Interoperability is one of the biggest and longest-standing challenges in healthcare. Government policymakers and private-sector companies of all shapes and sizes have been working on the problem for decades, offering all manner of approaches to the technical, syntactic, semantic and business-case hurdles of more seamless information exchange.

Stuart Hanson is CEO of Avaneer Health, an administrative healthcare collaborative data network that includes some of the biggest names in the industry, including Cleveland Clinic, Sentara, Optima Health, Aetna, CVS Health and Carelon.

Data exchange means different things to different people, he says, but one thing is true: Networks are key to unlocking what he calls true interoperability.

Healthcare IT News spoke with Hanson to talk about what "interoperability" means, centralized versus decentralized networks, clinical versus administrative interoperability, and how the right network can transform the industry and improve patient care.

Q. You contend that interoperability can mean a few different things to various stakeholders in healthcare. How do you define it?

A. In a truly interoperable healthcare system, data would not need to be requested, aggregated and validated each time it is needed. Instead, it would be continuously refreshed, always current and accessible in real time to those who are permissioned to access it, allowing all healthcare stakeholders to work together to create a cohesive, high-quality experience for the patient.

This definition of interoperable would be immune to existing data silos and system-based barriers for sharing and would enable completely new processes and workflows. It would be a giant step forward for improved human experiences and reduced costs, many of which we can’t even imagine today.

In addition to a better patient experience and improved outcomes, genuine interoperability would enable better collaboration among healthcare stakeholders, simplified transactional processes, as well as more timely, effective deployment of solutions throughout the market.

Q. You work in the data networking space. Please talk about the pros and cons of centralized and decentralized networks and why you believe the latter is critical to achieving interoperability in healthcare.

A. A centralized network is designed around a primary server that manages all information and activities on that network.

The benefits of a centralized network include:

• Data is aggregated so it requires less communication between participants to stay up to date and exchange data.
• Data is controlled by a single authority, which can make it easier to enforce rules or regulations.

The weaknesses of a centralized network include:

• Lack of transparency into how the data is used by a third party.
• Less likely that data is immutable.
• More challenging to ensure data is not latent.
• Less redundancy and vulnerability to attacks.

In a decentralized network, there can be multiple servers acting as primary servers. They each manage information on their own while still connecting with each other.

Benefits of a decentralized network include:

• Increased data integrity, immutability and traceability without data having to be aggregated and validated each time it’s used.
• Reduced need to manage multiple interfaces and standalone connections while giving data originators complete control over their data and who has access.

The weaknesses of a decentralized network include:

• Can be more complex because they require coordination and communication between many participants.
• Can require more resources (for computing and storage) because each participant must store their data locally to perform computation and processing.

We believe a decentralized network is important to achieving genuine data fluidity, as it eliminates many of the issues surrounding trust and friction by increasing transparency and data immutability.

A decentralized network also supports greater collaboration and innovation by enabling stakeholders to more effectively communicate, transact, and develop and deploy new processes, unlimited use cases, and innovative solutions together.

Q. You make a differentiation between clinical interoperability and administrative interoperability, and you focus on administrative. Why is this?

A. We have built our network with the aim of creating value for the industry and our initial focus on administrative interoperability is aimed at helping the industry achieve a rapid and significant return on investment.

The annual cost of administrative inefficiencies in the U.S. healthcare system is in the hundreds of billions of dollars, primarily due to manual, inefficient processes in billing, coding, physician administrative activities and insurance administration. This significantly impacts patient care, provider reimbursement and costs.

And it is money that could be better spent on direct patient care, investments in technology and innovation, and more value-based initiatives. We also believe administrative data is more ripe for a new network, as a single use case – eligibility, for example – can create a financial win for payers, providers and patients, all at the same time, with relatively limited effort to connect.

When our founding members – Anthem (now Elevance), Cleveland Clinic, CVS Aetna, HCSC, IBM Watson Health (now Merative), PNC Bank, and Sentara Healthcare – came together in 2017, they discussed how to create an ecosystem that facilitates collaboration, real-time data sharing, distributed governance, and common processes running in a trusted, permissioned and secure environment wherein participants can transact with one another.

This connectivity would include common data models, the latest in technology standards and infrastructure capabilities, modern security, and immutability that would solve healthcare’s connectivity and interoperability issues. That’s how the idea of Avaneer Health was born and it’s the reason we are focused on reinventing the back office – or the business – of healthcare.

Q. What do you believe healthcare provider organization health IT leaders should be doing today to solve the interoperability problem?

A. Health IT leaders already recognize the challenges of the current state of connectivity with trading partners – being very laden with technology debt, reliant upon custom point-to-point integrations, and reliant upon data intermediaries that add cost and time to important administrative exchanges.

And I encourage them to recognize that despite all their investments in legacy systems and platforms, many of them still struggle with a lack of truly interoperable functionality. This is all due, in my opinion, to dated infrastructure and technology debt and requires a new network to truly solve the issues.

Adding more bolt-on technologies isn’t the answer. The answer is to reimagine new ways of working together with other healthcare stakeholders.

Joining a decentralized network facilitates interoperability that is more complete in the following ways:

• Once connected to a decentralized network, providers don’t need to build direct connections to any other network participant with whom they choose to collaborate or send transactions.
• Data remains decentralized, and participants can control how and with whom they collaborate.
• Once the connection is established, data can be available in real time without having to be requested, allowing genuine data fluidity and transparency.

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