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It’s not hard to see why the seamless exchange of data between applications, providers, and healthcare organizations, known as interoperability, benefits all parties – providers, administration, and patients alike. The availability of relevant, real-time clinical data provides insights that help clinicians make more accurate diagnoses and prescribe more effective treatments. When data is easily shared across providers and organizations, clinicians access relevant patient records faster, speeding treatment and reducing errors, such as prescribing a medication that’s contraindicated with the patient’s other medications or health conditions.
Clinicians and administrative staff save time on tedious, manual tasks such as copying and faxing patient records and inefficient data entry tasks. Patients not only benefit from faster, more precise care, but they also have readily available access to their medical records and can perform tasks such as scheduling appointments and communicating with providers with ease.
While the benefits are clear, obstacles such as ensuring the security of personal health information (PHI) and integration challenges mean it’s not possible to simply share data freely across the industry. That’s why there’s a continued push for interoperability, the ability to share and exchange data with different sources without putting sensitive data at risk. To learn more about the progress made and promising ways to simplify inteoperability, we reached out to a panel of healthcare IT pros and asked them to answer this question:
“What’s the single best way to simplify interoperability in healthcare IT?”
Meet Our Panel of Health IT Pros:
Chris Wiegand is the CEO & Co-Founder of Jibestream. Chris is the driving force behind Jibestream. He started the company with a vision to change the way people engage with indoor spaces by fusing business data with maps. Chris has led Jibestream’s incredible growth from an idea to a globally recognized leader in the indoor mapping world.
“There is general agreement within the healthcare space that care delivery stands to gain much from achieving interoperability…”
Interoperability in healthcare would not only improve the delivery of patient care, but can also reduce costs and lead to better overall patient experiences. There is no shortage of technology platforms available in this industry, but unfortunately there’s a huge disconnect between them with many of these systems having been built in silos. While the industry is on board conceptually with striving to improve efficiencies in our hospitals, reduce errors, achieve more accurate reporting, and provide better access to more complete patient records, actually achieving the required interoperability to deliver these outcomes has proven to be incredibly difficult.
The ultimate goal of pursuing interoperability in healthcare is to make it easier for the devices and platforms used across the continuum of care to not only talk to one another, but to also communicate seamlessly with Electronic Health Records (EHRs) and other systems that support patient care delivery and clinical decision making. With the transition towards EHRs in recent years, the limitations and frustrations caused by the lack of interoperability have only become more glaring.
Throughout the interoperability conversation, there’s been much debate around data standards. Efforts by many different organizations have resulted in standards such as the FHIR (Fast Healthcare Interoperability Resources) for EHRs, DICOM (Digital Imaging and Communications in Medicine) for diagnostic imaging, and IEEE 1073 for the exchange of data between biomedical instrumentation equipment. However, we have not seen the widespread adoption necessary to enable providers to successfully connect, communicate, and collaborate. This is why there needs to be a shift in focus in the conversation towards APIs, which enable healthcare providers the flexibility they need to connect their disparate devices and systems. Since no one software or hardware vendor is going to be able to solve all of their business problems, they will need to work with an ecosystem of partners, and it’s increasingly important for those trying to build an effective Real-Time Health System (RTHS) to seek out vendors that are open and extensible.
The best road to interoperability in healthcare available to us today is to demand an open architecture from vendors and technology providers. Vendors should be technology-agnostic, have open APIs, and enable easy third-party integration. By establishing an open architecture with the highest levels of security for providers, device-makers, IT vendors, medical devices, and enterprise interfaces, the technology communication lines would open up to two-way data exchange, enabling real-time one-to-many communications. Rejecting point solutions with closed architecture and embracing vendor-neutral open architecture is the first step on a long path towards meaningful healthcare interoperability.
Zach Alam is the Chief Blockchain Consultant at onboard.one.
“In my line of work, I’ve seen this question a lot, and not just limited to healthcare…”
It relates to the bigger problem of how best to share data. The single best thing we can do is start to record medical records on a commercial-scale blockchain. The records can be made private through encryption, and decrypted to an authorized source when needed (hospital, doctor, ambulance, etc.).
A blockchain offers two important benefits with respect to medical data interoperability:
- A universally known location of where data can be retrieved.
- A predictable data format that any end party can interpret.
Dmitry Garbar is a Partner at Belitsoft, a software development company with a healthcare focus.
