The ABCs of Interoperability in Healthcare

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interoperability in healthcare
Senior Director, Healthcare Strategy

Must-know Terms for Your Next Interoperability Conversation

Interoperability. Merriam-Webster Dictionary defines interoperability as, “the ability of a system to work with or use the parts of equipment of another system.” Some common synonyms are “interconnectivity, interchangeability and operability.” Though just a single word, the weight, meaning, and impact of it runs deep.

And with Frost & Sullivan analysts predicting that the market for global healthcare interoperability will reach $7.96 billion by 2024, as compared with $4.17 billion in 2019 (13.8% CAGR), becoming intimately familiar with all things interoperability is a must. Why? The way the industry views interoperability has and will continue to evolve with the Cures Act and questions around who owns data along with what can and can’t be monetized.

interoperability in healthcare

While a seemingly simple definition by dictionary standards, we in healthcare know all too well that healthcare and the topic of interoperability are anything but simple. And it becomes quite a bit more complex when different terms and acronyms are tossed around in conversations.

While it may be fundamental to some, I thought I would take some time to share some must-know buzzwords associated with healthcare interoperability. Hopefully, it’s a helpful read to help shape current and future conversations, and perhaps even shed some light on parts of the interoperability puzzle you may be less familiar with.

Application Programming Interfaces (APIs)

APIs are certainly not just for healthcare – as they facilitate any exchange of data, information and communication from one product and service to another without having to build new connectivity each time. But what does this mean in the context of interoperability for the healthcare industry? This technology allows for the exchange of say your prescriptions, treatments and medical history to be shared with entities, you, as the patient permits and gives consent to. Both the Open Epic and Cerner open platform are good examples of how the healthcare industry is embracing this technology.

CARIN Alliance

This alliance is a bipartisan, multi-sector collaborative working to advance consumer-directed exchange of health information with members consisting of consumers, HIPAA covered entities and HIPAA non-covered entities. Their vision is for consumers and their permitted caregivers to access, use, and share their health information more easily. This ties directly into what healthcare interoperability is all about. CARIN is also responsible for the Common Payer Consumer Data Set (CPCDS), a data set required for exchange under federal mandates.

Cures Act

The 21st Century Cures Act requires health IT developers to implement bi-directional Patient Access API capability to align with certification criteria. This means patients can, from 2023 onwards, access health information from across their clinical visits and potentially direct information from their health insurance to secure apps of their choice.

Da Vinci Project

This is a private industry project under HL7. On its website the organization shares, that the goal of the Da Vinci project is to help payers and providers to positively impact clinical, quality, cost and care management outcomes and to empower end users to shift to value-based care. Da Vinci is comprised of healthcare members across payer, provider, pharmacy, and vendor organizations that share the common goal of accelerating the adoption of HL7 FHIR. Da Vinci defines FHIR Implementation guides for specific use cases within the payer/provider space to encourage interoperability.

Data Enrichment

How do you make current data assets better? Stronger? More comprehensive? The answer is depth and breadth of data. It takes a variety of sources to build a more complete golden record. Layering in LexisNexis Risk Solutions data sources such as Keep Contact, Death Masterfile and Socioeconomic Health Attributes will enrich incoming patient data further and provide more actionable insights that leverage our interoperability solution.

Data Harmonization

Data harmonization is the act of pulling data from multiple sources and presenting it in a way in a cohesive and consistent way so that it can used. Effectively, it is ensuring that you are comparing “apples to apples” when pulling data from different places.

Data Normalization or Data Standardization

Due to variability in data fields given different interpretations of the rules and level of completeness, a platform will need to offer the ability to provide a standard output despite variation on the data sources. An example of variability is the various clinical codes that can be used to record a medical procedure. Standardization would crosswalk the various inputs to one version (e.g., ICD-10) to ensure everything is reflected in the same manner.

