NQF says interoperability goes far beyond EHR-to-EHR data exchange
The National Quality Forum published a framework for measuring the progress of interoperable health information exchange.
Within the 83-page document, NQF defined interoperability as “the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user.” NQF said that definition is consistent with one the Office of the National Coordinator for Health IT uses in its nationwide interoperability roadmap.
To accomplish that, the agency outlined five guiding principles for defining key criteria of interoperability.
Interoperability is more than EHR to EHR. NQF pointed to various data sources, notably a Qualified Clinical Data Registry, mHealth devices, databases housing clinical trial and third-party payer information and practice management systems. “Interoperability focuses equally on ensuring that patients, their families, and caregivers have full access to view, download, and exchange their health data, contribute patient-generated data to providers’ EHRs, and arrange for the inclusion and exchange of data generated by multiple healthcare providers,” the report said.
Various stakeholders with diverse needs are involved in the exchange and use of data. In a truly interoperable healthcare system, patients, payers, providers and related government agencies should be able to actively access and use health data and each in their own ways, NQF said. Patients, for instance, should be enabled to harness technologies for engagement and self-care, when appropriate, while clinicians should be able to use interoperable data to make value-based care decisions. “The ability to gather multiple sources of data, organize and analyze it, and create actionable knowledge optimizes the decision making of both providers and patients,” NQF report authors wrote.
“Electronically exchanged information” replaces the term “outside data.” This one gets into the nitty-gritty of phraseology around interoperability but raises an important nuance. While interoperability can include the ability of a system to access data that is outside the host system, “this concept of outside data runs counter to the definition of interoperability,” NQF authors noted. “’Electronically exchanged information” is more congruent with accepted definitions and aligns with the intent of the Shared Nationwide Interoperability Roadmap developed by ONC, which emphasizes bidirectional and multidirectional exchange among diverse information systems and moves the framework closer to the objectives described within the 21st Century Cures legislation.”
Interoperability needs will differ depending on the care setting. While much of the conversation about interoperability focuses on hospitals and health systems exchanging patient data, payers and providers are not the only organizations critical to an interoperable healthcare system. Housing agencies, schools, jails and social services are all important as well and “social and environmental determinants of health are critical to better healthcare and better health outcomes,” NQF added. As such, careful consideration should be given to these entities.
All critical data elements should be included as interoperability increases access to information. The final principle builds on the first four to state that various data types including those from nonclinical sources — such as social determinants including economic stability, education, food and physical environment — that are not found in EHRs must be accessible. “The significance of these data is critical in both understanding and serving diverse populations with complex needs,” the authors wrote. “As the use of EHRs and other systems expand beyond providing information about a single patient at the point of care to accounting for communities and populations, it is important that critical data elements are included.”
Looking forward, the NQF said it intends for the framework to meet the 21st Century Cures Act’s definition of interoperability, which is that health IT not only enables secure exchange and use of data, but also allows for complete access and exchange for authorized use and does not constitute information blocking.