“Were it a technical challenge, healthcare interoperability would’ve been solved years ago…”
eLearning, for example, has a number of widely accepted standards: SCORM, xAPI, LTI, and a few less-important standards. All of them are supported by most Learning Management Systems. There already are some suggested interoperability standards in healthcare, like FHIR. But pretty much no one cares to adopt them.
Interoperability in healthcare IT is a business challenge because it doesn’t benefit EHR vendors or healthcare providers. Why would a company with a decent market share make its system interoperable with their competitors’ systems, thus making it easier for a customer to switch? Why would a for-profit hospital invest in something that would help their clients move their records (and their business) to another provider?
The best way to solve it would be to provide a governmental incentive for the EHR vendors and healthcare providers to implement interoperability. Without it, the problem would persist.
David Found is the Vice President of Product Development at Indellient and leads new product development initiatives within the company. His broad vision for a solution allows complex problems to be solved in an efficient and intuitive manner, specializing in modern and robust web applications. David earned his bachelor’s degree in computer science from the University of Guelph.
“When I saw the word interoperability and healthcare, I immediately thought of an intuitive solution as the solution…”
The market is moving away from generic and siloed systems to more purpose-driven use cases and specialist technology providers that integrate with affiliated content systems, repositories, and stores. IT leaders who demand a single solution fail to understand their users’ needs and behaviors and, ultimately, the nature of the digital business.
Speaking from experience as an organization that specializes in interoperability and alleviating the pain points of health plan marketing teams and health insurance companies, I have seen this sector struggle with the amount of paperwork they receive daily. Moving away from legacy systems into standardized and automated processes is the answer. Integrating with content systems and tools such as Microsoft SharePoint, Google Drive, Dropbox, and more can be all the difference they need.
By leveraging interoperability with intuitive solutions that can customize themselves into your IT environment (not the other way around), the healthcare sector can make smarter decisions, improve quality in output, and reduce cost.
Bobby Middleton serves as Vice President of Product Operations for PharmaPoint. In support of the organization’s strategic business needs, he provides executive leadership and oversight for the company’s software development, support, and go-to-market strategy. He brings 20 years of industry experience in high growth technology businesses to the team.
“The overwhelming amount of IT demands with the expansion of EHR adoption has turned too many conversations into strictly technical discussions (if it is anything outside the EHR)…”
I call it EHR economics. So many organizations are paralyzed, due to their enormous investment into their EHR. This can negatively affect their ability to solve more problems for their providers and patients. Standards have been in place for quite a while to allow for a basis for which to exchange data. So, it all boils down to discussing the actual job to be done. When you step away from the technical details for a while and identify the projects that have the biggest impacts on patient care, a plan can be established to accomplish the goal. I’ve been involved with innovative products that mostly live outside the core EHR system for more than 15 years. In all that time, I can say that when the job to be done has a strong value proposition for patient care and operational improvement, perceived technical barriers start to fall.
Nir Kshetri is Professor at University of North Carolina-Greensboro. He has authored nine books and about 130 articles in various journals. Nir has been quoted and interviewed in, and his work has been featured by, hundreds of
media outlets worldwide.
“The single best way to simplify interoperability in healthcare IT is to use blockchain…”
Using blockchain, patients hold ownership and ultimate control over their information. For instance, the patient can decide where their records can travel. In this way, the locus of control is shifted from the institution providing the healthcare to the patient. Third parties such as healthcare providers can see the patient’s data with their permission, but they are not required or expected to store the data. In this way, a blockchain-based model is superior to existing data governance models. The blockchain ledger includes an audit trail and data that are time-stamped, which allows the patient to know (within reason) who made what changes and when.
Amit Bareket is the CEO and Co-Founder of Perimeter 81. Amit served in the Israel Defense Force’s elite cyber intelligence unit (Unit 81) and is a cybersecurity expert with extensive experience in system architecture and software development. He is the author of 7 patents issued by the USPTO for storage, mobile applications, and user interface.
“As medical professionals and patients look to access health data remotely…”
It’s essential for healthcare organizations to embrace an easy-to-use security solution that works for everyone.
With the Software-Defined Perimeter (SDP) architecture, organizations can easily protect data transmission, secure data with strong encryption, and meet other compliance requirements to secure electronic Protected Health Information (ePHI).
The majority of ePHI breaches result from compromised mobile devices or networks that contain unencrypted data which can result in loss of trust, substantial fines, criminal charges, and even civil action lawsuits.
