The Healthcare Information and Management Systems Society is keenly focused on improving health and the business of healthcare through the application of information technology. To accomplish that, the global non-profit organization recognizes the very real need to improve interoperability, which is even more crucial as the United States moves to a value-based system that follows the patient across the continuum of care.
Perhaps it shouldn't be surprising that over the last few decades, the historically siloed healthcare industry has embraced numerous innovative programs and platforms designed to improve quality, outcomes and efficiency ... without giving much forethought to how that technology might interact with other entities. In fact, it's not even unusual to find multiple HIT applications that have trouble communicating under the same roof.
Joyce Sensmeier, RN-BC, MS, CPHIMS, FHIMSS, FAAN, who serves as vice president of Informatics for HIMSS, said breaking down those barriers to effectively share and interpret data is a core ... albeit complex ... focus for HIMSS. "At the foundation of it is the need for standards and for everyone to be implementing those standards in the right way," she noted.
Moving the Needle
The HIMSS Innovation Center, headquartered in Cleveland, Ohio, is the centerpiece of the organization's interoperability efforts. ConCert by HIMSS™ comprehensively tests and certifies electronic health record (EHR) and health information exchange (HIE) vendors. Built off of the findings of the EHR|HIE Workgroup and the IHE USA (Integrating the Healthcare Enterprise USA), the ConCert seal of approval means a product has been proven to be interoperable with other products.
Noting HIMSS works closely with IHE, Sensmeier said the annual 'Connectathon," which is usually held each January in Cleveland, fosters collaboration among competitors with the mutual goal of improved interoperability. "It's refreshing to see them working on that in a neutral environment," she noted of the approximately 500 systems engineers representing 100 organizations who come together to collectively improve data sharing.
Sensmeier added yet another barometer of interoperability momentum was on display this past February in Orlando at the Interoperability Showcase. "We had the largest number of participants this past year," she said, adding, "Vendors have to be able to show interoperability to even participate."
The showcases typically feature about 15 different use case scenarios to provide attendees the opportunity to witness how standards-based transactions could impact care across the continuum by decreasing duplicative entry and enhancing quality and safety. "It really brings a picture of what can be," Sensmeier said, adding nearly 10,000 attendees came through the showcase in Orlando.
Sensmeier said progress also is visible in the work being done by Regional HIEs. In the San Diego area, where Sensmeier is based, the large hospitals have worked together to enable access to patient data no matter the facility where it originated through the deployment of business agreements. While technology standards have enabled cross-communication at the base, Sensmeier said those business agreements are an equally important part of the overall interoperability equation.
The success among health systems has led to such agreements moving into other healthcare sectors including the prison systems, EMS, and VA, Sensmeier noted of the local uptake in her region. She added San Diego isn't unique and that such collaboration is occurring in pockets across the country.
"There's now an understanding it's the right thing to do and good business," she pointed out.
Movement is also happening on a national level. Last month, after nearly two decades of work and advocacy by the HIT community, Congress included report language in the FY17 Omnibus spending bill to address a prohibition on the unique patient identifier (UPI). The ban, which was put into place in 1998, stemmed from concern over patient privacy. The result, however, has stymied efforts to accurately match patients to their data across different systems and settings of care on a national basis.
In a blog post, Carla Smith, MA, FHIMSS, CNM, who serves as executive vice president for HIMSS, noted that over the last 19 years, the UPI language has prohibited the U.S. Department of Health and Human Services from engaging in any conversations with the private sector pertaining to the UPI. Over the past two decades, she said, it has become clear that a consistent patient data matching strategy is required across the public and private sectors of healthcare.
While the new Omnibus language does not allow HHS to use funds "to promulgate or adopt any final standard providing for the unique health identifier for an individual" without Congressional authorization, it does open the door for HHS to be able to study the issue through the following clarification:
"Accordingly, the Committee encourages the Secretary, acting through the Office of the National Coordinator for Health Information Technology (ONC) and CMS, to provide technical assistance to private-sector led initiatives to develop a coordinated national strategy that will promote patient safety by accurately identifying patients to their health information."
ONC officials have also announced the launch this month of a Patient Matching Algorithm Challenge. The challenge, which includes up to $75,000 in prize money, has a goal of spurring the adoption of performance metrics, reducing duplicative entry, and improving the linkage of critical data. More information is available at PatientMatchingChallenge.com.
Additionally, Sensmeier said, the ONC has been working to improve data exchange and usefulness through the Interoperability Standards Advisory (ISA). "ONC has raised the bar on identifying what standards are available in interoperability and what those standards serve," she explained.
Through the website healthit.gov/isa, there is a single public list of the standards and implementation specifications, which are published and open for comment. "It's a huge step forward," she said.
"The nut to crack is that providers and hospitals need to be requiring interoperability in the systems they purchase," Sensmeier stressed, adding interoperability should become a foundational part of the procurement process. "If the customers are asking for it, the vendors are more likely to make sure it's there," she noted.
"I think the will is there," Sensmeier continued of movement across public and private sectors to address interoperability. "We have the standards now, and we're pointing people to them."
While the U.S. is still probably several years out from deploying a comprehensive national strategy, Sensmeier said it is encouraging to see more pieces and parts come online. She noted interoperability certification programs are now in place; there is increasing patient demand and expectation that health information travels with the individual; and new provider reimbursement methods require improved connectivity across the continuum of care.
In meeting these demands, HIT products and systems should be well on the way to fulfilling the promise of enabling providers to deliver safer, more cost effective care.
HIMSS Defines Interoperability
In April 2013, the HIMSS Board of Directors approved a definition of HIT interoperability and outlined three functional levels: foundational, structural and semantic.
At the highest level, semantic, two or more systems have the ability to not only exchange information but also to be able to interpret and use that data. As outlined in the definition, "Semantic interoperability takes advantage of both the structuring of the data exchange and the codification of the data including vocabulary so that the receiving information technology systems can interpret the data. This level of interoperability supports the electronic exchange of health-related financial data, patient-created wellness data, and patient summary information among caregivers and other authorized parties. This level of interoperability is possible via potentially disparate electronic health record systems, business-related information systems, medical devices, mobile technologies, and other systems to improve wellness, as well as the quality, safety, cost-effectiveness, and access to healthcare delivery."
The board noted the creation of data exchange schema and standards should permit data to be shared across organizational settings and with patients regardless of the application or application vendor. Work to create and broadly implement such standards is ongoing.