Interoperability More than Machines Talking Together

Despite the continual chorus of voices singing to the rafters about the need for interoperability capabilities in healthcare – and while there has been quite some progress in that direction recently – it appears that those efforts have remained largely focused on finding and transmitting information, but not on usability. This is according to new research published by Health Affairs.

In reviewing a group of hospital data from 2014 and 2015, researchers wanted to see how they improved on four interoperability measures, including finding, sending, receiving and integrating electronic patient information.

From these hospitals, nearly 30 percent of hospitals questions said they engaged in all four areas in 2015, up slightly from almost 25 percent the prior year. Researchers report that the greatest gains were seen in sending and receiving with 8.1 and 8.4 percentage points, respectively. Only about 19 percent of hospitals said they “often” use patient data from outside providers to inform patient care decisions – that’s a problem.

So then, as more of these organizations adopt electronic health records and digital technologies, data sharing, they say will become more important than ever.

Accordingly, barriers to integrating information into EHRs and clinical workflows include not routinely seeking external data for clinical care and not taking full advantage of health information exchange organizations, the authors add. Researchers note that IT infrastructure has tended to focus on moving information between hospitals, rather than on integrating that data.

“A greater policy focus on integration, rather than on sending and receiving data, may help hospitals’ focus to making data available at the point of care when it is clinically relevant,” the authors note. “Hospitals should also assess important ‘last mile’ issues, such as when and where outside data are being used. Low levels of use, which have been found in other studies, should prompt hospitals to examine and address underlying barriers, such as low awareness of HIE capabilities or poor use interface design that makes it difficult to know when relevant information is available.”

On a separate note, it might be worth mentioning that healthcare organizations are focused on reimbursement. The results of a separate survey show that the top three main concerns of healthcare professionals for 2018 include clinical and data analytics, population health services and value-based payments. Ferris Taylor, chair of the board of directors of the HealthCare Executive Group and COO at Arches Health Plan in Salt Lake City, said one of the reasons for this is that healthcare organizations are creating interoperability to make it possible to bring various types of data together in one place is a priority.

"We're seeing that interoperability ... is really a difficult challenge, getting legacy computer systems to talk to each other. But the part of healthcare that is attainable and actionable is bringing the data together," Taylor said. "Clinical [data] is a very important part of that top ten statement, clinical and data analytics, because we have administrative data, but now it's time to bring in all of the pieces of data."

Interoperability isn’t solely a problem, though, and one way to rectify it might be to give patients better ownership of their health data. A new perspective published in JAMA offers a potential approach to doing that:

  • The establishment of common data elements in health records
  • Creating a “patient encounter data receipt” from every medical visit
  • Requiring a data use agreement (DUA) between patients and the entities that manage their healthcare information

According to JAMA researchers, the first point is important for the others. For example, a standard health record could help create interoperability. Healthcare Analytics News points out, “given that patients already generate reams of new data through wearables and health-tracking apps … this information should be paired with data created from medical testing and doctor input. It would allow for the creation of a more comprehensive look at a patient’s health and would also support secondary uses for better research and public health surveillance.”

The second tenet, a “patient encounter data receipt,” would hinge on the first point of standardization. It would require any healthcare provider to deliver “not just the visit summary, but images, billing and any other related information,” in a “timely” manner. “Modest EHR system changes would be required to implement receipt processes,” the authors write, but if automated, “could minimize clinician and patient burden.”

“Today’s existing architecture, however, fails both patients and clinicians,” the authors write. They believe precedent exists and that the long-term benefits of comprehensive, patient-controlled health data could save clinicians time, enable patients to take better care of themselves, and avoid waste, like redundant medical tests, which often spring up from a lack of interoperability.

For the foreseeable future, the interoperability chorus will continue to sing.

Scott Rupp's picture

Scott Rupp


Scott E. Rupp is a writer and an award-winning journalist focused on healthcare technology. He has worked as a public relations executive for a major electronic health record/practice management vendor, and he currently manages his own agency, millerrupp. In addition to writing for a variety of publications, Scott also offers his insights on healthcare technology and its leaders on his site, Electronic Health Reporter.

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