Fast Healthcare Interoperability Resources (FHIR®)

FHIR, which is pronounced like ‘fire,’ is the standard in which defines how specifically healthcare information can be exchanged between various systems and was developed on HL7. The Interoperability and Patient Access Final Rule requires the common adoption of a brand-new version of this HL7 standard, which builds upon all the lessons learned from previous versions of HL7. The FHIR formats (and the mandated specifics about which ones to use) bring much needed prescriptive requirements about the specific data elements to share, a standard data set that is sufficiently broad to deliver business value. It brings needed terminology or vocabulary standards, along with metadata, that enable the context of the data being shared. 

Health Level Seven International (HL7®)

HL7 is a not-for-profit, ANSI-accredited standards developing organization dedicated to providing a comprehensive framework and related standards for the exchange, integration, sharing and retrieval of electronic health information that supports clinical practice and the management, delivery and evaluation of health services.

Interoperability Solution

The LexisNexis® Clinical Linking to Improve Care Quality (CLICQ) platform provides our customers with a simple way to access a holistic patient view (including claims, clinical, pharmacy, socioeconomic and demographic data) via a single FHIR-enabled API. The CLICQ platform will connect to the manifold of Patient Access APIs, pull the data (with patient consent) normalize to a LexisNexis Risk Solutions FHIR standard on our cloud-based platform and offer data enrichment services with LexisNexis Risk data assets (e.g., Social Determinants of Health (SDOH), LexID®).

Patient Access Rule

In the initial phase, select health plans/payers were required to provide a standardized Patient Access API by July 2021 that would be accessible using third-party applications. These regulatory efforts, intended to reduce medical costs, improve patient care, and provide transparency, will substantially disrupt the healthcare data segment, which had previously only focused on data privacy and limited information exchange. The regulatory program will create, for the first time, a ubiquitous standardized data exchange capability for patient data. Patients can now facilitate benefit coordination across health plans.

Patient Consent

Whether it’s a physical form or through an app on your smart phone, there are terms and conditions that we all agree to (or don’t) daily – including those related to our health information. While HIPAA always required a patient to say ‘yes’ and agree to the terms of sharing their data or a business associate agreement (BAA) for data exchange, CMS has now made digital consent on the go possible. Providers, app developers and companies like LexisNexis Risk Solutions, are not the ones that control the exchange of such data – it all starts with us as individuals agreeing to where and how our data can and cannot be shared.   

Qualified Health Information Network (QHIN)

According to HealthIT.gov, QHINS are a network of organizations working together to share data that will connect directly to each other to ensure interoperability between the networks they represent. They are envisioned to be the next generation of Health Information Exchanges (HIEs).

Trusted Exchange Framework and Common Agreement (TEFCA)

Beside this term being a mouthful, in summary, the goal of this agreement is to establish universal interoperability across the U.S. It intends to establish the framework by which data can be exchanged between QHINs and the agreement that these QHINs will enter. ONC released the final V1 of the common agreement and trusted exchange framework on January 18, 2022.

United States Core Data for Interoperability (USCDI)

According to a fact sheet on the HealthIT.gov website, USCDI is a standardized set of health data classes and constituent data elements for nationwide, interoperable health information exchange. USCDI is a required data set for exchange per ONC/CMS final rule. The second version of this standard has included socioeconomic, race ethnicity, imaging, and clinical tests data amongst others. ONC has indicated that they plan to release new versions with expanded data elements on an annual basis. USCDI contains both clinical and demographic data for a patient/member. Future versions of USCDI contain encounter data, SDOH data, and possibly data elements for research. FHIR, via the FHIR API, is the data model/format that is used to exchange the USCDI data. 

While this list is by no means exhaustive, it hopefully creates a solid foundation for all things interoperability in healthcare.

Sometimes healthcare terminology can feel like another language. One of the ways to help navigate the ever-shifting landscape is working alongside a trusted partner that understands both the business of healthcare and your organization’s unique needs and goals and how to tie the two together. It’s time to pivot to the new age of interoperability today. Discover how we can collaborate today.

The DNA of Healthcare

At LexisNexis Risk Solutions, our goal is to provide the healthcare industry with insights and innovations to improve outcomes, grow market share, reduce fraud and increase compliance.

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