Today's healthcare landscape in the U.S. is awash in patient data, but organizations are often unable to use that data to its fullest potential, because much of it remains locked within disparate systems. It is less of a problem in nations with standardized health IT systems. Despite the known merit in full interoperability, the U.S. has yet to reach that point.
Here are the biggest hurdles to interoperability in the U.S., according to eight healthcare leaders:
Editor's note: These answers have been edited lightly for clarity and brevity.
Question: What is the biggest hurdle to achieving full interoperability?
Zafar Chaudry, MD. Chief Digital Officer, CIO, Seattle Children's Hospital:
Hurdles to interoperability revolve around the speed at which stakeholders can be coordinated via data sharing agreements; The ability to enforce and measure interoperability standards across healthcare providers and payers; the ability to enforce the end of information blocking and impediments to data sharing; and most importantly, the ability to find a standardized way of identifying patients. [Regarding patient matching,] we've had no real conversations on blockchain. It seemed to be gaining momentum just before the pandemic, but nothing much since then. I don't think it will mature within the next five years. Other countries have tackled this, such as in the U.K., where more than 90 percent of patients have a National Health Service number assigned to them, typically at birth. I continue to keep a close eye on the evolution of application program interfaces and fast healthcare interoperability resources to enable open and connected communities of health that focus on care coordination and patient experience.
Breanna Cunningham. Founder, Code Technology (Minneapolis-St. Paul):
Julie Doehrmann. Vice president of technology, Code Technology:
Without an understanding of clinical workflow, access to discrete data elements can be somewhat meaningless. EHRs and practice management systems are very configurable, and what works for one customer in identifying their data might not work for others.
So it doesn't matter what mechanism you use to develop the interoperability — whether you're using Health Level Seven, a comma-separated values report or third party vendors, you still have to understand how the individual customer is utilizing data elements in their system. There is no shortcut to this process; you have to take the time to understand how the data flows and how the system is being used to create a successful integration.
Rick Smith. Director of IT, Cibola General Hospital (Grants, N.M.):
Cost and lack of adherence to established standards are the biggest hurdles. Any time I consider an additional interface, the cost is typically $25,000 plus ongoing monthly maintenance. No EHR vendor has a solution without additional third party applications — not even [cloud-based EHR platform] Cerner CommunityWorks.
Pavan Attur. CIO, Hudson Regional Hospital (Secaucus, N.J.):
The biggest hurdle is the lack of a federal mandate requiring healthcare organizations to share data among all organizations, as it will help improve patient care and minimize duplicate tests that lead to increases in cost of care.
Another challenge is some EHRs' [lack of] capability to have bidirectional interfaces to send and receive protected health information from other systems.
Patient matching is another issue. Every system has a unique patient account number, and matching is a major challenge since many patients have the same first or last names and some don’t have Social Security numbers.
Aubrey Prince. Vice president of business development, HyperTargeting Medical (Billings, Mont.):
In a word, innovation. Companies who are constantly working to improve on the status quo create the differences that separate them from competitors. That separation gives practices the ability to engage with technologies that in turn put them in a better position over competitors. Having a standardized system that does not reward innovation quickly becomes a dinosaur in a technology environment that is progressing exponentially.
Allen Van Driel. CEO, Smith County Memorial Hospital (Smith Center, Kan.):
The biggest hurdle is the lack of vision and will to create a truly interoperable system. There remain far too many "silos" in healthcare: Physician clinics that don’t see the need to communicate with other physicians or hospitals out of fear of losing a patient; Hospitals that don’t or won’t communicate with other hospitals involved in a patient’s care because of misunderstanding of HIPAA rules or processes, lack of common interfaces between disparate EHRs, or a host of other reasons; Lack of connectivity between various types of providers; Post-acute providers (including skilled nursing facilities, long-term acute care hospitals, home health, and long-term care facilities) don’t share data with primary care physicians or hospitals electronically; And pharmacies that don’t use electronic communications for prescription renewal.
The list goes on, but it all boils down to lack of a strong vision of true interoperability that would make the patient’s health record available to those with a legitimate interest in caring for the patient.
Q: What interoperability technologies or solutions are you paying particular attention to?
Michael Sheerin. Senior vice president, Rothman Orthopaedic Institute (Philadelphia):
For Rothman Orthopaedics, we are focused on diagnostic imaging-sharing platforms and health information exchange technologies. The ability to seamlessly share studies and access patient information from other data sources is critical to efficiently providing value-based care. When working with our health system partners, developing solutions to monitor, manage and improve network integrity has been a priority.
Ms. Cunningham and Ms. Doehrmann: Because CMS is promoting an HHS-wide move to FHIR APIs, we are keeping a close eye on this technology.
Mr. Smith: No one interface is bulletproof. If we as an industry could standardize on a singular technology, IT directors could sleep better at night. HL7 and APIs are fine, but there is no standardization even within those technologies.
To make matters worse, there is no cost-effective solution to monitoring those interfaces. HP Openview could do the job, but the cost of acquisition (licensing, hardware, staff, training and hours involved in managing) is simply untenable for a 25-bed critical access hospital.
Mr. Attur: Hopefully we will have some regulatory guidance and incentives for participating in data sharing. At our organization we are connected to our NJ State health information exchange, but it's only unidirectional.
Dr. Chaudry: I continue to keep a close eye on the evolution of APIs and FHIR to enable open and connected communities of health that focus on care coordination and patient experience.