Clinical Interoperability is Happening: How Will You Respond?

By Faisal Mushtaq, senior vice president and general manager, Clinical Networks, at Change Healthcare  

Interoperability is a complex issue that has plagued healthcare organizations for years. The sheer volume of patient data collected across the care continuum and stored in disparate systems makes it extremely difficult for patients, providers, and payers to access and share information when they need to. New legislation, however, is making seamless information exchange a requirement—and that could prompt real change.

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) are aiming to transform how healthcare organizations approach clinical interoperability. With recently updated rules that activate elements of the bipartisan 21st Century Cures Act, along with continued work on the Trusted Exchange Framework and Common Agreement (TEFCA) standard, the federal government is pushing providers, payers, and healthcare IT vendors to eliminate data sharing barriers and improve the fluidity of information exchange.

How can your organization go from where it is now to consistently exchanging the full complement of patient data?

A key first step is to join a nationwide network. The TEFCA legislation may require your organization to join a Qualified Healthcare Information Network (QHIN), which will allow you to better connect with other providers, exchange patient data, and do it at scale. Some of the existing platforms like CommonWell Health Alliance® and Carequality are well positioned to achieve QHIN certification. These networks have seen huge growth in the last year. In the 12-month period between April 2019 and March 2020, CommonWell Health Alliance recorded some seven billion total document exchanges among its members, representing an explosive growth in record sharing among U.S. healthcare providers. As the platform service provider, Change Healthcare has been at the center of supporting and enabling this growth for the benefit of providers and patients. The number of document exchanges is expected to grow exponentially in the coming years as more providers—and eventually payers—join clinical interoperability systems, such as QHINs.

To realize more value from clinical interoperability going forward, organizations will need to work together to set the parameters for what an interoperable system should do. First and foremost, it should make it easy to exchange or consume the spectrum of patient data, whether that data is structured or unstructured. It should also connect with networks that interoperate with systems housing clinical data and behavioral data. In this context, clinical systems include electronic health records (EHRs), medical devices, imaging systems, laboratory systems, and wearables. Behavioral data could come from patient experience surveys and data on social determinants of health.

True interoperability requires capturing information about the entire patient journey—where an individual has received care, where they are currently receiving care, and potentially where they are going to need care based on everything we know about them and patients who are similar to them. 

When organizations commit to pursuing this level of interoperability, and take steps to realize it, the industry will start to see real change in how information is shared and care is delivered. Patients will be able to access a longitudinal record of their health journey from anywhere and share it with anyone. Providers and payers will be able to make meaningful progress in reducing waste, increasing standardization, driving quality, and reducing bias.

Some things to think about as you begin

Before ramping up interoperability efforts, it is helpful to develop a plan for the work. Interoperability is becoming a requirement, but that doesn’t mean achieving it will be easy. Your organization must think through key issues and make strategic decisions about how to move forward. Here are a few things to keep in mind. 

Don't wait to familiarize yourself with the interoperability rules. Although the new requirements don’t officially go into effect until January 1, 2021 and enforcement will be delayed due to COVID-19, you can expect serious penalties for non-compliance. Acquaint yourself with the rules now and understand the implications they will have on your business. Since any penalties could build on already serious financial challenges brought on by the pandemic, it’s important to get in front of the work quickly.

Note that your ability to easily share information will also have implications for value-based care initiatives, making interoperability more than just a regulatory concern. Strong performance in this area will help you remain competitive in the marketplace and could be instrumental in attracting and retaining patients.

Develop a strategy for becoming more interoperable. Creating highly connected systems requires careful planning, innovative thinking, and strong technical expertise. In many cases, achieving this level of interoperability will present new challenges for your developers. You should carefully review your staff’s capacity to support the work and determine whether you will need to augment existing resources with different skillsets. With the right staff in place, you can begin working through some of the existing hurdles, including how to handle unstructured data, enable venue-agnostic data exchange, address cybersecurity concerns, and consistently obtain patient consent.

Consider partnering with a healthcare interoperability expert. Another option is to work with an external partner that already has the necessary expertise and has thought through many of the previously mentioned complexities. At Change Healthcare, we’ve been in the business of interoperability for years and are on the forefront of new developments. Our open, industry-standard APIs are already helping organizations seamlessly and securely share patient information. As we’ve developed these APIs, we’ve honed our approach, incorporating best practices from numerous industries into our development and implementation strategies. 

The future of interoperability in healthcare has arrived

Although healthcare organizations have struggled with the intricacies of interoperability to this point, the increased emphasis from the federal government stands to push innovation to the next level. Your organization should be spinning up interoperability efforts to meet not only government requirements but more importantly the data access needs of your patients. By committing to this work, you can lay the foundation for more patient-centered and data-driven healthcare.

Learn more about how Change Healthcare’s knowledge and experience can help you achieve greater interoperability.