Interoperability has been a red-hot trend in health IT for some time, and it has never been more important. In order to deliver the best care with the best outcomes caregivers need access to patients' complete medical records – and all available information. That cannot be achieved without interoperability of systems and data.

Here, five healthcare interoperability experts from Boston Children's Hospital, CitiusTech, Holon Solutions, Medicomp Systems and Q-Centrix offer healthcare CIOs and other health IT leaders some best practices for making sure interoperability technologies and strategies are optimized to reap the best results for individual healthcare-provider organizations.

Interoperability as a powerful business tool

Interoperability, like beauty, is in the eye of the beholder, said Jon Zimmerman, CEO of Holon Solutions, a point-of-care data-integration-technology vendor.

"Providers care the most about their patients, their time and their income: We should always ask ourselves, 'What can interoperability do for them?'" he said. "So, when we think about interoperability, we should not think about it only as a technology, but rather as a powerful business tool to help achieve prioritized objectives for enterprises, practices and patients."

Perhaps, he suggests, health IT leaders should start with "why." Why would a provider find value in interoperability? How might interoperability:

• Improve their patient’s experience or life?
• Save them time?
• Enable them to increase their income?

“The good news is it is happening today,” he said. “Some are using interoperability technology to ensure that referrals are not only sent electronically, but also completed properly and efficiently. These cases include both traditional providers in the industry, but also include community resources such as transportation and housing authorities."

"When we think about interoperability, we should not think about it only as a technology, but rather as a powerful business tool to help achieve prioritized objectives."

Jon Zimmerman, Holon Solutions

“How great would it be if the sender knew exactly what information the receiver wanted to receive and, specifically, how it was to be sent?” he continued. “What if the sender and the receiver needed to ‘chat’ about the referral to ensure the best experience and outcome? They should be able to do that both within the context of the patient and their care, while also using modern chatting technology.”

Set an inside-out strategy

Whether it's a case of implementing a new EHR system, optimizing an existing EHR or deploying a data warehouse, healthcare providers often amass multiple vendors and outside partners to create and manage their large-scale IT projects. Unfortunately, more outside partners equals different priorities, despite promises of interoperability.

“The more practical approach to interoperability is not one that is led by outside vendors,” said Brian Foy, Chief Product Officer at Q-Centrix, a registry-data-management company. “Instead, consider an inside-out strategy. The first step to an inside-out data strategy is deciding what you want to achieve from your data. You will need to align on your priorities and needs in order to unlock the greatest value from your data. Then, make decisions that optimize processes for your strategy.”

"The more practical approach to interoperability is not one that is led by outside vendors."

Brian Foy, Q-Centrix

For example, Q-Centrix partners with hundreds of healthcare providers throughout the country to manage their quality data. Many of those organizations engage the vendor once they have determined their priority is to align quality data with their organization’s overall data strategy.

“They witnessed incredible insights when they married registry, or other robust quality data, with their revenue cycle, financial and other clinical data,” Foy contended. “Ultimately, their ability to set their priorities internally first, allow[s] us to prioritize appropriately and smoothly contribute to their data strategy.”

Adoption of standard terminology

Dr. Jonathan Bickel, senior director of clinical health record, business intelligence, and medical library and archives at Boston Children’s Hospital, said that first and foremost healthcare organizations need to know where they stand relative to the adoption of standard terminology.

“If your organization has a long history of adopting standard terminology in its core business practices, you are in a much better place to take advantage of interoperability technology,” he explained. “Most of the latest technology presupposes that there is a common language spoken between provider organizations. Unfortunately that is not always the case. Oftentimes the ability to be interoperable starts with a lengthy terminology mapping process.”

"If your organization has a long history of adopting standard terminology in its core business practices, you are in a much better place to take advantage of interoperability technology."

Dr. Jonathan Bickel, Boston Children’s Hospital

Legacy systems did not envision interoperability or standard terminology as part of their data model and healthcare organizations will find they will be retrofitting these systems, he added.

“An organization’s ability to adopt and optimize the technology depends upon having that standard language in place,” said Bickel. “For example, if you have any experience in the new HL7 FHIR standards, much of the interoperability depends upon each concept being expressed in standard terminology coding – SNOMED, ICD, etc.”

