Variances in EHR record sharing, data integration standards, and clinical and claims data are technical roadblocks to interoperability.
Interoperability has been an ongoing topic in healthcare for roughly a decade. In 2009, when the HITECH Act was introduced, providers were encouraged to shift away from paper-based charts to electronic health records (EHRs) — and so began the ongoing battle to successfully address interoperability.
As we’ve detailed in previous posts, interoperability barriers can be broken down into three categories: business disincentives, operational barriers, and technical challenges.
These days if a health organization isn’t pursuing interoperability, it often is a result of competing priorities (e.g., business disincentives). And even when an organization is using data integration tools, it can still face operational interoperability challenges. Essentially, operational challenges boil down to the ability to communicate with not only data but also meaning. Just because two physicians use the same EHR doesn’t mean they’re using it the same way; one doctor may enter diagnostic details into an entirely different field than the other.
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In addition to the business disincentives and operational barriers, there are also technical roadblocks to interoperability. These include variances in the standard format for EHR record sharing (CCD or CCR), data integration standards (FHIR v. HL7 2.0), and payer/provider data matching (clinical v. claims data).
Technical Barrier No. 1: EHR Record Sharing
At a basic level, the continuity of care document (CCD) dictates the specifications intended to prepare patient records for exchange with requirements for encoding, structure, and semantics. This standard is used to identify types of information being transmitted (e.g., diagnoses, prescriptions, family history, procedures, care pathways).
While this helps to regulate the transfer of medical data, it has its limitations. Because the implementation of CCD format can vary from EHR to EHR, health IT systems are often unable to send and receive information accurately, which is a roadblock to interoperability.
Technical Barrier No. 2: Data Integration Standards
To get more granular, beyond the differences in EHR standard formats, the industry also experiences variances between the types of electronic information exchange standards it uses. There are several different options, though the most popular is HL7 2.0 and now FHIR.
These standards offer a variety of different features that make them more or less attractive to the organizations based on their needs. FHIR offers speed, efficiency, high bandwidth, and security — and is expected to be applicable under a wide range of circumstances related to real-time data exchange. That said, for most healthcare use cases that don’t require real time or high bandwidth, HL 7 2.0 is great and already widely adopted across the industry.
Technical Barrier No. 3: Combining Clinical and Claims Data
Technological interoperability challenges are also present when combining clinical and claims data. With the industry shift toward value-based care, we see a bigger emphasis on accurately aggregating these disparate data types into information sets that payers and providers can trust and agree upon as the basis for risk sharing.
So far, third parties (e.g., HIEs) and combined payer and provider entities (e.g., ACOs) have been most interested in integrating clinical and claims data. Going forward this challenge is to be increasingly assumed by the payers and providers themselves. This means real-time information (labs, hospital admissions and discharges, vital signs, etc.) must be synchronized with batch filed claims records adjudicated 30 to 90 days post-care on top of incompatibilities between standards.
This asynchronicity is further complicated when you have clinical systems sharing data standards (e.g., HL7, DICOM) and using clinical vocabularies (e.g., SNOMED), which get translated into ICD-10 and CPT codes and transmitted as HIPPA transactions to payer adjudication and processing systems, which use the X12 standard.
As we’ve learned, the transference of data in and out of different organizations can present challenges because of the varied standards, systems, and workflow patterns. The payers and providers are more than likely operating with different integration tools, which again makes interoperability difficult.
Overcoming the Technical Barriers
So how do we get over these hurdles? It’s important for all healthcare professionals to first acknowledge that because of the nature of technology, interoperability challenges will persist. However, it’s also important to acknowledge that there are many tools and technologies available that can support, address, and manage these obstacles.
As an industry, the conversation continues to focus on what is preventing true interoperability when there are so many solutions we could be using to our advantage. Organizations must use the integration technology they feel best supports their internal goals and the direction and requirements of the industry — which is why flexible, extensible approaches that connect as many protocols, standards, languages, and hardware are so essential.
An on-premise enabler — like an integration engine — brings systems together and offers a variety of built-in standard capabilities that support the seamless acquisition and exchange of health data. When the technical aspects of interoperability are being managed, it opens the floor for other more meaningful conversations — from practical and technical aspects of implementation to transforming interoperable access, aligning organizational behavior, and shifting industry thinking toward its responsibility to patients and members.
Source: mhealth Intelligence