Using Software-Defined Perimeter architecture, healthcare organizations can:
- Lockdown Confidential Data and Databases to a Specific IP Address: Designate user access according to specific IP address, limiting data access and segmenting the network.
- Provide Nonstop Security with a Kill Switch Feature: A kill switch ensures that if your encrypted connection disconnects, the Internet connection is stopped and no data is transferred so that no third party can see your data in plain text.
- Implement Two-Factor Authentication and Identity Provider Integration: Two-factor authorization is key to security because it prevents hackers from accessing your account even if they were to obtain your login credentials.
- Gain Visibility into Cloud Usage: The average healthcare organization uses 780 cloud services, many of them unknown to IT. With SDP, you can assess potential risks and secure confidential health information.
- Automatic Wi-Fi Security: Automatic Wi-Fi Security is a patent-pending feature that automatically activates military-grade encryption the moment an employee connects to an unsecured Wi-Fi network.
- Easily Achieve Compliance: Drive compliance by preventing unauthorized access to protected health information (PHI) and enforcing strict data storage and transmission policies in the cloud.
Karan Shah is the Director of Solute Technolabs.
“The best way to simplify interoperability in health IT is…”
SNOMED, also known as Systemised Nomenclature of Medicine. The issue with healthcare IT is that many systems speak different languages and none can talk to each other. SNOMED, started in the US, is accepted in many countries and contains a global dictionary of medical terms, medicines, and more (even translated into different languages).
Twila Brase is the President of Citizens’ Council for Health Freedom (CCHF) on interoperability.
“Interoperability has been called a $30 billion unicorn hunt…”
Congress wants to make medical records interoperable – able to be exchanged and used across different computerized record systems without any special effort. A 2016 law allows the government to issue penalties for ‘information blocking’ between systems.
But interoperability has been called a $30 billion unicorn hunt, because that’s what we’ve spent already and it hasn’t happened. Even the federal departments of Defense and Veterans Affairs don’t have interoperable medical records after spending $1 billion. But knowing that HIPAA allows potentially 2.2 million entities, plus government, to access your data without your consent, do you really want them to succeed?
Dr. Reed is a leader in the health IT space working on a suite of services focused on clinical decision support tools which include: electronic benefit verification, real time benefit check, electronic prior authorization, and integrating specialty pharmacy workflow into the EMR at the point of care. A pharmacist and patient savings advocate, Dr. Reed is the founder of BestRXforSavings.com.
“Due to healthcare and healthcare IT being two of the most highly regulated industries in the U.S….”
Simplifying interoperability is easier said than done. Key pieces of the foundation have been laid though, those being the broad adoption of EMRs, the development of open API concepts within most major EMRs, and the maturation of the FHIR HL-7 standard. Quicker wins will exist where large healthcare organizations have systems that allow the free exchange of this data. Regulators and patients must let go of idea that patient data exists in an episode or a single hospital visit. Instead, the patient record must be viewed as linear over the lifetime of the patient. From birth records and immunizations to childhood, adolescence, and becoming an adult. One system that the pediatrician uses can’t trap the data and not allow the data to flow through to other providers over time.
Prior to serving as a Chief Innovation Officer with Managed Solution, Jeremy founded Gordian IT Healthcare in 2011, where he oversaw the overall strategic direction, customer retention approaches, and growth strategies. Jeremy also served in various senior level roles within the technology sector. As Vice President, Western Region for Affinity, Inc., a leading information technology consulting firm, he had P&L responsibility for the development of the Western Region. Previously, Jeremy was responsible for the development of the IT PMO and IT Governance Office at Avery Dennison Corporation (NYSE: AVY).
“Healthcare Interoperability is the ever-elusive effort for enterprises to pursue…”
It’s big data management, it’s data governance, it’s carefully selected tools, and it’s the combination of these things that allows the first real steps to interoperability and more effective patient care. Don’t just buy a tool — that’s fool’s gold. Instead, develop a strategy around the data and the desired end state, then layer in technology, Informatica, Hart, etc. to automate.
“The single best way to simplify interoperability in healthcare IT is to…”
Have a usable, standardized API. The key word there is usable because while standardized APIs exist, most of them are an absolute nightmare to work with.
Something like FHIR is a step in the right direction, but it might not be the last word on the subject. But it is eminently more usable than the existing solutions and it is fairly well standardized — there are a ton of ad hoc solutions in healthcare IT, which is an absolute nightmare in terms of integration and maintenance.
