Interoperability in healthcare was one focus of discussion at the HIMSS 2013 conference, particularly because of the lack of new policy announcements. Read part one of this two-part series to learn what attendees had to say about the future of health information exchange (HIE) and why a data exchange standard won't automatically lead to interoperability.
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Even if providers did agree on one set of standards, it wouldn't necessarily solve the problem. Covisint, which provides information exchange and population management services to providers and other organizations, recently partnered with the state of Vermont to set up an HIE. John Haughton, M.D., chief medical information officer at Covisint, said the exchange typically receives information in the consolidated clinical document architecture (CCDA) format, which stage 2 codifies as the standard for communicating summary-of-care information.
Yet even though many different providers are using this standard, the data received by the HIE is far from uniform, Haughton said. Some systems have different ways of filling out data fields, which makes it difficult to interpret the CCDA uniformly. He feels interoperability certification doesn't prove real-world data liquidity. Once systems are implemented, things can change. Vendors could improve interoperability by maintaining greater fidelity to standards, he said.
Accountable care organizations will demand collaboration, drive interoperability
IT systems will have to become more interoperable, as the healthcare system continues to transition away from fee-for-service payment models. Providers will be expected to collaborate on keeping patients well, which means doctors in different offices and care settings will have to share information with each other.
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"The ability to do a query of the data to see what happened to the patient is critical to the ACOs," said Janet Hofmeister, senior program manager for state HIE programs at Harris Healthcare Solutions, which operates the Florida HIE. "They need to know when the patient goes to the hospital" or other care provider.
This means that practices that decide to operate as an ACO will be reliant on systems that can connect to other vendors, either directly or via an information exchange. Hofmeister said she feels there is sufficient infrastructure in place to facilitate this kind of connectivity at the scale that will be needed for the health system to transition to accountable care.
But David Caldwell, executive vice president at San Jose, Calif.-based Certify Data Systems, isn't as optimistic. He said that many of the practices moving to value-based purchasing systems may be disappointed at the availability of the infrastructure needed to connect with partner organizations. ACOs have been "focused more on the model of care than the IT infrastructure," he added. "As they take on financial risk, they're going to wake up."
In addition to experiencing connectivity issues, ACOs are likely to be disappointed by their analytics initiatives, Caldwell said. Because interoperability is still so limited, most analytics systems will struggle to get the data they need to operate efficiently out of EHRs, he said.
Drive to interoperability will change the role of HIEs
Assuming that EHR systems become more interoperable in the near future, the role of HIE organizations may change. Currently, they function as intermediaries that take data from disparate organizations and put it into a format that others can use, regardless of their IT system. But if the industry progresses to a point where each EHR system can produce standardized documents and seamlessly share this information with other systems, there will be less of a need for organizations that do this.
Hofmeister said HIEs will eventually become the "string that holds the pearls." Just as home Internet users still need a line from their cable or phone company piping the Internet to their house, users of interoperable EHR systems will need some kind of infrastructure to carry their information. Hofmeister sees HIEs providing this service.
Caldwell agreed that public HIEs won't disappear, even when their current role diminishes. He said they will become the "network of networks" that will help connect doctors' offices. Within three to five years, all vendors will be offering completely interoperable systems, he added. By this point, providers won't need HIEs to translate documents for them.