The importance of interoperability cannot be overstated: it is one of the key drivers of success for healthcare providers today. Moreover, interoperability in healthcare is a critical part of the movement towards value-based care that can effectively drive down costs, improve patient care, and enhance healthcare outcomes.
But what is interoperability exactly, and why is it so important?
The Healthcare Information and Management Systems Society (HIMSS) defines health information interoperability as “the ability of different information systems, devices, and applications to access, exchange, integrate, and cooperatively use data in a coordinated manner, within and across organizational, regional, and national boundaries, to provide timely and seamless portability of information and optimize the health of individuals and populations globally.”
At its core, interoperability is the capacity for healthcare providers to access and share clinical information and the most up-to-date and complete patient medical records, regardless of the healthcare system where they work or the technology they use. The foundation of interoperability is made up of Health Information Exchange (HIE) networks designed to facilitate the transfer of clinical data, in addition to electronic health record (EHR) systems that store clinical information digitally. With HIEs and EHRs, patients’ medical information can be accessed securely across healthcare systems.
To answer the question, “why is interoperability important in healthcare?” it is helpful to consider why the digital transformation began, where we currently stand in the interoperability movement, and what the future may hold.
Looking Back at the History of EHRs in the United States
In the 1960s, doctors and healthcare providers used handwritten paper medical records and a paper filing system to keep patient medical history; but by the mid-1960s, academic centers began to develop their own clinical information systems for storing electronic medical information. In this same period, Lockheed Martin created an innovative software for medical records that was the first to allow many users to enter the system at once.
Over the next decade, companies and medical institutions worked together to develop technology for storing and accessing electronic medical information. By the 1970s, the U.S. Department of Veterans Affairs implemented a computerized patient record system that helped to reduce medical errors and improve quality of care.
Throughout the 1980s and 1990s, a movement to end the use of paper medical records and establish an EHR system in the United States took hold. Using paper filing systems meant that patient records couldn’t travel with them, be readily accessed by healthcare providers in an emergency situation, or be used when the patient transferred to different healthcare systems and providers. An electronic clinical record system that could be accessed from anywhere and by any provider or payer was believed to solve these issues and improve care coordination and patient outcomes—while reducing excess costs from redundant testing and mistakes caused by incomplete patient data.
In 2004, President George W. Bush established the Office of the National Coordinator for Health IT (ONC) to lead the implementation of an interoperable health information technology infrastructure. Then in 2009, President Barack Obama signed into law the Health Information Technology for Economic and Clinical Health (HITECH) Act. The HITECH Act aimed to increase the use of EHR among healthcare providers by offering them financial incentives for meeting “meaningful use” criteria related to their use of EHR and technology. With financial incentives in place and Medicare/Medicaid reimbursement reductions for failure to meet the meaningful use criteria, the adoption of EHRs and HIEs ushered in an era of more secure medical record exchange and enhanced privacy for patients.
The Importance of Interoperability in Healthcare Today
Presently nothing travels as fast as information, and seamless transfer of documents and care plans via health information exchange can lead to better health outcomes. These health records can be lifesaving to ensure continuity of care, especially in situations where a patient is entering an emergency room or transferring to a new healthcare system. Since the beginning of the shift away from paper medical records, EHR vendors have multiplied, and now healthcare providers have seemingly endless options when it comes to selecting their healthcare information technology (HIT) options.
However, more EHR options does not necessarily mean that U.S. healthcare providers have achieved the level of interoperability hoped for at the advent of this transformation to digital clinical information systems. The ability of these various EHR systems to communicate and work seamlessly across devices, networks, and providers remains a challenge for the various technology and EHR vendors, government organizations, and healthcare systems to address in order to achieve optimal interoperability. EHR vendors have played an important role in facilitating interoperability, but the federal government, the ONC, and standards development organizations (SDOs) like HIMSS and Health Level Seven (HL7), have also played pivotal roles in developing standards for HIE and data sharing in healthcare.