Adam Sbeta is a Cyber Security Analyst & Speaker at Oakland Cyber, tracking down and analyzing malicious behavior since his teenage years. After a decade of experience in designing, integrating, supporting, and securing technologies for enterprises, Sbeta has shifted his mission to make SMBs more cyber secure than enterprises.
“The best way to simplify interoperability in healthcare IT is to…”
Not re-invent the wheel and use existing integration/automation technologies.
Many IT departments try to write scripts and integrate between systems on their own. This doesn’t only pose wasted time and resources, but also poses a huge cybersecurity risk of opening a loopholes somewhere in the middle. This happens all the time. IT staff are passionate on building something unique, but not having the experienced background and security skill can have devastating results in the long run. You’re better off working with a vendor that is specialized in the healthcare industry and experienced in the problem you’re trying to solve. This way, you’ll work with a mature product that has been tested in real life, and you can validate if they have invested in adequate security. If such a product is not found, then a vendor outside the industry that might have a similar solution could still be better than building it from scratch in-house.
Sia Mohajer is the Founder of Privacy Australia. For the last three years, he has been helping people around the world reclaim digital sovereignty. Data is the new oil. Don’t give yours away.
“Web application security starts with a simple premise…”
All systems must be interoperable or vulnerabilities will become exposed. You don’t get large scale deployments of IT projects with incongruent data architecture. The same applies for healthcare. If you want healthcare systems to talk to each other and become interoperable, then you need to create standards for data security first and foremost. Otherwise, what you get is a patchwork of outdated systems running outdated Windows installs getting hacked all over the country. A lot of people will blame politics, funding, or other issues, but the answer is security. Things that work independently of each other are more vulnerable. Open source standards is the best way to simplify healthcare IT.
Harry G. Greenspun
Dr. Greenspun has served on the advisory boards for the World Economic Forum, Anthem, and Healthcare Information and Management Systems Society (HIMSS). Prior to Guidehouse, he was CMO of Korn Ferry Health. Previously, he served as the Managing Director of the Deloitte Center for Health Solutions.
“The single best way to simplify health IT is for customers to…”
Agree on how it should work and then demand that of their vendors. If buyers are able to reach consensus and then dictate plug and play functionality, the industry will come to adopt interoperability as a fundamental requirement for success.
Nicole Hovey is a Marketer at BestNotes.
“Because it facilitates communication, interoperability can benefit patients, providers, and payers in a variety of ways…”
Improved care: Data sharing among providers is an important benefit of interoperability. As both providers and payers focus more on value-based care, which emphasizes improved patient outcomes, clinicians need a picture of a patient’s entire health. This often requires a patient’s different clinicians to be in contact with each other.
Increased efficiency: When information can be shared quickly and consistently, clinicians can make better decisions, faster. This can help them better focus on patient needs, improving outcomes. Better data sharing also puts less of a burden on patients to convey information from one provider to another, or between the provider and payer.
Lowered costs: Greater efficiency in data sharing can lower costs by reducing the risk of errors in billing or patient records, which also helps save staff members’ time. By improving care, interoperability can lower healthcare costs by reducing the risk of diagnosis or treatment errors, or removing the need for unnecessary testing.
More providers and payers recognize the value of data sharing, and electronic health record (EHR) technology is becoming more widely implemented. This will make interoperability an increasingly important issue for behavioral health and addiction treatment providers to address.
Clinical implementation aside, there are numerous regulatory changes that have made (or will make) interoperability an unavoidable issue in healthcare.
As policymakers and regulators promote not only EHR use but interoperability, new laws and standards may extend to behavioral health. Here are a few things behavioral health providers may want to keep an eye on:
Launching Interoperability Under HITECH Act
The Health Information Technology for Economic and Clinical Health (HITECH) Act, enacted as part of the American Recovery and Reinvestment Act of 2009, was intended to promote meaningful use of health information technology. This law legislatively mandated the Office of the National Coordinator for
Health Information Technology (ONC), which is intended to support the adoption of health IT and promote interoperability.
Medicare’s MyHealthEData Initiative Would Encourage Interoperability
In February 2019, the U.S. Department of Health and Human Services (HHS) proposed new rules to support interoperability in electronic health information (EHI). These proposals are intended to increase choice, competition, and innovation in health information. Under the rule, patients would be given electronic access to their EHI at no cost.
