals.

• Is it a good option? – Let’s start with what we can all agree on – For better patient care and patient’s right to access their medical data, the goal of seamless information sharing and interoperability is a noble one. Prioritizing interoperability gaps is incredibly important as this will help set healthcare organizations. It will also effectively navigate and manage any interoperability challenges they encounter, but we must also consider disparities across healthcare organizations when it comes to adopting interoperability capability.
• Is it a bad option? – Potentially, not everyone will address the mandates of the rule at the same pace. The awareness and understanding of the rules are relatively low. Wealthier organizations or healthcare providers will be strategically able to meet the requirements of the rule more quickly, thanks to their financial resources but at the same time, rural or less financially stable organizations will stay behind in the race, which could ultimately widen the gaps of interoperability. To stay ahead of these regulations, every organization will need to shift their perception of the mandates and seek innovative approaches to build out and achieve interoperability as a strategic asset.

Scope Of Need To Think More Strategically

• Regardless of when the proposed rules ultimately come to existence, there is strong momentum to improve patient care and lower costs through a more transparent system.
• Today’s interoperability challenges will only be compounded by tomorrow’s, so we hope this rule motivates organizations to think more strategically about how they address and pursue data integration and management.
• Data will be fully transparent and exchanged via a trusted network through interoperability, there is a crucial need for payers to ensure the data is accurate, clean and actionable. Healthcare organizations and providers will have to have scope for investment in modernizing their technology and systems architecture, including adopting master data management strategies, to enable interoperability (keeping proposed rules in mind). we urge organizations to zoom out and look at things from a more strategic and long-term perspective.

Look Froward For Compatible HealthCare IT

As we know the consequences are like both sides of the coin, so the best thing healthcare providers can do now is to assess their EHR’s capability and plans. The government is looking ahead to turn the page as soon as 2019 ends, so the providers don’t have to sit back and wait till Information Sharing And Interoperability Rule comes to existence. They must talk to their EHR vendor and tell them about their requirements for the ability to get access to the data because vendors won’t move forward without the demand from their customers. If the EHR vendor is not planning on adding interoperability access, it may be time to look for another one to avoid being left behind. iPatientCare can be your trusted vendor for all your demands. It gives you the real power of EHR interoperability by facilitating standards-based data exchange with other EHR systems, health information exchanges (HIEs), labs, pharmacies, payers, immunization and disease registries, and public health agencies. All these exchanges between healthcare information systems happen accurately and securely within the existing work-flow.

There is a transformation of healthcare outcomes due to the simplicity of blockchain. It enables new ecosystems to evolve, ensuring trust by increasing the quality of care, data provenance and efficiency to improve profitability. Blockchain has brought about a change in the way information is stored within the organization, with healthcare partners, payers and most importantly with patients. The blockchain decentralizes the healthcare information, increasing data availability, efficiency, transparency, and trust. It also requires careful planning to make the most out of the advantages it gives.

For instance, in a prescription system firstly a patient visits a doctor, then visits a pharmacy and finally the patient picks up the prescription. But if done through blockchain, it ensures that the right medicine reaches to the right person. The blockchain system makes the transactions transparent by containing all of the patient’s medication history in one registry accessible by all the pharmacies. This system allows for the information to be easily updated and making it immune to the human error or tampering; thus solving the issues of dangerous drug consumption.

To elaborate on this, when prescribing a medicine, the health care providers have an accurate and immediate view of patient’s health records. In the next step, pharmacies can provide exceptional customer service based on patients’ previous drug history. Medical records are made accessible so as to control harmful drug interaction. The blockchain solutions have the potential to support the complete life cycle of a patient’s electronic medical record while also keeping health data private and secured. Finally, it is a process of drug track that creates a reliable system of monitoring legitimate drugs and ensures that the patients get appropriate drugs for their individual needs.

Because the development and research of the new drugs are costly and high-risk, there could be new drug development and lower costs by making patients’ lab reports readily available (with the permission from patients); through blockchain. Blockchain would also drastically reduce tampering capabilities in the drug manufacturing phase and ensure pharmaceuticals are genuine.

Blockchain for healthcare industry provides:

1. Security – patient information is shared across a network where authorized personnel has access. If anyone changes the information it is instantaneously updated to all users.
2. Accountability – currently the practices are disparate and disconnected. Healthcare data is very valuable and many institutions are reluctant to share it with other providers/specialists. This lack of collaboration between institutions make it extremely difficult to process all the generated data and halt some process which can harm patients’ health. For example, the pharmacies will be able to view the approved prescriptions and also view the patients’ past medical history from the providers’ side, creating a layer of accountability and transparency.
3. Authority – the blockchain solves the issue of harmful drug interaction by allowing medical personnel to monitor and cross-check the patient’s drug history. Also by using automated billing service, it reduces admin costs and eliminates other intermediaries, thus making billing process more efficient.
4. Efficiency – due to the blockchain, there is an overall improvement in services that are provided, gaining more trust. For example, the prescription system ensures that patients will receive one on one treatment based on their previous history.

