Healthcare information interoperability has been in the news a lot in 2017. This fall the Acumen blog featured a 3-part series by Eddie Hedrick reviewing the interoperability landscape. Eddie’s December 4th blog post focused on Consumer-Directed Exchange (CDE), which sounds like a holiday gift for all of us who have been patients. CDE is about consumers “invoking access”—controlling access to personal health information. While CDE is very desirable, we’re definitely not there yet. As Eddie noted, some vital pieces are missing, such as consistent standards for health data storage and the ability to match patients or use a universal patient identifier.
Private sector interoperability progress
In past years, federal policy- and rule-making shaped the Health IT agenda. At the beginning of each year we would look for new Meaningful Use (MU) requirements or mandates from the Office of the National Coordinator for Health IT (ONCHIT) to plan our work. This year there’s no new ONCHIT national roadmap and Healthcare IT News reports that most of the interoperability progress is coming from the private sector and not the government.
In 2017 the private sector made connections to move interoperability forward. Private sector interoperability champions include vendors like Epic, health systems like Intermountain Healthcare, and HIT standards groups like HL7. HL7 continues to develop the Fast Healthcare Interoperability Resources (FHIR) specifications which support interoperability of systems by standardizing commonly exchanged health data. Redox, supported by Intermountain Healthcare, is an intermediary using application programming interfaces (APIs) to connect to healthcare entities and facilitate data exchange.
In his October 9th Acumen blog post Eddie noted that MU interoperability focused on provider-to-provider and provider-to-patient information sharing. This led to patient portal development and MU measures for patient-record view, download, and transmit. Future interoperability development should be even more patient-centered making each of us the curator of our own healthcare data.
Putting patients at the center of data exchange solves common healthcare fragmentation problems. Like me, many people are old enough to have multiple healthcare providers and spend time manually trying to move data among them. I have several patient portals with data and often copy and paste, transmit files, or even print and fax records to share with providers. We need an interoperability solution that allows patients to digitally share personal data as needed with multiple providers.
Even young, healthy patients may find they have to share records among several providers during a health care event. In his December 4th post Eddie described his bicycle accident, which generated a personal healthcare data management opportunity.
The November 30th Geek Doctor blog post highlights the personal inefficiency, cost, and frustration of the lack of interoperability in “Another Dispatch from a Broken Healthcare System.” This is the story of a healthcare executive mom and her child with a chronic health problem who have the need to share healthcare information after moving from one city to another. Changing healthcare providers created a burden of collecting records and manually moving them from one healthcare system to another. Even when patients are willing to manage their records, EHR systems fall short of enabling digital record exchange.
Epic’s Share Everywhere
As one of the largest EHR vendors, Epic has led the way in provider-to-provider interoperability with “Care Everywhere” technology. For healthcare systems using Epic this has allowed provider-to-provider data viewing and exchange. In September Epic announced a patient-centered interoperability solution, “Share Everywhere”. The announcement image is a person holding a phone, illustrating that this is a technology easily controlled by individuals using a smart phone. “Share Everywhere” gives patients the power to authorize access to their personal health data in the Epic “MyChart” portal. On the spot in a provider’s office, patients can generate a one-time access code for a provider. The provider accesses the Epic “Share Everywhere” website and, using the access code and a verification of the patient’s date of birth, has a view of the patient’s “MyChart” records. In addition the provider can enter a progress note to send to the patient’s other provider.
Cerner and the government
In October the Department of Veterans Affairs announced that Cerner would be the new EHR vendor in a multi-million dollar public-private partnership. The Cerner system is used by the Department of Defense, creating the opportunity for business and clinical data exchange with the large VA health system. The VA issued functional system requirements including secure information exchange and collaboration with VA affiliates like community health partners and private sector providers, so interoperability is a key feature. VA decisions and demands will drive private sector innovation.
Interoperability in 2018
It is refreshing to talk about big efforts to bring people and data together through interoperability. New efforts in the private sector and in public-private partnerships are promising. New technology is patient-centered, putting people in control of their own data with smartphone apps. Epic’s “Share Everywhere” is literally that, enabling healthcare data sharing and access anywhere in the world that the patient and provider have internet access. Maybe interoperability will be the poster child for public-private cooperation, people-centeredness, and global solutions for 2018.
Many good wishes for a Happy New Year and national and global progress toward sharing and peace!
Dugan Maddux, MD, FACP, is the Vice President for CKD Initiatives for FMC-NA. Before her foray into the business side of medicine, Dr. Maddux spent 18 years practicing nephrology in Danville, Virginia. During this time, she and her husband, Dr. Frank Maddux, developed a nephrology-focused Electronic Health Record. She and Frank also developed Voice Expeditions, which features the Nephrology Oral History project, a collection of interviews of the early dialysis pioneers.
Image from www.canstockphoto.com.