Divya Malhotra is the founder and CEO of Purple Pivot. Prior to starting Purple Pivot, she was the Executive Director of Analytics and Innovation at Stamford Health in Connecticut where she led the analytics strategy and internal consulting for the organization.
“The single best way to simplify interoperability in healthcare is…”
Implementation of standardized and centralized universal patient Identification numbers. The biggest challenge healthcare faces today is that patients and consumers have their data distributed across practices, providers, hospitals, and post acute care settings. While technology to tackle data integration is seen as the new panacea for integration, what is often overlooked is that the single biggest challenge is patient matching across systems. If healthcare leadership is able to figure this out, a large part of the interoperability challenge will be solved.
Tom Feltham is the Product Director of Software Path.
“Simplification of health IT interoperability begins with system integration, so the best way to ensure simplicity is to…”
Factor integration support into software selection and implementation. Too often, health IT systems such as EHR, e-prescription, or practice management software are chosen solely for their physician or patient features, with integration addressed after a system has been chosen. This leads to complex, custom integrations being developed to deliver interoperability.
If interoperability is a key part of your software requirements gathering and implementation plan, you will find it is possible to select systems that have built-in integrations, tailored to the workflow your practice follows.
Kimb is the Co-Founder of digital agency Make Do, specializing in practical and modern web solutions and trusted experts in the WordPress platform. Kimb has 15+ years industry experience in web and digital, design and development, engagement, and project management, including health sector experience and public sector projects where he has worked as a private consultant or freelance.
“Always aim to use open source…”
Interoperability means that you need to make your systems talk to each other using open and easy-to-main standards. Off-the-shelf systems from some vendors lock in their technology and aren’t open meaning that getting data out of systems like this can be like getting blood from a stone. At worst, you’ll be stuck doing manual interoperability, and at best, you’ll be charged an additional license fee to get the data out of your system.
Open source tools are generally designed to be fully open and have built-in APIs which can easily be connected and integrated with other tools. Take WordPress, for example, which comes with its own ‘REST-API’ out-of-the-box and can easily be modified to integrate with any external data source.
Joe Bailey is the Operations Manager at My Trading Skills.
“The best way to simplify interoperability in healthcare IT is to…”
Allow and ensure transparent, efficient, and autonomous collaboration between the exchange systems within the health networks. Consolidation and collaboration between the systems will ensure that the holistic views of patients’ health are developed so that they are provided with the most effective care and treatment.
Cindy Mallory is a Fund Partner, the former CMO of a VR Games studio, Co-Chair of the VRAR Association Blockchain Committee, and a global educator on analytics and VR. She has an extensive background in Blockchain, IOT, systems design, and mixed reality systems.
“The best way to simplify interoperability in healthcare is by becoming a technophile…”
I’m involved in disruptive medtech projects intersecting emerging economies with emerging technologies with a focus on blockchain.
Blockchain is a trustless way for computers in a network to communicate and share information. An immutable record is kept on the cryptography fueled ledger. Pilot projects are being deployed by large players in the medical arena that utilize blockchain technology for everything from record storage, data privacy, and ownership of health records, and tokenized ecosystems of researchers, patients, and companies developing new incentivized ecosystems of knowledge sharing and improved healthcare.
The way healthcare IT is simplified is by understanding the next digital revolution, utilizing the tech to solve the problems you face with interoperability of systems, and enforcing best practices established by the technologies.
Blockchain interoperability is crucial to the digital resolution. I believe that healthcare stakeholders should champion the best practices established by developers. A foundation of trustless and secure exchange of information protected from self-beneficiary siloing of healthcare data while protecting patient privacy.
Michael Dershem, founder and CEO of healthcare payments platform MAPay, has been a serial entrepreneur for more than 20 years, beginning as co-owner of RX Returns, which grew to become the largest pharmaceutical returns company in the nation. Later, Michael was founding CEO of Pharmasset, an Emory University start-up company.
“Despite the fact that interoperability has plagued the healthcare industry since the advent of the Commodore computer, until now…”
These records had been hard-siloed off into institutional and/or business structures that did not communicate with one another. Interoperability is not a technology hurdle anymore, but rather a business brick wall, allowed by the legacy industry competitors to continue.
With the rise of new technology, such as AI, blockchain, and machine learning, the goal should be to place healthcare records on its permissionable multi-node environment for secure patient-driven use, as well as using this information to impact population health management. Patients should be able to authenticate themselves into the healthcare ecosystem — not the other way around.