Update 11/18/2016 Why interoperability is crucial in radiology http://www.healthdatamanagement.com/opinion/why-interoperability-is-becoming-more-important-in-radiology
It’s not just the intellectual capital of vendor products or the need to ensure the security of PHI, or to maintain patient confidentiality; there are very real needs to share data securely among systems (and providers) for the benefit of decisions made on behalf of patients. Clearly, there is no single standard in healthcare, nor does semantic interoperability exist. What does the Security Rule say about flexibility in its implementation? HIPAA regulations for security of PHI is required. Is flexibility in the rule to enable the flow of information between providers, or integration, that can be enabled to provide improved quality of care for patients? Take a listen to Carlos on the Security Rule Flexibility Principle (and visit HIPAA Survival Guide on YouTube for other short videos).
An a recent article in Health Data Management, it stated “IT vendors are not helpful when it comes to integrating.” They either require complex Application Programming Interfaces (APIs), “flatly refuse to transmit the data,” or require additional fees for exchanging data. Also, in my experience, providers were required to purchase additional software for secure transmission of health data. Why are there so many ways to get from point A to point B? It’s expensive, time consuming and an uphill battle at best.
The Centers for Medicare and Medicaid Services (CMS) is promoting full interoperability even though it was NOT part of the attestation of certified EHRs at the onset of Meaningful Use nor its subsequent updates. CMS has sponsored “a major PR effort to get vendors to sign the toothless Interoperability Pledge” plus the MACRA rule now requires that providers attest to “not blocking information.” Providers have previously complained that EHR vendors were unwilling to share data or they charged cost prohibitive fees to make sharing possible. [i]
There are situations where the need for claims information is necessary for patient conditions, and a vendor has required significant programming efforts before enabling integration. Why continue these practices? Not only are they difficult to address, but in many cases (and in this example) may negatively impact decisions by practitioners due to lack of a complete medical history.
Moreover, lack of common semantics is a key inhibitor to interoperability. Without a single standard at the granular level of patient data, too much time is spent assimilating data from various formats into a single standard. Health Data Management says “we’re not talking about producing breakfast cereal.[ii] HIMSS Electronic Record Association reported that “Value-based payment and delivery system reform remains the biggest driver of interoperability.”[iii] Let’s hope that is the case.
Lack of interoperability and its resolution is long overdue. Fortunately, ONC Health IT Certification Program recently passed Enhanced Oversight and Accountability and amended the Public Health Service Act (PHSA) to create “Title XXX – Health Information Technology and Quality” (Title XXX) to improve health care quality, safety, and efficiency through the promotion of health IT and electronic health information exchange.[iv] It’s like Mother telling Child. You must do what I say or there will be consequences. Yes, the ONC can take certification away from those who do not comply. Is this what we need to exchange or share healthcare information – a big stick approach? Seems that way.
[i] Gue, D’Arcy Guerin. "HIT Think Is Information Blocking Finally on Its Last Leg?" Health Data Management (2016): n. Web. 17 Nov. 2016.
[iii] "Interoperability in Healthcare FACT SHEET June 2016." HIMSS. HIMSS Electronic Record Association, June 2016. Web. 17 Nov. 2016.
[iv] "ONC Health IT Certification Program: Enhanced Oversight and Accountability." Federal Register. Office of the National Coordinator for Health Information Technology, Department of Health and Human Services., 19 Oct. 2016. Web. 17 Nov. 2016.