As the federal government and many patients push for a national electronic exchange of health information, big EHR vendors like Meditech will have a lot of say in how quickly we get to that point.
As part of its series on health IT interoperability, Becker's recently talked to Mike Cordeiro, senior director of interoperability market and product strategy for Meditech, about what it will take to get there. Mr. Cordeiro has worked in this arena since the inception of the meaningful use requirements for hospitals and witnessed the subsequent evolution of electronic health data sharing. (Read parts one, two, three and four of the series here.)
Note: Responses have been lightly edited for clarity and brevity.
Question: How has EHR exchange evolved since you started working in the space, and what it will take to get to full interoperability?
Mike Cordeiro: Prior to the federal government pushing for more open exchange of health records, interoperability was pretty much relegated to connecting the EHR with peripheral devices and specialty devices like PACS [picture archiving and communication systems] and Pyxis machines. And that evolved to exchanging lab results and medical summaries.
The federal government has mandated the exchange of data through its meaningful use programs for interoperability and the Cures Act, and that has pushed the topic to the forefront and actually forced vendors to more openly attempt to exchange using methods and schemas defined by CMS. So as a result of government involvement, we've progressed a bit with our ability to exchange records across care settings.
What we need to do is continue to evolve it, and that is predicated on vendors and providers actually seeing the value of having that data exchanged. So, today in time, we're exchanging structured documents for treatment purposes, for instance. But there are large payloads of data, and clinicians are having to comb through pages and pages of multiple documents to find the relevant pieces of data they want at the point of care.
So as health systems see the value and push for more streamlined workflows and more defined use cases, the burden of looking at all this data and trying to make sense of it from a clinician standpoint will improve, especially as technology improves and the standards improve.
That includes the work the FHIR at Scale Task Force is doing with finding how to share discrete data via FHIR [the Fast Healthcare Interoperability Resources exchange standard] in the hopes to get the right data at the right time to the right person, as opposed to having that person comb through large data sources to figure out what salient points of data they need to treat the patient.
Q: What are the challenges of getting to full interoperability?
MC: Healthcare data is complex, right? So it's really about the ability to map concepts and data, the ability to share the right pieces of data at the right time for the right person as opposed to just disseminating everything you have in hopes that the recipient will parse through those large payloads. Privacy and security also are concerns, as health systems have to safeguard the data as well as share it.
As the government continues to iterate on its programs, there's a bit of a burden on health systems to deploy the new code, to support the new technology, implement it, test it — and once they start rolling it out, there's another set of standards potentially, or another regulation that they need to comply with — and then they have to do it all over again. And that competes for resources with other projects that these health systems have to do.
It's not as easy as just defining a standard and exchange model. It's then ensuring that you're gathering the data in the right way, the data is codified, the data is triggered when it's supposed to be triggered, etc. So there are multiple complexities to rolling out some of this stuff.
But as the government seems to be moving from penalties to incentives for the adoption of some of these programs, I think that'll actually help with some of the challenges health systems have in quickly being able to adopt ever-changing regulations. And instead of deploying standards for the sake of meeting a government regulation, they're actually able to have some time to deploy standards in a meaningful way and measure outcomes.
Q: Where are we at now as a healthcare system in terms of interoperability?
MC: At this point, we have defined standards for sharing data. That could be FHIR. We have networks that facilitate the exchange of data. With [the 21st Century Cures Act], the ONC has put other frameworks in place to ensure that there's regulation and conformity between those networks.
Now it's simply a matter of working with health systems and other vendors to promote value, measure outcomes, and improve implementations for how the data is shared.
Q: What are the benefits of health IT interoperability to patients and the health of the public?
MC: It's really putting patients in charge of their health journey and their health outcomes. So they actually have access to their health records and are able to share their health records with the providers that are caring for them. And they're able to ask questions based on the information they have access to.
It's a clinician having access to a patient's record when they're treating that patient, especially when that patient arrives at an unscheduled care setting. It's a patient going from their [primary care provider] to a specialist and not having to re-explain their [medical] history. Then, of course, there's the cost reduction with not repeating tests.
Q: Is Meditech doing anything else to advance interoperability?
MC: Meditech has been participating in a number of different workgroups and collaborating with the vendor community. We're participating with the FHIR at Scale Task Force under the pretense of getting the right data at the right time to the right person. So sharing that discrete FHIR data.
We're participating in CommonWell [Health Alliance] and facilitating the exchange of data through exchange networks. We're participating in HL7 Argonaut workgroups for defining implementation guides for how to adopt buyer standards. So interoperability is definitely something that is a pillar of ours and something that we are heavily invested in and want to push for.