How to Improve EHR Interoperability

Healthcare has become increasingly decentralized. We are all receiving care in distributed environments, not only from physician practices, clinics, and hospitals. The rise of telehealth and other digital care providers, an increase in ambulatory care centers, payers moving into the provider space, and other market shifts have only compounded this complexity. 

Exchanging data from various hospitals and medical practices, clinics, laboratories, and pharmacies depends on the ability to forge connections to obtain aggregated, normalized data – all in the service of making patient care better. 

Fax machines in office environments are relics of a bygone age, but in the healthcare realm, they were used as recently as 10 years ago as a primary mode of communicating doctor’s notes, insurance forms, and lab test results for 63 percent of physicians. This statistic from the 2012 National Physicians Survey seems shocking, but the Health Information Technology for Economic and Clinical Health (HITECH) Act was only two years old at that point. The 2009 legislation designed to improve the nation’s healthcare delivery system by making all patient records digital provided more than $35 billion in incentives to promote and expand the adoption and use of electronic health records (EHRs). Today, nearly everyone in the healthcare industry has adopted EHRs — and yet significant barriers to interoperability remain.

Some have even gone so far as to call the results of the U.S. government’s attempt to create a seamless system that would share computerized medical histories immediately among physicians, hospitals, and health systems through the conversion to EHRs “an unholy mess.” “Death by a Thousand Clicks: Where Electronic Health Records Went Wrong,” a joint report released in 2019 by Fortune and Kaiser Health News, found the promise of the HITECH Act to be unmet. Also, in 2019, a University of New Mexico study found that 40 percent of physician burnout – which already ran rampant but has spiked since the COVID-19 pandemic – was attributable to EHRs. 

According to a 2020 white paper co-authored by KLAS Research and the College of Healthcare Information Management Executives (CHIME), “deep interoperability” has doubled since 2017. “The overall rate leaves much to be desired, but signs of progress are visible,” its authors wrote. Unrestrained vendor competition and the proprietary nature of medical records software have been blamed for significant gaps, but significant opportunity exists for EMR vendors and provider organizations to positively impact patient care. 

As defined by the Office of the National Coordinator for Health Information Technology (ONC), the U.S. Health and Human Services (HHS) division tasked with the coordination of nationwide efforts to implement and use the most advanced health IT, interoperability is the ability of two or more systems to:

  1. Exchange health information.
  2. Use the information once it is received.

The term “deep interoperability” or “true interoperability” has come to signify the ability to achieve the second part of that definition, because unfortunately a lot of the healthcare industry is still struggling with the first part. 

Levels of Interoperability

The Health Information and Management Systems Society (HIMSS) outlines four levels of interoperability:

Foundational (Level 1): Establishes the inter-connectivity requirements needed for one system or application to securely communicate data to and receive data from another.

Structural (Level 2): Defines the format, syntax, and organization of data exchange including at the data field level for interpretation.

Semantic (Level 3): Provides for common underlying models and codification of the data, including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user.

Organizational (Level 4): Includes governance, policy, social, legal, and organizational considerations to facilitate the secure, seamless and timely communication and use of data both within and between organizations, entities and individuals. These components enable shared consent, trust and integrated end-user processes and workflows.

Getting everyone on the same level has been a journey. The recently released ONC’s Cures Act Final Rule supports seamless and secure access, exchange, and use of electronic health information and Micky Tripathi, national coordinator for health IT, said at the annual ONC meeting in April that 2022 will be a pivotal year in the digital health transformation.

"The exciting part is that we get to think about how we want to redesign our healthcare system without the constraints of paper, brick, and mortar," Tripathi said, adding that he is encouraged by thinking beyond minimum viable compliance, which is when organizations do only what is required and nothing more. "We encourage everyone to make compliance the floor of what you do and not the ceiling of what you do," he said.

Interoperability vendors such as Health Gorilla are reaching for the stars and making great strides in helping the healthcare industry improve patient and physician satisfaction, care delivery, clinical and operational outcomes, and equity.

Normalization Through FHIR

Seeking a way to ingest data uniformly, Health Gorilla built its Health Interoperability Platform (HIP) using Fast Healthcare Interoperability Resources (FHIR). The fourth version was released in January 2019 by Health Level Seven (HL7), a not-for-profit organization that develops international standards for the exchange of health data.

FHIR is a free, vendor-agnostic specification for exchanging clinical and administrative healthcare data using a standard that is based on REST and OAuth. By breaking down data into modular components, these standards are ideal for web environments and work for EHR data, as well as cloud and mobile applications. Data is retrieved by assigning it unique identifiers, allowing different applications to identify and access the same data. 

Benefits for healthcare providers and software developers include:

  • Off-the-shelf interoperability.
  • Simplified implementation and a reduced level of entry for developers.
  • Flexibility that allows base resources to be used as-is.
  • Adaptability.

Using health data standards in a consistent and comprehensive manner is one of the most important steps toward enabling meaningful healthcare interoperability.

Useful Connections

With Health Gorilla’s Patient360, EHRs have access to complete historical records from a vast network of high-quality data organizations working together to enable provider organizations with the data they need to identify care gaps and make better treatment decisions.

EHRs can gain an actionable view of each patient’s medical history, reduce the cost of meeting interoperability requirements, and increase their value to provider organizations.

Health Gorilla is one of the only interoperability vendors with memberships to all three national healthcare networks — eHealth Exchange, Carequality, and CommonWell Health Alliance. This means our users have access to 92 percent of healthcare organizations, more than 220 million patients, 120,000-plus connected care sites, and hundreds of integrated lab vendors.  Partnerships like these increase our ability to expand healthcare interoperability services for patients, providers, payers, life insurers, diagnostic laboratories, public health officials, and digital health developers.

Health Gorilla is also preparing to apply for a Qualified Health Information Network (QHIN) designation under the Trusted Exchange Framework and Common Agreement (TEFCA) this year. We are continuing to work closely with the Office of the National Coordinator for Health Information Technology (ONC) and the Sequoia Project, TEFCA's Recognized Coordinating Entity, as the Framework and Common Agreement are developed to bridge the gap between TEFCA's interoperability goals and the private sector.

Choosing Your Partner in Interoperability

The race towards true healthcare interoperability has been a marathon, not a sprint. And as we enter the home stretch, it’s vitally important that you choose the right company to help you get to the finish line. 

In our free guide What to Look for in an Interoperability Platform, you’ll learn:

  • How the demand for interoperability took on new urgency with COVID-19.
  • Why you should choose a platform built with interoperability in mind from the ground up.
  • The rising cost of a cybersecurity breach and the growing importance of security protocols.

Learn more or download it here. You can also contact us any time to speak with a sales representative or schedule a demo.