Removing to Obstacles Achieving Healthcare Interoperability

September 23, 2019 - Over the last decade, the healthcare industry has undergone an intense digital makeover, with providers shifting from paper-based charts to electronic health records (EHRs). The HITECH Act in 2009 was introduced to stimulate the adoption and meaningful use of EHRs, and today nearly all hospitals, health systems, and most practices are using them. 

With widespread adoption, the expectation was that EHRs would relieve documentation burdens and that patient records would be easier to share, aggregate, and analyze. But here we are today, a decade after the HITECH Act, and the healthcare system continues to struggle with interoperability, creating barriers to effective population health and coordination of care, and negatively impacting outcomes, innovation, and patient experience.

So why is the industry still struggling with interoperability? Three broad categories experts often refer to as roadblocks to interoperability are business disincentives, technical challenges, and network effects. In this article, we are going to take a look at the first category and see if there may be ways to flip some classic disincentives and view them as interoperability incentives.

Business Disincentives

Health systems — like other business — compete for customers and patients, and they generally do not want to make it any easier than necessary for patients to take their business and records to a doctor at a competing facility. While the difficulty of transferring patient records may not play a huge role in keeping patients from switching, it is a factor, and health systems certainly have no strong incentive to prioritize portability over other IT initiatives.

Another concern for health systems is sharing what they see as valuable proprietary information with competitors. If a competitor is able to access data on a health system’s patients, that may allow it to target high-value patients or potentially gain insights into sensitive clinical or business practices.  These types of concerns often impact provider organizations’ willingness to facilitate data sharing.

So where is the industry headed? 

Earlier this year, the Office of the National Coordinator for Health IT (ONC) issued a new set of proposed rules, including an information blocking rule. If implemented, the concept is that patients will have increased access to their medical records and healthcare entities will no longer be able to withhold information from them or their doctors. The rule also outlined the following seven conditions that would exempt interfering actions (from healthcare providers, developers of certified health IT, health information networks, or health information exchanges) from being considered information blocking:  

• Engaging in practices to prevent patient harm
• Engaging in consistent, non-discriminatory practices to protect the privacy of electronic health information
• Implementing practices to promote the security of electronic health information
• Performing maintenance or improvements to health IT performance with the agreement of the user
• Recovering reasonable costs to allow for the access, exchange, and use of electronic health information
• Receiving a request to provide access, exchange, or use of electronic health information that is infeasible because the request would impose a substantial burden that is unreasonable under the circumstances
• Allowing for the licensing of technical artifacts to support the interoperability of EHI on reasonable and non-discriminatory terms

The information blocking rule will transform interoperability initiatives from strategic efforts to compliance programs, which will require a shift in psychology and approach. While slower-to-adopt organizations will be forced to comply with new regulations, organizations that are already ahead of the game will need to look beyond the compliance mentality. Organizations should still seek innovative approaches to achieve or extend leadership, in addition to complying with new regulations in order to continue building interoperability as a strategic asset.

Increasingly, these traditional disincentives to interoperability will flip to become incentives.  In a world where record portability is mandated, organizations that do it best (quickly, accurately, and shareable with any destination system) will enjoy a competitive advantage in the form of better patient experience. Similarly, concerns about sharing sensitive data with competitors will be overshadowed by the benefits health systems with strong interoperability foundations can reap from access to de-identified population health data to help improve outcomes, efficiency, and patient experience.

Now that we have looked at the business disincentives affecting interoperability and what is currently being done to address it, keep an eye out for part two of this article series where we will examine some of interoperability’s higher-level technical challenges.

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ABOUT THE AUTHOR

Lyniate partners with healthcare organizations around the globe delivering cutting-edge solutions to address interoperability challenges. Our industry-leading products, Corepoint and Rhapsody, are used by thousands of customers to send hundreds of millions of messages every day. Lyniate is committed to delivering the best interoperability solutions for healthcare organizations, from specialty clinics to large networks, from payers to vendors, and everything in between. We’re building the future of interoperability.