The idea of making EHRs work together, known as healthcare data interoperability, has become a hot topic due to healthcare standards and regulations such as the Cures Act Final Rule. This act, signed by President Obama, mandates that EHR systems must incorporate APIs to enable seamless data exchange. It emphasizes the importance of making healthcare data available to all stakeholders. Practices that impede data sharing may be considered ‘information blockers’ and can face civil fines of up to $1 million.
Now, let’s delve deeper into clinical data interoperability. We will define interoperability in healthcare, provide an overview of its standards, and discuss the core benefits and challenges.
What is Interoperability in Healthcare Information Systems (HIS)?
Interoperability is the ability of different systems, devices, and apps to collaborate and share information. It means they can access, exchange, and integrate data, even if they come from different organizations, regions, or countries.
In healthcare information systems, interoperability aims to streamline data exchange and reduce redundancies experienced by patients, providers, and payers. The outcome? A more efficient, coordinated, safe, and accurate patient experience.
Moreover, interoperability leads to fewer clinical errors, lower costs, and increased payer margins.
Examples of Interoperability in Healthcare
Here are the three schematic examples of the interoperability of healthcare systems:
Example #1: Appointment Check
Patients can use mobile or web applications to check their appointments quickly. Here’s how it works:
- The patient submits a request through the application.
- The application sends the request to the hospital information system (HIS).
- The HIS uses standardized messages to communicate with the electronic medical record (EMR).
- The EMR retrieves the patient’s appointment information and sends it back to the HIS.
- The application receives the appointment details, and the patient can view them.
Example #2: Hospital Transfer
When a patient needs a transfer to another hospital, the process can be simplified through interoperability. Here are the steps:
- Doctor #1 initiates a transfer request using their EMR.
- The EMR sends a standardized message to the EMR of the receiving hospital.
- The clinical data of the patient is transferred to the receiving EMR.
- Doctor #2 at the receiving hospital reviews and approves the transfer request.
- A standardized message sends The approval status back to Doctor #1.
Example #3: Lab Test Results Request
Doctors can request lab test results to provide prompt answers to their patients. The process involves:
- Patients ask their doctor to analyze their lab test results.
- The doctor submits a request using their EMR.
- The EMR sends a standardized request to the laboratory.
- The laboratory generates a standardized report and sends it back to the EMR.
- The doctor reviews the lab test results within the EMR and provides answers to the patients.
These examples show how interoperability helps in healthcare process improvement.
How Does Interoperability Impact Healthcare Delivery?
Interoperability enables providers to access prescription lists, discharge summaries, hospital admissions, lab test results, and healthcare plans. With access to this data, healthcare providers can make optimal healthcare decisions.
It reduces the likelihood of duplicated processes and tests. Interoperability also reduces administrative costs associated with manual and faxing workflows, while allowing organizations to enhance the efficiency of healthcare operations. This is because it minimizes errors.
Healthcare Interoperability Standards
Different categories of standards are used for interoperability in healthcare systems. The main ones are vocabulary/terminology, content, transport, privacy and security, and identifiers. Let’s overview them one by one.
Vocabulary/Terminology Standards
These interoperability standards in healthcare ensure that concepts in health information are represented clearly and consistently between different systems. They include codes and classifications for medical procedures, diseases, drugs, and other health-related terms. Examples of such standards are CPT, ICD-10, LOINC, and SNOMED-CT.
Content Standards
Transport Standards
Transport standards address the format and methods of exchanging health information between computer systems. They define protocols and architectures for secure and efficient data transfer. Examples include DICOM for medical imaging, Direct Standard for secure messaging, and FHIR for electronic health information exchange.
Privacy and Security Standards
Data security and privacy standards protect individuals’ rights over their health information. HIPAA in the US and GDPR in Europe are examples of privacy regulations, while the HIPAA Security Rule provides guidelines for securing electronically protected health information.
