Improving Care Through Better Interoperability

By Matt Phillion

While there has been much focus on regulatory initiatives around interoperability in healthcare in recent years, overall adoption has been slower than expected. The desire for better interoperability has been clear, however—providers, health plans, technology vendors, and even patients themselves have been in favor of better openness and interoperability for sharing data in healthcare.

What can stakeholders do to ensure open, appropriate data sharing is prioritized in the industry? As healthcare works toward improved patient safety, more secure interoperability, and increased collaboration in an evolving regulatory landscape, there is much on the line to get it right.

“It’s been a long, slow journey,” says Brian Drozdowicz, senior vice president and general manager for Acute and Payer Markets with healthcare software company PointClickCare. PointClickCare recently became the first long-term and patient acute care-focused organization to join the Coalition for Health AI (CHAI). “We’ve seen a lot of change, but at the same time, the rate for change compared to other industries is a whole heck of a lot slower.”

There are several challenges slowing down the move to better interoperability and improved data sharing, he notes. There are many, many vendors in the healthcare space, all of which use different formats for sending and sharing data, for example.

“Standards have been slow to evolve,” says Drozdowicz. “There’s not a software company in the world that doesn’t have a roadmap looking years out, and when a new standard comes out, it’s often years of development to implement it, and that’s just for version one. New standards come up all the time and that evolution is often a driving force as you work to meet the needs of the standard.”

There has been a lot of action around government incentives, subsidies, and programs that were effective at driving early adoption, Drozdowicz explains.

“We haven’t seen any of those persist or survive in the long run,” he says. “I go back to things like meaningful use and some of those early legislative components even as far back as the Obama administration put in place, and a lot of that is gone now. There are still vestiges of those different initiatives encoded with vendors to this day, and they continue to evolve.”

What happens next with mandates about interoperability remains to be seen, says Drozdowicz.

“What will happen with the new administration will be fascinating because they don’t believe in mandates, but they do believe in technology,” he says. “Whatever we do, however data is shared, it also needs to be secure.”

This is a facet everyone, in and out of healthcare, is well-aware of, Drozdowicz notes.

“Find me a person who hasn’t received a piece of mail notifying them of a data breach,” he says. “And healthcare information is super sensitive—we tend to be conservative about what security protocols are in place, what does good security look like, and arguably people are even more concerned about their healthcare data than they are about even their financial information.”

The way forward

Several market trends that have pushed the industry toward more open data sharing and interoperability, Drozdowicz notes, particularly around different evolutions of value-based care.

“That’s probably been one of the most successful drivers for adopting some of these new strategies,” says Drozdowicz. “We’ve got some stuff in place from the last administration that we think is a reasonable, sound, safe framework for data exchange. We’ll see if that survives or not. But in the last 10 or 15 years, a lot of progress has been made, primarily driven by collaboration between payers, providers, and ACOs that sit in the middle—they require a vast amount of data across many different encounters, and work with a lot of systems to make the best decisions.”

This intersection of different stakeholders is asking for information to be provided to everyone participating in these value-based contracts (VBC).

“VBC is here to stay, and as long as that’s the case, everyone will be looking to make the best decision possible for the right care, not charging too much, avoiding duplicative services for diagnosis, ensuring thoughtful orders for meds,” says Drozdowicz. “And you can only do that with interoperability and broader data sets.”

These stakeholders will be the ones to lead the charge for further improvements, Drozdowicz says.

“Vendors want to but have often been laggards. It’s hard to do this in a safe, secure way, but vendors have stepped up their game,” he says. “Find me a vendor today that has a large, successful business that isn’t interoperable. I think it’ll be tough to find one. There’s a real push from the market and from vendors like us to say, ‘This is what we need.’ It’s really a fine mix of providers working together with payers and vendors to say this is what we need to make these decisions.”

The regulatory role

There has been a reasonable framework in place for sharing healthcare data for treatment, payment, and operations purposes, Drozdowicz says, but there is room for continued improvement.

“What I think would help is continued work from the government, together with payers and providers, to evolve to that next stage of appropriate use,” he says. “There are absolutely some bad actors out there, and we’ve come across those who disguise themselves as healthcare entities. They’ve made connections with national networks and shared data for uses outside the appropriate categories, and that’s not good for anybody.”

Enforcement around appropriate use can be tricky to enforce, he says, and this can put vendors in a difficult position.

“Having stronger governing bodies around appropriate use would be helpful,” says Drozdowicz.

There’s also a lot of room for growth in consumer and patient education.

“I think the overall healthcare consumer’s awareness of what data exists, what is derivative of that data, and how it is used by stakeholders in the healthcare ecosystem is very low,” says Drozdowicz. “They’re usually more aware about financial data: you probably know what your credit score is, what drives that score, and what actions you need to take if your score changes. You can get a credit card, buy a house, buy a car.”

Data in healthcare is used in similar ways, he says.

“Insurers have employed actuaries for years, and AI is not a new thing in healthcare for predicting certain events, determining certain diagnoses, or used in cost analysis or predicting mortality rates,” says Drozdowicz. “But if you were to ask the average consumer what the drivers are and their risk, those things are not as well understood. And to be honest, it’s a whole heck of a lot more complicated than a credit score.’

There’s a lot of information available for providers and others to offer education to patients but effectively communicating that out to the masses in terms of how their data is used and what they can do with it to live healthier lives is in the very early stages.

“Better education would be better for everyone in the ecosystem,” says Drozdowicz. “If you see your credit score dropping, your instinct is to figure out how to improve that. Take, by comparison, lab values. A lot of people get that information from their annual physical exams, but they don’t always know what to do about it. People inherently want to do the right thing but making it simple really is key.”

Drozdowicz sees the industry in the early stages of being able to take that information, put it in the hands of a layperson, and have them take three top actions away to improve them.

“There’s a lot of momentum across the board with that wide array of stakeholders—certainly providers and payers in the ways they collaborate, and vendors are some of the most informed around what’s possible,” says Drozdowicz. “Everyone needs to ask more of the system, and we will see a natural evolution of what’s shared, how it’s shared, and how that drives outcomes.”

There may be some changes or disruptions in the near term as new policies emerge or deregulation occurs, Drozdowicz notes. It’s a balancing act, he says.

“Very strong legislation has been proven not to work, but evolving legislation with more granularity of how data can be shared would be a step forward,” he says.

Things are headed in the right direction, if slowly.

“Data availability and quality are going to greatly improve,” says Drozdowicz. “Getting the right data to the right person to make the right decision, and that decision translating to an action is really where we’ll see a massive improvement in the coming years. Things like having a full picture of a patient’s history allow for the best clinical decisions to be made. The tools are there, the tech is there, but what we do is more complicated than in other industries, so I think it will take more time to get there.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at matthew.phillion@gmail.com.