While EHR vendors have improved the technology of their platforms to enhance the ability to communicate with other software and applications, the SDOs have been focused on developing standards regarding clinical language and terminology, patient identifiers, formats for information exchange, and privacy and security. Currently, having many EHR vendors and various HIEs that work using different identifiers, language, and formats makes exchanging critical patient health information across healthcare systems more difficult, which is why SDOs have made standardization a priority to create a more streamlined process.
For example, tech companies and EHR providers have built proprietary application programming interfaces (APIs) to allow for seamless and secure data transfer between EHRs. The HL7 took this idea of using an API and developed an API standard for interoperability, known as HL7 Fast Healthcare Interoperability Resources, or FHIR, to further break down the silos between EHR systems. All these elements are crucial to enhancing health information interoperability to improve patient care.
The Future: Heading Towards Deep Interoperability
There’s no doubt that significant progress has been made when it comes to interoperability. According to a recent report from KLAS on trends in electronic medical record (EMR) interoperability, healthcare providers have noticed improvements when it comes to EHR vendors supporting data sharing with healthcare information exchange (HIE) partners, moving from 50% satisfaction when working with partners using different EHR vendors in 2016 to a 64% satisfaction rate in 2020. In addition, the KLAS report found that provider organizations are closer to achieving deep interoperability, which is based on four levels of interoperability:
- Access to data – Often or nearly always having access to necessary data through interoperable means
- Locating records – Can easily locate patient records or present patient records automatically to clinicians
- Clinical interface – Have patient data integrated into the EHR system’s native data fields or in its own tab in the EHR
- Benefit to Patient – That the patient data accessed in the EHR benefits the patient care outcome
Regarding access to data, providers in the KLAS report ranked their ability to access critical patient data as 67% successful in 2020, up from just 28% success in 2017. When asked about their ability to locate the patient records they needed when helping a patient, providers said they had a success rate of just 13% in 2017, but that number jumped to 44% success in 2020. Providers ranked the ease of use for the clinical interface of their system at just 8% in 2017, but by 2020, providers ranked the interface usability at 38% satisfaction. With these improvements to their access and use of patient data in their technology, providers’ say the EHR benefit to the patient more than doubled from 6% in 2017, up to 15% in 2020.
As the KLAS report demonstrates, great strides have been made even in just the past few years towards achieving deep interoperability, which would ideally be at 100% for all healthcare providers in the future. However, there is room for improvement, and obstacles to reaching optimal performance in all four stages of deep interoperability remain. Providers surveyed in the KLAS report say that EHR and HIT vendors need to focus on improving patient-record exchange, while the ONC continues to support the enhancement of information exchange through its efforts to implement FHIR-standards-based APIs as part of the 21st Century Cures Act.
Helping healthcare providers achieve deep interoperability will require breaking down silos of healthcare IT development and EHR systems. This can be accomplished by improving technology, standardizing APIs for information exchange, facilitating technology use, and continuing to measure the impact of HIT on patient outcomes and care coordination.
There are many stakeholders involved in shaping interoperability today, from payers to providers to the EHR vendors and other HIT companies. Coordinating these stakeholders to create consensus-driven improvements to technology and HIE remains an area of key focus. While obstacles remain to achieving that seamless exchange of information that is necessary to truly move to a value-based healthcare system, EHR vendors will play a critical role in helping providers to achieve deep interoperability and enhancing HIE.
As a pioneer in the interoperability space, Audacious Inquiry provides solutions to health information exchange obstacles through healthcare data integration services and products like our communication solution for efficient patient transfer, Encounter Notification Service® (ENS®) and PROMPT® – Proactive Management of Patient Transitions for admissions, discharge, and transfer (ADT) support.
About the Author
Diana Bauza is a content writer based in the Greater Philadelphia area. She writes about products and services in the health and technology industries, with the goal of empowering consumers with quality information to help them make decisions that best serve their needs.