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  • Luis Montes

ONC Annual Meeting - It's All About Interoperability

Healthcare has been waiting for interoperable systems for a very long time now. In fact, we’ve been talking about this for so long that the industry (me included) may have had lost some hope on the promises of a hyper connected healthcare world. I know some people who don’t even like saying the word “interoperability”. I must confess however, that after attending the ONC’s 2017 Annual meeting in Washington, DC this month on behalf of Casamba, I have some renewed hope.

 It is always interesting to look at health IT in the light of both private sector giants and government regulators – specially while they are all gathered in the same room! Albeit these two groups often time share opposing view-points, when it comes to the ‘connectivity’ of healthcare they all share one theme in common: interoperability of health IT systems is not only changing the way we do healthcare, but it is unquestionably becoming an essential component of cost effective patient care.

It is no surprise then that healthcare interoperability and health IT usability were at the core of this year’s meeting. Both private and public healthcare stakeholders in attendance recognized that interoperability – or the ability to allow systems to communicate and securely exchange data within health information technology (HIT) systems and medical devices – is currently playing a critical role in a healthcare landscape that is clearly moving towards value based care.

Interoperability and the standardization of data elements used to exchange patient health information (PHI) is also at the center of Medicare’s triple aim goal of improving patient care experience; improving the health of populations; and reducing the per capita cost of healthcare. This has been exemplified by the 21st Century Cures Act which makes application program interfaces (APIs) in EMR the law. One aim of this Act is to make digital health data more accessible, emphasizing the use of API’s in healthcare to increase electronic medical record (EMR) interoperability and improve patient records matching. 

Advances in the field of information data exchange and new proposed data standards are now allowing providers to start sharing patient care information much more efficiently than in previous years. Open application programming interfaces (open API’s) such as SMART on FHIR (a set of open specifications for integration with EMR records, portals, health information exchanges and other IT systems), RESTful APIs and even early attempts at using Blockchain technology are also enabling innovators to create apps that seamlessly and securely run across EMR systems. These technologies are allowing developers to connect to the EMR in a much more fluid and dynamic way. By using an EMR system or data warehouse system for example that supports the SMART standard, patients, doctors, and healthcare provider can draw on this library of new apps to improve clinical care, research, and public health. We are already seeing this at work in some major healthcare systems across the country who are integrating with new third-party healthcare app vendors. 

Achieving full scale interoperability across the healthcare system is a daunting task, however these technologies and standards are getting us closer to that reality. The benefits for stakeholders will be valuable at multiple levels:

·        Patients will be empowered to have access to their medical record in real time and allow their own health data to seamlessly travel with the them anywhere they go no matter what provider or health system their PHI resides in. This was a key focus across the private sector and governmental agencies that attended the conference.

·        Healthcare providers will have quick access to the data they need from other institutions to provide care to their patients and reduce medical errors. In other words, providers will be able to tap into the data they need at the time they need it.

·        Healthcare Institutions will be able to streamline data aggregation across the entire institutional system throughout the county. Healthcare institutions will no longer be bound to using only one EMR brand simply because it interfaces across departments. Open API’s will allow the institution to pick the best system and apps based on the specific departmental workflow needs.

·        Public Health organizations will be able to gather data from highly interoperable heath systems to study trends across population health such as epidemic and public disease trends.

·        Innovators and developers of new health IT applications will be able to seamlessly connect to the EMR system and rapidly launch and scale new technologies that can have high impact on the care of patients. Companies such as Allscripts for example have created an ‘app store’ type of ecosystem with open API’s that allow third party developers to rapidly interface with their own EMR systems. Biotech and pharma industries will also readily have access to large data banks for clinical and pharmaceutical research.

The combination of interoperability and the complete digitalization of healthcare through the electronic health record is inevitable leading to an explosion of healthcare data. This is transforming healthcare and allowing the industry to more effectively shift to a pay-for-value system. Advances in big data analytics, machine learning and artificial intelligence will disrupt our healthcare system in a very positive way. A clear example of this is already happening in the field of genomics and research within population health management.  This is evident in the market place as EMR systems like Cerner are collaborating with tech giants such as Amazon to leverage the power of this data. Moreover, companies like Alphabet (Google’s parent company) and Apple are also looking at various ways in where they could themselves (or in collaboration of an HIT partner) leverage big healthcare data for various different patient or provider use cases.

Given the ubiquity and importance of EMR systems in healthcare today, usability of electronic medical records (EMR) also play a pivotal role in the delivery of care and as such was also at center stage during the conference. Since the HITECH Act of 2009, we have seeing a rapid proliferation of the EMR across the acute and post-acute care (PAC) environments and almost 95% of all healthcare systems now have some type of electronic health records in place. The rapid growth has not only led to an incredible aggregation of data across systems but has also created a new way of providers and patients to interact with one another. EMR systems still have a long way to go in terms of providing a seamless provider user - patient experience. Physicians more often than not still face their backs to patients as they are typing in a PC monitor while patients are talking to them.  And often times, healthcare providers still have a hard time extracting exactly what they need from the EMR at the point of care without been clouded with extra data that is not pertinent to the care of their patient.

However, advancement in the field of Human Factors (how machines interact with people or end users) as well as improvements in implementation standards and EMR training best practices are improving the overall usability and experience of EMR systems.

Government regulations certainly play a vital role in the usability of software. Providers feel the burden of this regulation and EMR systems must have checks and balances in place to comply with these regulations. Seema Verma – Administrator for the Centers for Medicare and Medicaid – in a keynote address publicly recognized the need to decrease the regulatory burden on providers so that they can better focus on patient care (an initiative she called “Patients over Paperwork”). Over regulation tends to not only overburden providers but also put a tax on EMR vendors who have to develop excessive technological resources to meet regulatory compliance rather than investing those resources into innovation.

Good things often happen when government and the private sector collaborate in innovation – the internet and GPS are two examples that rapidly come to mind. Given that interoperability is at the center stage of both of these groups I have some renewed hope in an interconnected healthcare system. My hope is renewed by the fact that we have the technology and standards in place to make this happen and that in a way, healthcare is already in the middle of this transformation. Patients, providers and anyone involved in the delivery of healthcare are depending on it.

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