Identifier Standards
Identifier standards help ensure accurate identification and matching of health records. Examples include EMPI for patient identification within healthcare organizations, MRN for unique patient identification during hospital stays, and NPI for identifying healthcare providers.
Benefits of Interoperability in Healthcare
Interoperability in healthcare benefits patients by ensuring they receive improved care. It allows their healthcare providers to access all their medical information, including diagnoses, treatments, and medications. For providers, interoperability means faster and easier access to patient information, making their tasks more efficient and effective.
Decreased Errors
Medical errors, a significant concern in healthcare, contribute to many preventable deaths. Medical error ranks as the third leading cause of death in the United States (pre-pandemic), with 44% of these deaths considered preventable, as highlighted by a study published in The BMJ. While not all medical errors stem from inaccuracies in medical records, it is evident that some errors can be attributed to them. Data entry errors, particularly in medical records, often result in duplicate patient records, compromising the accuracy of patient matching and leading to inefficiencies such as redundant lab tests. Addressing these errors through improved interoperability can help mitigate risks, enhance patient safety, and optimize healthcare system resources.
Improved Patient-Centric Care
Achieving interoperability across this continuum of care becomes vital as it allows all providers to access a patient’s complete medical history, enabling them to deliver optimal and comprehensive care. A survey of U.S. health system executives and finance leaders revealed that 52% of respondents believed data sharing to be the technology with the most significant positive impact on the patient experience, emphasizing the transformative potential of interoperability in enhancing patient care outcomes.
Invoicing And Billing Process Simplification
According to Business Payment Coalition, adopting electronic invoices can lead to significant cost savings, with estimates suggesting that businesses can save $4 to $8 per invoice. For healthcare providers, such as a hospital issuing 2,500 invoices monthly, this translates to potential savings of $10,000 to $20,000 per month, highlighting the financial benefits of interoperability in making the invoicing and billing process easier and more efficient.
Challenges to Achieving Interoperability in Healthcare
Interoperability issues in healthcare have serious consequences, like compromised patient safety, increased clinician burnout, and significant financial losses. A study revealed that the lack of healthcare data interoperability costs the United States health system more than $30 billion annually.
Inconsistent Information in Multiple Sources
Providers store data in various locations and systems, resulting in fragmented and disparate data sets. This lack of standardized and harmonized information hampers the seamless exchange and integration of data across different platforms. It leads to inefficiencies and wasted time for health IT departments as they struggle to reconcile and synchronize data from different sources.
Verifying Electronic Patient Information Requests
As mandated by law, ensuring patient health records’ privacy and security is paramount. Providers face the challenge of determining when it is permissible to process electronic requests for patient information. Simply relying on the approval of their EHR provider is insufficient, especially with the introduction of new training and certification requirements under the Cures Act Final Rule.
Overcoming a Company’s Reluctance to Share Data
Specific stakeholders may have a vested interest in withholding data from other providers. For instance, hospital systems may compete with urgent care clinics for patients. It leads to limited motivation to share data when requested by these clinics through the hospital’s EHR system. Yet, the law mandates that health data should be accessible across organizational boundaries and to patients themselves.
Hiring Interoperability Management Professionals is Expensive
Achieving interoperable EHRs can be a demanding task requiring significant time and expertise. In many healthcare settings, it is challenging for a single individual to dedicate themselves to this responsibility. Moreover, hiring a qualified professional to maintain EHR interoperability can be costly, especially for smaller organizations.
Conclusion
To sum up, interoperability in healthcare information systems has become increasingly important in 2023 due to the growing emphasis on seamless data exchange and accessibility of healthcare data. This helps healthcare organizations make informed decisions, track population trends in healthcare industry, and follow regulatory requirements. It also fosters uninterrupted care coordination as healthcare providers gain seamless access to complete and updated patient information, regardless of where patients receive treatment. This synergy helps avert unnecessary repetition of tests, reduces the likelihood of medical errors, and guarantees that treatments are firmly based on the most precise and up-to-date data available. Interoperability is a key enabler for a more connected and collaborative healthcare ecosystem.
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