Focus on interoperability: What we learned

Top takeaways from a month of reporting on today's current state and the future of health data sharing.
By Tom Sullivan
10:25 AM
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The table is set for interoperability but it’s still going to take a lot of work because the various players — electronic health record vendors, hospitals, policymakers — are not exactly on the same page yet and critical questions remain unanswered.

That’s the takeaway from our Healthcare IT News Focus on Interoperability during April, wherein we interviewed industry luminaries, health IT thought leaders, EHR executives, and more to dive deep and glean their insights.

Let’s take a look at what we learned along the way.

Pulse Check

For starters, three charts based on original HIMSS Media research demonstrate that three-quarters of participants are already into the second level of interoperability. Whereas the first, foundational level of interoperability is simply being able to exchange data between systems, the second structural level means end users can interpret it in data fields. 

It’s worth noting that the structural level is not the endgame, however, as there is at least one more level, semantic, which is where two or more systems can exchange and actually use health information — only 29 percent of survey respondents indicated they have achieved that.

EHR vendors tend to take a lot of blame for the interoperability challenge. So we asked some of them to explain where they stand. Yes, there’s reason to be skeptical and there are key questions for prospective customers to seek answers about, beginning with: How many patient records do your customers exchange daily?

Another key consideration in the broader discourse about nationwide interoperability is: Do we have the value proposition upside down? AMIA CEO Dr. Doug Fridsma said in an interview that the industry should be thinking not just about what we want to achieve with interoperable data but, instead, what we will need to do years into the future — because it’s going to change.

FHIR + APIs

The current proliferation of open APIs will help. So we took a look at what you need to know about APIs including the challenges, methods and what the future might hold. Hint: It’s bright if the steps are taken to ensure that health data is usable at the point of care.

One physician CIO said moving from CCDA to FHIR will go a long way and also recommended a national patient matching strategy based on biometrics.

The FHIR specification hit something of a milestone earlier this year when HL7 released version 4, the first iteration to be normative, meaning that future versions will be backward compatible. That should open the doors to developers holding back because they knew that until FHIR 4 became available any app they write for FHIR 3 would have to be overhauled.

The arrival of FHIR 4, in fact, has many experts saying that because the spec is more modern, functional and flexible than what previously existed it is much easier to use. And HL7 has already offered a glimpse of what to expect in FHIR 5, saying it will build on FHIR 4, support apps that use multiple versions and bring other advancements. 

But no one is saying FHIR will solve all of healthcare’s problems.

Next up for interoperability

Striking an optimistic tone in this in-depth interview, Dr. Don Rucker, head of the Office of the National Coordinator for Health IT, said that it’s still early but we’re getting close.  

Rucker pointed not just to policy work such as the 21st Century Cures Act and forthcoming final regulations to eradicate information blocking but also to private sector developments — notably Apple’s work with well more than 100 health systems and several thousands of providers to deliver data in a format patients can actually use. 

It's not just Apple, either. Provider organizations are starting to figure out how HIEs and AI can be used to improve interoperability as part of population health programs.

"Certainly as you look forward, it's pretty exciting in terms of what we think can be done," Rucker said. "Obviously we're doing it to help the American public, but I do believe that will actually facilitate a lot of things for providers as well." 

Twitter: @SullyHIT
Email the writer: tom.sullivan@himssmedia.com

Healthcare IT News is a HIMSS Media publication.