“Interoperable” – A Lifesaving Word

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By Zach Finn, CEO Centralis Health

Have you heard of interoperability in health care? If not, you’ve escaped the relentless parade of vendors, regulators, trade associations, and computer scientists droning on and on over the last quarter-century. Want an example? How about this little ditty from the non-profit Healthcare Information and Management Systems Society 1(HIMSS): “It is the ability of different information systems, devices and applications (systems) to access, exchange, integrate and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries to provide timely and seamless portability of information and optimize the health of individuals and populations globally.”

If you’re like me, you understand these words in English and even recognize a few concepts in that statement. But, man, I’m really not sure what those concepts look like in the real world. Fear not! I’m going to offer a story so we can discuss the most recent rules and regulations flowing from CMS and others.

Let’s try putting interoperability into the context of patient care. A man shows up at a gastroenterology appointment and meets the doctor for the first time. “What brings you in today?” the doctor inquires. The patient says, “I’m not really sure. My regular doc saw something during my physical.” 

Here’s where interoperability play comes in.

The doctor says, “Give me just a second,” and turns to her computer. There she can see that the man’s primary care physician was concerned about a potential hiatal hernia and sent him to a general surgeon for a consult. This surgeon wanted a fuller picture of the man’s condition and sent him to the digestive clinic for a full evaluation prior to making a judgment on his suitability for a surgical solution.

The interoperability allows the gastroenterologist to pull up the information and see the patient’s prior visits, physician’s notes, and lab results in her examination room, without having to call three or four locations, request records, and wait (potentially for days) to get the information necessary to play her role. She can gain the insight she needs immediately and deliver to the other providers her contribution to the care of that patient without the “overhead” of coordination of care (i.e., it saves a bunch of labor).
So, our gastroenterologist just “interoperated.” A verb, an action, and a result that provides faster, more effective treatment.“This sounds wonderful!” you say. “Why aren’t we doing this right now?!?”

If you were to ask most HIT professionals, regulators, or vendors, all would say that we are close – but some daunting barriers still exist. Most prevalent is something called Information Blocking. In simple language, information blocking is a practice that is likely to interfere with access, exchange, or use of electronic health information (EHI). Sadly, many providers, vendors, networks, and even health information exchanges (HIE) have these practices in place.

The good news is that government regulators understand that we must stop this information blocking if we are to interoperate (notice the verb). And they have published a final rule (official regulation within our governmental system) that says in essence, “Thou shalt NOT block information.” This rule is called the ONC 21st Century Cures Act and it covers providers, Electronic Health Record (EHR) vendors, and HIEs. Of course, as with all regulations, there are hundreds of pages clarifying what is and is not information blocking.  Long and short, it’s complicated. There are endless nuances of data formats, networks, protocols, semantics, and yes, politics, money, and fear. Competition among different EHR vendors and health systems often results in each refusing to share information, creating barriers that limit access, exchange, or use of patient information. EHR vendors have been reported to engage in information blocking practices, including artificially high prices and restrictive contract language. HIEs interact with health care providers with the goal of establishing connectivity and sharing information for the overall benefit of the health care landscape. 

One Florida firm specializing in navigating these difficult technical and regulatory waters is Centralis Health. Centralis is the only vendor and participant(handling both technology AND legal regulatory paperwork) on the national eHealth Exchange. The exchange typically connects hospitals, medical groups, pharmacies, and other sites of care within federal regulations. Centralis Health’s recent addition was a landmark and shows it is a trusted entity in this space.

After all, when it comes to the efficient sharing of data, a patient doesn’t want an ER doc waiting for a fax to learn a key aspect of the patient’s history. A pharmacist will want to instantly see what other medicines a patient is taking for unrelated conditions in order to make sure the drugs are compatible. And a change in primary care physician shouldn’t involve a data transfer that requires an army of IT professionals.

 1 https://www.himss.org/resources/interoperability-healthcare#Part1

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