Editor’s note: This article is the first in a three-part series on common barriers to population health management. In Part 2, “At the Heart of Population Health: Data,” Dr. Jain examines how gaining access to information and knowing how to use it are the keys to population health management. In Part 3, “How Hospitals Should Build a Data Infrastructure,” Jain addresses the challenges of building the right infrastructure.
Although health care providers are making great progress in their push toward coordinated value-based care, interoperability among information systems remains challenging.
According to one recent survey by eHealth Initiative and Premier of 68 public and private accountable care organizations, 85 percent have technologies in place that allow them to capture and interpret data from the various information systems within their organizations. But most are challenged with integrating data from out-of-network providers.
More than two-thirds of them are having a particularly hard time assimilating information from specialty-care settings — in-network and out-of-network alike — despite their investments in health information technology.
Interoperability is critical
It’s easy to see how interoperability might be the key to coordinated care. If an organization is to achieve better outcomes for a defined population at lower cost, its many clinical and administrative systems must be able to communicate and exchange relevant data.
The problem, of course, is that organizations typically are not able to do so. “Information systems are designed for the unique needs of different settings and specialties,” reads a report put out by the eHealth Initiative and Premier team in the wake of its survey. Because systems lack a “common language” to facilitate information sharing, interoperability “is often nonexistent or requires complex interfaces for standardizing and transmitting data.”
Without interoperability, it’s impossible for providers to know for sure if a patient’s records are comprehensive. And without key information from disparate systems collected and available in a single place, it’s impossible to use data analytics to develop the insights that ultimately improve performance. Although that exchange of information is often not enough, it is a key first step to make information that is subsequently actionable and credible.
What can health care organizations do to make interoperability a reality? Here are a few ideas:
Establish interoperability criteria. First, tackle the governance challenges and ensure that every stakeholder in your organization understands, supports and has the opportunity to contribute to your interoperability goals. You must have the backing of everyone involved, including your colleagues in the C-suite, your clinical analysts and the many clinicians on the front lines of patient care. Interoperability is more than just data integration. It’s also about connecting real people and communicating the value those connections provide.
Provide training as necessary and monitor adoption. As the report notes, providers “must purchase and learn to use complex health [information technology] systems that support data exchange for cost and quality outcomes monitoring, performance measurement and care coordination across the continuum.” While some providers may find these systems intuitive, others may think they just make life difficult. Plan on providing adequate training and support so that everyone feels comfortable with the technologies involved.
Monitor the use of the technology to identify the super-user providers who can then work with those who have trouble adopting. Consider the types of barriers and address them accordingly. For example, you will address barriers that are related to technology (such as usability and access) differently than you will address barriers that may be system issues. The latter may need to be addressed at a regional level by bringing together stakeholders from multiple health systems.
Stay current on regulations and choose vendors and partners who do the same. For interoperability to scale and succeed, data must be standardized to common terminologies (ICD-9/10, Current Procedural Terminology, Logical Observation Indentifiers Names and Codes, RxNorm and so forth) to be integrated and exchanged. Standardization is a technical endeavor, but thanks to the work of a group called Health Level Seven International, protocols like Fast Healthcare Interoperability Resources are in place that health care organizations can follow.
Likewise, it’s important to stay up to date on all regulations (like the Health Insurance Portability and Accountability Act and the Health Information Technology for Economic and Clinical Health Act) pertaining to interoperability, and to work with manufacturers, vendors and other partners that share your commitment to best practices. Identify any variations in privacy issues (state, local or organizational) that may limit the exchange of sensitive information to ensure that they are addressed.
Give specialists and out-of-network providers the assistance they need to achieve interoperability. Better communication with specialty-service and out-of-network providers can reduce errors and redundant procedures while minimizing the gaps that are common in patient care. But with incompatible systems, the need for data-sharing agreements and the legal restrictions pertaining to patient information, the act of improving exchange between such providers is easier said than done. A solution may be close at hand as new regulations make interoperability more feasible. Health care organizations can also facilitate the process by offering incentives that encourage providers to adopt the technology, processes and behaviors that advance the goal of interoperability.
Time for action
Although interoperability between disparate electronic health records remains a technology challenge, much can be done now to align providers, processes and partners to increase adoption.
Whatever you do, keep the end game in mind: Every step you take to connect your organization brings your providers and patients that much closer to the future of health care.
Anil Jain, M.D., is a vice president of IBM Watson Health and former senior executive director of information technology at the Cleveland Clinic. He continues to practice and teach internal medicine at the clinic.
The opinions expressed by the author do not necessarily reflect the policy of the American Hospital Association.