It appears that healthcare interoperability is finally having its day. As it transitions from a buzzword that has circled around the industry into a meaningful reality, patients, healthcare systems, health plans and health information technology (HIT) companies each stand to benefit from this new approach to data sharing. Improved technology, enhanced access to personal health data, and strong defined standards to streamline the exchange of health information.
These are some key aspects of new rules passed in March 2020 by the U.S. Department of Health and Human Services in the 21st Century Cures Act.
Healthcare Interoperability Puts the Focus on the Patient
The new federal rules put the patient front and center. The goal is to allow individual Americans to decide how their health information gets shared, with whom and for how long. But like almost every other initiative connected to the U.S. healthcare system, it’s complicated.
That is where application developers can facilitate the seamless transfer of the health data under Fast Healthcare Interoperability Resources 1 (FHIR) standards. The most relevant information arrives to the right provider or party nearly in real-time via application programming interface (API), boosting the efficiency of this essential communication.
Beyond greater access and control of their health information, another benefit could emerge for patients. Specifically, a means to share data on their health patterns and care utilization – versus a siloed snapshot of their health during an annual exam – with those who support them on their journey through the healthcare ecosystem.
For example, the longitudinal claims data pulled from a health plan might show a patient went to the ER six times in a previous six months. A provider with access to these insights could instead refer them to an appropriate specialist. Another patient might be calling an ambulance to get to the hospital because they lack transportation. A discussion about alternative transportation could help that patient and lower overall costs at the same time.
Furthermore, patient access data might show someone stopped filling prescriptions and would be a more reliable and comprehensive source of information in showing active medications compared to self-reporting. A provider or pharmacist armed with this data could then ask the patient why at the point of care – do they have problems affording their treatment? Or a wellness application might interact with a member who has an elevated BMI but also shows evidence of asthma in their clinical history – and not recommend a vigorous exercise regimen as a result.
Let the Data Flow Freely
In other words, when data flows freely in a standardized fashion from multiple sources, it boosts the ability to create meaningful insights for patients looking to improve their health outcomes. The power of the data is amplified if it can be accessed in near real-time, while a patient is visiting their provider.
I can call an API and get a response in a minute, if not seconds. When the information comes in a standardized format that conforms to FHIR standards, I know exactly what I am getting back and how to ingest and analyze it. This system therefore can provide a much faster, more secure, more sophisticated means compared to traditional approaches to gathering patient data from disparate sources. Historically, requests for health information are very labor intensive, costly and involve complex, multi-step processes.
Facilitating access to a large-scale network of data sources via a single API, LexisNexis Risk Solutions can provide a meaningful and timely process to create health insights for individuals. For example, interpreting lab results in the context of patient demographics and health utilization, pulled from multiple sources (e.g., the individuals health plan and provider office), provides more information on what is going on with an individual and helps healthcare professionals meet patients where they are.
Our ability to connect to, ingest, and normalize the various data sources, coupled with our industry leading focus on data security, make us the ideal collaborator for application developers in this interoperability space.
Trust Building for App Developers
Health and wellness app developers will play an essential role in initiating and providing value to this data exchange. Although the rules emphasize patient-driven data sharing, I don’t know of many patients likely to write code to interact with API technology. In reality, various types of application developers will be working on the behalf of patients.
With this role comes great responsibility. App developers will need to be transparent about why they need access to the data, how they plan to use it and how their interpretation will help individuals. The more data a patient shares with an app, the more tailored the health or wellness recommendations can be.
The crux will be developing terms and conditions that are built on trust and appropriately safeguard sensitive health information while still enabling app developers to gain meaningful insights on their patients. There is a built-in disincentive to handle health data maliciously. Any app developer who misuses personal health information will face serious legal and regulatory consequences, as well as a lack of trust among their clients.
Widespread Adoption of Healthcare Interoperability
Research shows most – 84% of hospitals and 61% of clinicians – adopted and implemented certified API technology with FHIR as of 2019. “Efforts to expand use of FHIR among data and technology users should be encouraged by this data,” the authors write.
This is important because the need for companies to facilitate data exchange in this new world of healthcare interoperability is likely to only grow going forward.
As of July 2021, there are only a couple of hundred of organizations (namely health plans with government sponsored business) that need to deploy Patient Access API technology. However, as soon as providers and electronic medical record (EMR) vendors come online with the new standards in 2023, there will be thousands, if not tens of thousands, of APIs popping up.
It is unrealistic to believe that every organization that needs access to this data will be able to write these APIs and access the standardized information. This is one reason LexisNexis Health Risk Solutions is creating a middleware platform. We’re technologically savvy, we can write the APIs, we can facilitate the standardized data and we can enrich data with our own data to make it much more holistic and clinically relevant.
Although the health IT industry has discussed interoperability for years, final rules from the Department of Health and Human Services’ Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) add structure and enforcement to the idea.
The interoperability rules are a rare example of federal provisions with “hugely bipartisan” support, pointed out Don Rucker, M.D., former head of ONC during the Trump Administration.
“It puts in place a fundamentally different way for healthcare companies to think about data, and certainly for the federal government to think about getting data. That over time will be transformative in helping drive value in healthcare,” Rucker said in an article posted on Healthcare Dive.
“Americans will now have electronic access to their health information on their smartphone if they chose,” Rucker added in a Fierce Healthcare article. These federal rules coupled with implementation both now and going forward will be a “game changer” for healthcare in the U.S. After all, it is nearly impossible to know what your patients are going through and where they are really encountering costs unless you have good access to quality data.