Six healthcare interoperability barriers to watch

Is interoperability in healthcare a dream, or will payers, providers, and technology vendors finally come together to make data more available to one another?

An April 2016 survey by Black Book Market Research found that 83% of physician practices and 40% of hospitals admit that they are still in the planning and catch up stages when it comes to sending and sharing healthcare data.

Patricia B. Wise, RN, MS, MA, FHIMSS, retired Army COL., vice president of the Healthcare Information and Management Systems Society (HIMSS) says interoperability is the “biggest barrier” health systems are facing.

Here are six reasons it is so difficult for healthcare systems to get their information to flow more smoothly.

1. The variety of EHRs and EHR interfaces

WiseMost health systems aren’t using electronic health records (EHRs) right out the box. Though EHRs are government certified to meet efficiency standards, they often need hundreds of customizations to make them user-friendly in the workplace. “In hospitals, CIOs are putting these systems in a test environment, and there can be hundreds of unique interfaces,” Wise says.

Customizing EHRs through unique interfaces is one of the biggest issues when it comes to interoperability because it increases the complexity required to share information.

Addressing interoperability is also not the only issue healthcare systems face when it comes to EHRs, which means it is not always the top priority. For example implementing and maintaining EHRs can be a strain financially. The Office of the National Coordinator of Health IT (ONC) estimates that the cost of an in-office EHR system at $33,000 and a software as a service (SaaS) system at $26,000. However, maintenance costs can reach $4,000 for in-office systems, and $8,000 for SaaS, annually. Many health IT experts say that this is a conservative estimate when considering new modules and technology, reporting, and support if something goes wrong.

Installing and optimizing an EHR system can also be a tedious process, especially when making that system function properly within a work culture, says Wise.

Next: The growing number of data sources

2. The growing number of data sources

JonesSixty million fitness, activity, and sport trackers will be sold in 2016. That number could increase to 187 million devices by 2020, according to the CCS Insight's Global Wearables Forecast released in February 2016.

Providers are still wrestling with the relevance of patient-generated health data from wearable health technology and smartphones. But as the market continues to grow, finding ways to store, share, and use data from patients with chronic conditions, elderly patients, wellness programs, and from remote patient monitoring will be a key interoperability issue. Yet, many health systems lack interfaces that can interact with the emerging technology.

Creating fuller health records that can gather this medical information, and also payment and behavioral information, is a future application that requires more layers of interoperability, says Leroy Jones, CEO of GSI Health, a cloud-based healthcare software company. “Other information that is important to the care plan, such as behavioral health and psychosocial information is not the same nature as medical information. Integrating this information into new sources is an emerging challenge,” Jones says.

3. New partnerships that increase complexities

CrislerAs larger hospital systems acquire smaller practices, getting all of the IT systems to work together can be a budget buster, says Beverly Crisler, director of service delivery for Peak 10 Atlanta data centers. “When IT staff is figuring out how to integrate records into a larger system, it can be time consuming. These systems include scheduling, call center management, and possibly paper records. It can be cumbersome, but it’s a necessary part of an acquisition that isn’t always considered,” she says.

Crisler suggests a thorough audit of a potential acquisition’s IT system-not just by the CIO, but a taskforce that includes IT staff and system users. “It doesn’t need to be intrusive, but you need to know what you are buying before signing the dotted line.”

Crisler says an interoperability game plan with a reasonable timetable should be a crucial part of the buying decision. “The CIO can have a business conversation about the areas of concern and ways to respond. The more IT staff is involved in acquisitions, the better for practitioners and patients,” Crisler says.

Next: Payer participation challenges

4. Payer participation is critical, but challenging

Payers have large amounts of information that would be helpful to providers when creating comprehensive care plans for patients, but have been slow in participating in interoperable systems, Jones says. “The question is, do payers want to participate? They have a treasure trove of information about patients that they don’t contribute in the same way providers do.”

For example, payment information for high-risk patients, and those with multiple medications, could be insightful for providers when creating care plans, he says. “[Payers] could offer pre-adjudicated claims and actually be a part of the care teams. Payers could add more value the same way a provider team does.”

More than 90% of payers say they are leaving public health information exchanges (HIEs) to work with regions and states to create private HIEs, according to the April 2016 Black Book Research survey that included 2,300 payers using HIEs. This could leave providers with yet another expensive technology change, as they work to ensure their technology is compatible with the new HIEs.

Jones says that as more value-based care models are introduced, more collaboration between payers and providers will be essential. “Payers are moving to new models, and sharing information has to have a purpose, not just principle. Some of the things we did in the past, such as HIEs, are not as valuable,” Jones says.  “When asked to create care plans, there will be less emphasis on HIE and EHRs, and more emphasis on common care plans, alerting patients and practitioners, real-time feedback, and a broader assessment of what patients need.”

Next: Standards that don’t always lead to uniform approaches

5. Standards that don’t always lead to uniform approaches

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was introduced as a way to establish more value-based models, and to repeal the controversial Sustainable Growth Rate. In April 2016, the Notice of Proposed Rulemaking for MACRA was released by CMS, and it outlined several ways interoperability would be prioritized. This includes health IT certificate surveillance, HIEs, and assessing data blocking and work flow real time.

“If [MACRA] goes through, it will be a tremendous step forward in understanding and getting to solutions around interoperability. It will help the ONC understand the real-world challenges in health systems,” Wise says. The final rule MACRA had not been released at press time.

SensmeierThe ONC has made interoperability a priority in its 10-year interoperability roadmap. In the next two years, the organization aims to see widespread implantation of standards and support systems that will aid software development. “One challenge with these implementations is that the standards are not always being implemented in the same way,” says Joyce Sensmeier vice president of Informatics for HIMSS North America. “So, even though two systems have implemented the standards, the systems are not necessarily interoperable.”

Sensmeier says that Integrating the Healthcare Enterprise (IHE), which works to promote technology standards in healthcare, has addressed this challenge by publishing profiles that describe specifically how to implement standards for a particular use case or case scenario.

To add further rigor to the goal of interoperability, HIMSS has launched a certification program for EHR and HIE products (ConCert by HIMSS), so that vendors can take their products through a rigorous process of testing and certification, monitored by a neutral certification body, to achieve a seal that the products deliver the interoperability that was promised. “This seal will provide more clarity in the marketplace so that provider organizations will know which products deliver interoperability prior to purchase,” Sensmeier says.

Next: Work flow issues

6. Staff work flow issues

“You need to think about interoperability as having two layers, one about data and the other about work flow,” says Charles Webster, MD, MSIE, MSIS, a medical informatics marketing/ work flow technology expert, and president of EHR Workflow, Inc. “We are making great progress with the data layer. Part of the reason some don't think so is that they are blaming lack of progress on problems in the data layer when they should really be thinking about the work flow layer. You need work flow engines executing models of work flow [collections of tasks] to make data useful and actionable.”

Webster says that making sure staff work flow related to information input and exchange is running efficiently is a valuable investment.

“Interoperability is not just about interoperability standards; it is also about actual integration of work flows between healthcare organizations,” he says. “Go to your frontline staff, those who know your organizations work flows base, and create automated work flows within your organization and between your organization and your partner organizations.”

Donna Marbury is a writer in Columbus, Ohio.