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How to achieve interoperability of health information systems

Creating interoperability of health information systems is harder than it needs to be, a group of experts says. Here are the solutions they think will work.

It's question time during a session about interoperability of health information systems at the Health IT Summit...

in Boston. An audience member made a comment about data blocking: "The vendors say they don't do it."

To which Laura Adams, president and CEO of Rhode Island Quality Institute, a nonprofit that provides the statewide HIE, concisely replied: "Yes they do."

Considering interoperability happens seamlessly in other industries, the fact that it isn't occurring as much as it should in healthcare is frustrating.

Dave Levin, M.D., chief medical officer at SansoroHealth -- a health IT company in Minneapolis that sells an interoperability application via APIs -- and the moderator of the panel, said healthcare compares poorly to well-known companies : "How come Amazon and UPS can tell me where my package is from shelf to doorstep? How come Google was able to show me all the flights home from Boston regardless of who the carrier was and all the prices? But in healthcare, my PCP has no idea what happened to me in the ED across town last night?"

Many health IT experts, including those on the panel, assert that data blocking is not a problem with technology, finances, legalities or business operations.

"Many of us have concluded the real barrier is political," Levin said.

Barriers from under-appreciation of patient data

But Adams said that another major barrier is the fact that providers don't realize and appreciate that they will need patient data from everywhere.

The institutional EHR starts to look like a commodity.
Adrian Gropper, M.D.CTO of Patient Privacy Rights

"People say, 'No problem. My patients pretty much just go to this hospital. They pretty much just go to these labs,'" Adams said. However, that often is not the case. "We can sit with the ACO [accountable care organization] and say, 'You have a 40% leakage problem because we can tell you that your patients are not going to the hospital that you think they're going to. That 25% of them are being admitted over here to this ED.' ... If you just never study where your patients go, you just have a lot of assumptions."

Ultimately, she said, this situation means providers don't drive health IT vendors towards interoperability.

Experts laud APIs and patient-centered records

According to Adrian Gropper, M.D., CTO of Patient Privacy Rights in Austin, Texas, alternative payment models alone are not the answer, especially when it comes to stopping information blocking.

Gropper, Levin and other experts outlined two technology approaches that they said will create interoperability and stop information blocking: APIs and patient-centered health records.

Levin believes open APIs and web services are a big part of the answer when it comes to the technical barriers of creating interoperability of health information systems. Although APIs may be new to healthcare, Levin said they have worked in other industries.

Robert Havasy, executive director of Continua Health Alliance, an international nonprofit of nearly 240 healthcare organizations based in Beaverton, Ore., and vice president of Personal Connected Health Alliance, a collaboration between Continua, mHealth Summit and HIMSS focused on engaging consumers via personalized health solutions based in Arlington, Va., agreed with Levin and explained that the reason why APIs are so successful in other sectors is because the user experience is often a pleasant one.

"For the [users] going to Google, for the [users] going to UPS, stuff just works," he said. "When things just work easily, people use them and they grow."

Patient responsibilities debated

Meanwhile, to Gropper, patient-centered health records are key to the success of interoperability of health information systems.

"This means, effectively, that the institutional EHR [electronic health record] starts to look like a commodity," he said, adding that the way to achieve this will be to design for outcome rather than process -- in other words, value-based care.

But Gropper suggested more than that. He's argued that decision support at the point of care should be independent of the EHR and in the hands of the patient. "If that ... decision support is available independently of the Epic system or the particular hospital where it's installed in, then you've won because now [patients] have market power," he said.

But Adams warned against putting so much responsibility on the patient via patient-centered health records and patient owned data. Although she supports the idea of patient-controlled exchange and patient-controlled data, in the end, she said it would be overwhelming for patients to be in charge of gathering all their health data from all the various healthcare organizations they have been to and sought care from.

She knows this from personal experience when she battled breast cancer not too long ago.

The last thing Adams wanted to do was deal with making sure her health data got to the various healthcare organizations she was receiving care from.

"I wanted someone to get that done for me and make it accessible to me," she said.

Next Steps

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