The blockchain is not for large storage data sets. It is not an analytics platform. However, it is ideal for ensuring data integrity where the control is decentralized. The three prominent opportunities are:

1. Medical records – a medical record is generated and signed. It allows medical records of patients to be accessed by healthcare providers at any time required. It gives immediate access to all healthcare information across all the providers that they have visited. It also gives patients’ the opportunity to grant anonymous access to their personal medical records to researchers. The record is never altered, and the integrity of the medical record is ensured. When it comes to integration of medical record, it has an impact in legal cases as well.
2. Then comes the Consent Management – where every state has different privacy and consent regulations, with help of blockchain the patient records could be used and shared with the patients’ consent. Anyone seeking to exchange medical data about a patient could check the blockchain for permission to do so.
3. Finally, the Micropayments – if patients stay healthy, follow their appointments and their care plans, then there might be rewards offered through the blockchain. Similarly, patients might also be rewarded for contributing their data to clinical research using the same approach.

Therefore, the obvious benefits of the blockchain are:

• Transparent billing management – it provides realistic solutions and minimizes frauds.
• Easy data exchange and interoperability – the system is irrevocable and cryptographically secured.
• Efficient monitoring – powerful and precise monitoring is the key to better healthcare management.
• Organized processes – blockchain technology not only save patients’ important data but also traces all the distributed data.
• Collaboration – a success of public health depends on collaborating with various providers/specialists into vital healthcare trends.
• Cost efficient – there is more precision during diagnosis and eventually gives a better cure for various diseases. The hassle-free data sharing across the system offers cost-efficient treatments.
• Uniformity
• Agility
• Quality
• security

One of the major challenges in the healthcare industry is how to transmit patient data across geographies, without compromising security and privacy. But now, blockchain is changing things. Most of the healthcare organizations are recognizing the ability the blockchain has to reduce the time, cost, and risks.

This technology places the patient at the center of the health care, increasing the interoperability, privacy and most important – security of the health data. Blockchain makes electronic medical records more efficient and can provide a new model for health information exchanges (HIE). By centralizing the results of diagnosis and storing them in a way that is accessible, can become part of research and in turn lead to quick innovation.

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Interoperability can be explained in the sense that developing and deploying interfaces that move health information or the process of freely exchanging healthcare information among electronic systems, that boils down to delivering the highest-quality, most efficient care to the patients. To fulfill this, the providers must have the best information available at the point of care when making diagnosis and treatment decisions, and communicating them to the patients.

There are three levels of Interoperability:

• Foundational Interoperability – enables one information system to exchange data with another. The system at the receiving end does not need to interpret the data; it is instantly available.
• Structural Interoperability – defines the format of the data exchange so that the operational or clinical purpose of the information is evident and passes through without alteration.
• Semantic Interoperability – is the highest level of connection. It lets medical providers share patient data even while using different EHR software solutions from the vendors. The technology has matured in many ways that the data is able to flow between most certified EHR technologies. But still the providers spend enough time trying to manage working with different EHR interface. The providers are likely to change their order and treatment protocols a few times at the point of care. Therefore, it is very important to have tools, available at the point of care. Although the EHR cannot prioritize worklist, the EHR interface can make it available to the providers at the point of care, enabling them to take proper action for high-risk patients.

The integration often does not happen due to numerous objections. For e.g. The EHR integration requires EHR access to test and configure the interface to enable the availability of worklists and any other alerts. This limited access sometimes raises concerns. Not any software code access is required and protection can be put in place to assure an EHR vendor. The health systems manage access to the third party tools without fear of violating contracts. A survey said that there is a struggle to collect data as there is increase in number of specialists and out-of-network providers who are unable to convey data back to the initial ACO provider.

There are lot of gaps when it comes to social determinants of health, activity based costing data; due to lack of interoperability. When all the information about the patients is not available it becomes difficult to administer and coordinate overall care.

Adaption of interoperability in the digital health technologies will allow for faster, and more accurate collection and interpretation of public health data. Recognizing, tracking, and predicting the spread of contagious ailments can limit their spread, enabling better preparation and increasing the effectiveness of the treatment.

How Interoperability in Healthcare Plays a Vital Role in Better Outcomes

This technology will reduce the time spent by the providers to interpret the data. There is no need to send, receive patient data through email or fax. This reduces workload of front-desk staff too. Interoperability sounds all well and good but it is time-consuming to implement it.

While it is very useful to the providers, Interoperability also helps patient’s medical records to follow through the health care system. Easy and fast access of medical records will help the patients to receive better quality of care. This speedy transfer of information has a real impact on the patient’s health, as many conditions require immediate intervention to save the patient’s life or minimize long-term effects on their health.

Integration is the first step towards providing these services. These services help us move towards a more holistic view of patients and constituents, a position that has been repeatedly proven to improve outcomes. Secondly, collaboration; interoperability empowers sharing of data and analysis in contemporary ways that will assist from duplicate efforts and be efficient to take more actions towards collaborative solutions.

Interoperability in healthcare is a must, it affects the social sector and by focusing on collaborative solutions, integrated services and interoperable systems, can help take charge of this trend and use these benefits for the patients being served. iPatientCare has created functionalities and processes to enable integration with the third party vendors without creating any technical burdens.