Navigating interoperability and the quandary of information blocking

By Mahesh Kalva
09:44 AM

Although forward-thinking hospitals, health systems and government facilities acknowledge that smooth information transfer between settings will improve patient care, reduce waste and enhance customer service, obstacles on the road to realizing interoperability still exist. In an effort to overcome the hurdle of disparate technologies, a new obstacle, one facilitated by both patients and providers, looms on the horizon. Information blocking -- the purposeful withholding of information pertinent to a patient's medical history -- has arisen as a formidable challenge to health information exchange efforts, often resulting in fragmented or incomplete electronic health records (EHR).

The reasoning behind resistance
Both providers and patients can be hesitant to exchange patient information with other government healthcare entities -- hospitals, specialists and step-down settings ─ for a number of reasons. Patients may be uneasy at the prospect of their information being shared with someone outside their immediate physician or hospital, fearing the data will fall into the wrong hands and result in adverse outcomes. Recent healthcare data security breaches only serve to further these anxieties.

From an alternate perspective, there are separate factors causing providers pause. Cost concerns are seemingly the biggest deterrent, as it can be relatively expensive to share health information, especially for a small or medium-sized organization. Although a provider may see the value in exchanging healthcare data to enhance care quality, unease about the resources involved with setting up an EHR that has the appropriate security standards may curb a provider's enthusiasm. There are also administrative components with which to contend. Providers cannot just open up their data to all requesters. Instead, there must be defined agreements, which require ongoing monitoring, auditing and reporting to guarantee safe and reliable information transfer. 

Business incentives also limit data exchange, as some organizations feel the tactic of holding onto data is a way to preserve market share. The easier data sharing becomes, the easier it will be for patients to receive care from a multitude of providers, rather than a single healthcare organization. As a result, patients' impetus to remain with an integrated health system--where all physician practices and hospitals across the enterprise share data -- may go down, because when information is interoperable, it will no longer matter where a doctor is affiliated.

Providers may also be wary of liability in the event of a breach -- fearing they would be held accountable for and face fines and lawsuits if information is not securely transferred or is compromised in some way. Despite these concerns, the reality is that when interoperability is safe and secure, there are tremendous benefits. It must therefore be clearly illustrated to organizations that, when orchestrated effectively, the benefits of data exchange far outweigh any potential risks.

The necessity of interoperability
Despite both patient and provider apprehension, achieving interoperability remains crucial in efforts to yield improved outcomes. Without seamless information sharing, a patient's medical record can be incomplete or incorrect, leading to duplicative therapies, incompatible treatments, inadvertent care gaps and/or other serious patient safety issues. For example, if a patient visits an emergency department for an acute condition and his or her primary care doctor is uninformed of the visit, poor follow-up could result in negative post-discharge outcomes and unnecessary readmissions. Not only is this bad for the patient, it is also concerning for the provider, especially as reimbursement shifts from quantity to quality.

How can you pioneer the effort?
While the concept of overcoming information blocking may seem intimidating, there are some practical strategies to consider in order to pave the way for seamless and complete health data exchange. Here are two specific tactics to keep in mind:

• Engage patients in their care plan. The best way to mitigate patient worries is to face them head on. This involves talking with individuals about the value of interoperability and how robust information sharing can improve health outcomes. To underscore these points, organizations should offer scenarios that the patient can relate to. For instance, if the patient has diabetes and a penicillin allergy, a provider should describe the advantages of having all those involved with the patient's care aware of the conditions--and illustrate the risks of withholding the allergy information. To enable better dialog, organizations should consider developing easy-to-understand tools, such as infographics or short videos, to guide providers through the discussion.

• Make interoperability local. Most of the benefits associated with information sharing are at the local level, where a majority of patient activity occurs. While national standards that govern data exchange are valuable, the cost/benefit ratio of participating in a national program may not be overly compelling. Additionally, it may be easier to address liability and security issues on a smaller scale where participating organizations can reach solid data sharing agreements and target specific patient populations. For instance, a VA Medical Center and a local integrated health network that treat a similar population would clearly benefit from exchanging information. In this scenario, there would be a high percentage of participation and focused domains of clinical information. The two entities could establish well-defined rules of engagement and security. The more successful and contained the effort, the more apt providers will be to set aside their concerns and embrace the benefits of information sharing.

Ready or not, interoperability is coming
Organizations committed to realizing interoperability must acknowledge the risks associated with information blocking and work to mitigate concerns by fostering education, initiating open communication and, incentivizing action. By exploring proactive methods of preventing this issue and testing some strategies to overcome provider and patient hesitation, organizations will come one step closer to achieving dynamic information exchange.
Mahesh Kalva is Chief Technologist and Life Sciences and Engineering Head for Lockheed Martin Health and Life Sciences.