Marilee Benson is president of Zen Healthcare IT, a technology vendor that aims to make interoperability simpler with a flexible health data exchange platform and on-demand data exchange experts. Zen's Gemini Integration Platform covers the range of healthcare interoperability needs, including simple API access to more than 600,000 providers via the national data-sharing networks.

Benson, with more than three decades of experience in health IT, is an expert in the interoperability needs and challenges faced by hospitals and health systems of all sizes. She is passionate about leveraging technology to improve patient outcomes and is a recognized leader in the healthcare interoperability community, currently serving on the Carequality advisory board.

Healthcare IT News spoke with Benson to talk about the impact of interoperability on hospitals and health systems, strategies for overcoming common challenges in healthcare data exchange, the role of technology and interoperability in improving patient outcomes and the future of healthcare interoperability.

Q. What does interoperability enable for hospitals and health systems?

A. The most important impacts of interoperability on hospitals and health systems are those that directly enhance the patient experience. I recently read an article that said improving patient experience was a top priority for hospital and health system leadership.

That makes sense because we are entering a stage where patients have more and more options as to where they seek care, including many more virtual options. To compete in this more complex healthcare ecosystem, hospitals and providers need to ensure they are delivering a great patient experience.

On the other hand, patients and caregivers continue to be frustrated by how difficult it is to move through different healthcare settings and have their important information follow them throughout their healthcare journey. Hospitals and health systems that want to prioritize the patient experience are either already focusing on this aspect or will need to do so soon.

And it's not enough to just "be on Epic." The Silver Tsunami we all keep hearing about means a given patient is more likely to be in and out of a wide variety of healthcare settings, managing multiple conditions.

And, even if you aren't silver yet, you probably have aging parents. Putting a focus on ensuring the seamless flow of data between all the different healthcare settings via a focus on healthcare interoperability is a core requirement for improving the patient experience.

When I speak of improving patient experience, I also mean improving patient outcomes. Health systems are investing in promising technology for improving patient outcomes – especially purpose-built AI technology that finally seems to be delivering on its promise to be able to improve health outcomes. Granted it's still early, but I do not see the healthcare AI trend slowing down over the next five years.

These promising AI tools do not work without data, which again brings us back to the critical need for better interoperability between different systems.

Q. What are a few strategies for overcoming common challenges in healthcare data exchange?

A. The biggest trends right now in overcoming challenges to healthcare data exchange are strategies to replace a DIY approach with a managed platform/outsourced interoperability expertise approach.

We are seeing this strategy deployed for both traditional direct data exchange – what I call "bread and butter" healthcare data exchange use cases – and for broader community-based exchange via old-school IHE-type connections, which for many years has been powering nationwide data exchange for treatment-based data sharing.

FHIR isn't an exception to this trend. FHIR has many of the same issues as other healthcare data standards, including multiple versions and implementation guides, and most importantly, the need for FHIR to coexist with older standards.

Traditional interface examples include lab orders/results interface, radiology orders, and results, or data feeds sending admit/discharge data to your local health information exchange. A managed platform approach can enable a single EHR data connection to route to multiple other systems needing that same data, saving time and money – and reducing the number of point-to-point connections that have to be managed long-term.

Also, as health systems continue to look to outsourcing core IT functions as a way to add cost savings and gain efficiencies, a platform plus expertise approach starts to make sense. How costly is it to maintain a staff of interface/interoperability engineers over the long term? And for smaller organizations, how costly and disruptive is it when their one interoperability expert leaves?

For broader data exchange with the healthcare community, we are seeing providers and health systems looking for ways to enhance the provider experience – which in turn improves the patient experience. Providers are looking for better ways to receive and digest data from outside their practice or facility to better support referrals and care transitions.

Managed platforms purpose-built for this type of broad-based data sharing are starting to show they can optimize these referral/chart review processes, now that there are more ways to plug into regional or nationwide data exchange networks. These platforms may operate as pure middleware, using automatic processes to retrieve data and send it to an EHR, or provide an optimized purpose-built user interface to visualize inbound data from external sources much more effectively than the typical EHR system.

