Meaningful use expert: Time to think about next generation interoperability
For all it success in spurring uptake of electronic health records at hospitals and physicians practices, meaningful use didn't necessarily incentivize effective interoperability – especially not at the long-term, post-acute, home care and other settings where it could truly drive value.
Kathleen Sheehan, program director for meaningful use at UHS Inc., says we could be doing a much better job connecting sites across the care continuum. And there are several reasons for – and remedies to – that, which she'll be discussing at HIMSS17 along with her colleague, Sindhu Raveendranathakammath, a clinical informaticist at UHS.
"Interoperability is generational," said Sheehan. "Hopefully in the industry there will soon be a paradigm shift and think about the next generation."
The first generation is secure email, such as Direct messaging, she explained. That works pretty well on the ambulatory side, but Sheehan argues that it's still never quite found its footing as an embedded workflow in the hospital: "How am I going to distribute these things that are coming in by the hundreds, when we don't even have a standard subject line?"
The second generation is the decentralized, federated model – a commodity-based exchange mechanism that's something "we all need," she said. "But the problem with it is that it's voluntary membership, so already you've got vendors fighting: 'I don't want to be in the same sandbox with you.' But we need seamless exchange. If we have five or 10 federated models they're all going to have to talk to each other, seamlessly, if we're going to experience the true benefits of interoperability."
One unintended consequences of the EHR Incentive Program, of course, is that eligible providers and eligible hospitals were the only entities incentivized to adopt certified technology. Long term and post-acute care were left out of the meaningful use mix.
"So what's the consequence? Well, we're a far cry from having a complete digital record," said Sheehan.
What's more, even among those eligible providers who were incentivized, health information exchange remains low in many cases. At UHS, for example, "our performance for exchange under meaningful use in 2016, our highest was 30 percent. Why? Because there's not enough community providers to send electronic mail to, because they don't have it."
Sheehan contends that there's a better way forward – that providers should be able to embrace more inclusive, less restrictive methods of data exchange.
While ONC may have meant will with its stringent requirements for certified EHR technology, Sheehan argues that "we don't have to wait for everyone to adopt certified tech to wait for the benefits of interoperability. Providers need to know the value proposition associated with exchange. They don't need to have a certified EHR. If we can just get exchange rolled out across the continuum, that's interoperability. "
Sheehan recently asked her providers to show her an inbound or outbound CCD from their certified EHRs. "We couldn't believe how all over the map they are," she said. There was all sorts of extraneous information, the display and organization of the data was sometimes confusing, the "look and feel" of the documents varied widely.
The healthcare industry – providers, policymakers, vendors and others – need to come to a consensus on the "key components for meaningful exchange, and then let's start exchanging them," said Sheehan. The idea of federated exchange is so tantalizing, but "we're still struggling with membership and what to exchange," she added.
"The technology really holds so much promise," she said. "But how do I sell across the continuum, even to providers who don't have certified technology? Because many don't even know there's a value proposition in exchange. Someone needs to tell them there is!"
Partly, she said, that's job of those "in the business of creating these products – creating the demand for them: Is it relevant at the point of care? Is it meaningful? What's my confidence level in the accuracy of it?"
Policymakers still have a guiding role to play, she added, but "I think it's going to be the private sector that does this."
If we can get to that "next generation" of easy, seamless widespread exchange, the benefits will only proliferate, said Sheehan. Health information exchange is "a silver bullet in reducing costs associated with duplication. It will improve quality too, because then the other silver bullet is care coordination, which is huge."
Sheehan's session, "Overcoming challenges/obstacles to achieving interoperability," is scheduled for Tuesday, Feb. 21, from 10-11 AM in Room W311A.
HIMSS17 runs from Feb. 19-23, 2017 at the Orange County Convention Center.
This article is part of our ongoing coverage of HIMSS17. Visit Destination HIMSS17 for previews, reporting live from the show floor and after the conference.