The average hospital generates 50 petabytes of data every year – but is that information being used to its full potential to support patient care? Without effective systems and policies to ensure interoperability in healthcare, most information is siloed within separate organizations; the result is a fragmented and often actively counterproductive information ecosystem.
This article explores how interoperability impacts patient health care and costs – using the latest research to reveal the most common barriers to data exchange and how organizations can solve them.
Health interoperability is the ability to send, receive, query, and integrate patient data between multiple different healthcare IT systems, devices, and departments. The result is a seamless and secure flow of information between multiple healthcare providers, researchers, and public health providers – regardless of geographic location.
The importance of this is reflected by recent legislation: the CMS Interoperability and Patient Access Rule creates a mandate for providers, payers, and third-party developers to eliminate data silos and ensure healthcare data can flow freely – ensuring patients can freely access their protected health information at all times.
Healthcare providers require a clear picture of patients’ medical histories to evaluate their needs and develop effective care plans – but this data often exists in multiple different systems. A patient may have moved hospitals or be using multiple providers for different healthcare needs. Interoperability ensures all information can be easily accessed and taken into account by the healthcare provider.
Rather than spending time manually sourcing data, the provider can quickly and easily access it within the patient’s electronic health record (EHR)
With faster access to more accurate healthcare information, a wide range of errors and challenges can be overcome – leading to dramatic savings for healthcare organizations. One research initiative estimated interoperability would save in four key ways
Shortening the length of stay through more timely transmission of critical information such as lab results ($18 billion)
The risk adjustment process is crucial to ensure healthcare providers receive accurate and fair reimbursements from insurance plans. But when a patient’s medical history is not easily accessible, physicians are forced to search for data manually. This often leads them to overlook or miss relevant diagnoses in the HCC coding – which leads to sub-optimal reimbursements.
Increased interoperability therefore helps to avoid coding errors and ensure providers receive the repayments they are entitled to. Data gaps are closed, physicians spend less time searching for data, and care costs are fairly covered by the insurance provider.
However, despite the clear benefits interoperability is still not widespread. Just 62% of US healthcare providers are able to send, receive, find, and integrate data – due to a handful of persistent technological challenges.
Interoperability is not a problem that can be fixed by a single party; it requires collaboration between different organizations or systems. But with a lack of fixed standards across IT systems, data formatting, and various other factors, sharing and receiving data can be extremely difficult.
The most common reason cited for a lack of interoperability is that the exchange partner uses a different vendor platform. Similarly, 52% of providers are unable to send data as they would like because their exchange partner does not have the right EHR.
Another major hurdle is the safety and security of information. Patient data is highly sensitive and therefore heavily protected by the Health Insurance Portability and Accountability Act (HIPAA), which polices the unauthorized disclosure of protected health information (PHI).
Sharing information between organizations and systems therefore presents a potential compliance problem. Governance and cybersecurity processes are required to ensure all data is protected and interoperability does not create security vulnerabilities – but these are complex, expensive, and time-consuming for most organizations.
Healthcare IT systems today are extremely complex, with multiple separate machines and digital touchpoints. Worse still, these tech stacks have often been assembled piecemeal, with a lack of consistent strategic planning; in fact, 83% of providers are running some outdated software.
Overhauling such systems and enabling them to share data safely is not just complicated – it can be extremely time-consuming and expensive. Many organizations
Each of the challenges above can be partly addressed by application programming interfaces (APIs), which allow disparate systems to exchange information and functionality in a discrete and computable fashion. Recent US policy interventions have focused on APIs as a core solution to interoperability issues, with the potential to make sharing data between different healthcare organizations easier and cheaper.
A simple example of this is Inferscience’s API: it enables seamless HCC coding data exchange among providers, payers, and third-party vendors. Not only does this support more accurate risk adjustment; it allows payers and vendors access coding analysis without having to develop complicated EHR integrations.
Want to explore how it could help your organization offer more value to patients and providers?