The emergence of these non-EHR-based types of systems optimized for data queries has led to a new use case for nationwide data exchange. Under the Carequality trusted exchange framework, it is referred to as an "on the behalf of" use case.

The idea is that a different technology is being used to initiate a national network query, versus the EHR, which is acting as the responding entity, since that is the source of truth for the patient's full medical record. This same concept is being adopted in TEFCA, just using a different name.

Q. What is the role of technology in improving patient outcomes? And how does interoperability play a part here?

A. Since the possibilities of how technology can improve patient outcomes seem limitless to me, I am going to just focus on one very important use case: individual access to our healthcare data.

The vast majority of people today rely on technology to organize almost every aspect of our lives. I rely on my phone's calendar to know what meeting is coming up next. I rely on my travel app to store and view my travel-related information.

The same thing is true for our health. I use an app to remind me to take my meds and even an app to test my hearing. I make frequent use of patient portals, and like many other folks, hate the fact that I've got to log into multiple patient portals.

Currently, I have a family member in the hospital. It is incredibly frustrating I do not have access to their medical records, as the hospital docs are asking me questions I cannot answer. When we can't answer those health history questions in an emergency situation, our loved one's care suffers. Technology can fix that issue for us – we just have to move beyond EHR-tethered patient portals. And this is where interoperability plays a crucial role.

Individual access – also known as patient access – to our health data has been one of the hardest interoperability problems to solve. And frustratingly, it's not been a technology problem. The national networks like Carequality, eHealth Exchange and Commonwell Alliance have created implementation guides and run pilots related to patient access.

The issue has been adoption – the willingness of hospitals, health systems and providers to embrace electronic patient access as a required data-sharing use case. But two important things have changed and it leads us to what I think is the biggest next step in having interoperability make an even bigger positive impact on health outcomes.

This leads us to the future of healthcare interoperability.

Q. What does the future of healthcare interoperability look like?

A. TEFCA, the government's trusted data exchange framework, is going to be a huge driver of the future of healthcare interoperability. Even though the private national networks already are hugely successful for treatment-based exchange (Carequality participants are sharing just under 1 billion clinical documents monthly), that still leaves a huge gap, with the most important being individual access, as I mentioned earlier.

But TEFCA has been successful at making individual access a mandated exchange purpose for healthcare organizations making treatment queries.

Add to this big change the recent Epic announcement that they are asking all their customers to transition to TEFCA-based exchange by the end of 2025 – via Epic Nexus, a qualified health information network, or QHIN, under TEFCA. Now you have all the ingredients for individual access to gain widespread adoption.

Epic represents a huge number of hospitals and providers, and this move will be the driver for other EHRs, HIEs and health tech vendors to also transition their providers to TEFCA-based exchange.

This means that sometime near the end of 2025, we should all be able to use a TEFCA-qualified health app to access the TEFCA data exchange framework – and be able to make one query to get all our important medical history into one app of our choice. This will help all of us better manage our own health information, which I think is the most important missing piece to having technology really improve health outcomes.

At the end of the day, the decisions we make every day as humans living our lives have the biggest impact on our long-term health.

To step back a moment to look at healthcare data exchange overall, I do not believe TEFCA is going to eliminate the need for other types of interoperability such as direct point-to-point interfaces. There will always be a need for many different types of direct interfaces, using a variety of healthcare data standards, as those standards and use cases are not going away.

But if we each have our own complete health record in our pocket, we've opened up a whole new avenue for our caregivers to gain access to our data at critical moments in our health journey, without having to rely on what we or our family members can communicate or remember.

Personally, I remain committed to making all healthcare interoperability use cases simpler, more secure and easier. However, I am most excited about the positive health impacts of making individual access a routine part of healthcare data exchange.

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