Having some discipline within an organization for keeping up with the terminology as it evolves is important, he insisted.

“As an organization continues to build new content, having the discipline to require that the content is in standard terminology code sets will facilitate your ability to continue to take advantage of interoperability technologies,” he said.

Strong, dedicated teams

In order to build a high-functioning interoperability practice, healthcare CIOs need to build strong, dedicated teams that think broadly about optimizing operations across the full enterprise, said Abhay Singhal, senior vice president for provider and healthcare services at CitiusTech, a health-IT vendor that specializes in, among other things, interoperability.

"With a strong team, an organization can create an enterprise-interoperability strategy that gives equal weight to technology, as well as the people behind it."

Abhay Singhal, CitiusTech

“Healthcare IT leaders should continuously invest in their teams to regularly upgrade their skills as emerging technology trends continue to evolve, including API-based standards, FHIR or artificial intelligence/machine learning,” he said. “With a strong team, an organization can create an enterprise interoperability strategy that gives equal weight to technology as well as the people behind it.”

This, he added, assures an organization has the depth of skills and expertise needed, and the processes required, for strong governance with well-defined standard operating procedures, implementation guidelines and playbooks.

Own your data

Once a healthcare organization sets up an interoperability strategy, it wants to get as much as it can from every incremental interface that it implements, said Foy at Q-Centrix.

“The secret to interoperability is not choosing outside partners that tout this capability, but rather taking matters into your own hands and having control over your entire data ecosystem,” he said. “One example of how our current partners take control is requiring vendors they exchange critical information with to ‘round-trip’ this data from external data repositories into their internal data infrastructure.”

Central to “round-tripping” is ensuring that the data is returned in a manner ready for immediate use, he explained.

“For instance, we believe our healthcare-provider partners own their data, and therefore our solutions optimize the data for real-time reporting and delivery back into their data infrastructures,” he said. “A commitment to round-trip your data from both your organization’s internal teams and outside partners will help achieve more seamless data flow at every incremental stop on the data journey.”

The needs of clinician end users

When selecting and implementing interoperability technology, healthcare CIOs must first consider the needs and wants of clinician end users, said David Lareau, CEO of Medicomp Systems, a vendor of physician-driven, point-of care systems designed to enhance EHRs.

CIOs must collaborate with clinicians to ensure that new solutions actually solve clinicians’ problems and do not create new challenges, he said.

“For example, a hospital might want to provide clinicians with more complete patient data to improve clinical decision-making; therefore, a CIO starts searching for an interoperability solution that facilitates data-sharing between other hospitals, physicians, HIEs and all the disparate systems within the hospital,” he explained.

"The reality is that most clinicians don’t want additional patient data dumped into the EHR unless it is logically compiled, transformed into information, and available at the point of care."

David Lareau, Medicomp Systems

“While hospital leaders might assume that clinicians would support such an initiative,” he continued, “the reality is that most clinicians don’t want additional patient data dumped into the EHR unless it is logically compiled, transformed into information, and available at the point of care – because users already are overwhelmed with too much unorganized data.”

Clinicians do not want “solutions” that require them to search through pages and pages of unorganized data to find the patient- and problem-specific information they need.

“Clinicians don’t want technology to slow them down, which is why it is imperative for CIOs to collaborate with clinicians at the beginning of the process, throughout the implementation and even after go-live,” he said. “CIOs must ask clinicians what data they want, how they want it filtered and organized, and where within workflows they want it available.”

To optimize interoperability technology, the CIO/clinician collaboration must be ongoing, and CIOs must be committed to addressing the needs of end users, he added.

Interoperability for value-based care

Zimmerman of Holon Solutions said another best practice for optimizing interoperability technologies is ensuring interoperability for value-based care.

“The good news is that value-based care can create a better experience for patients, and providers can get rewarded for better outcomes,” he said. “The not-so-good-news is that more information from different places needs to be consolidated and converted into relevant knowledge at the point of care to make the value and benefits come to life.”

Ideally, a system will know what the practice needs to do for each member of its population and at, each encounter, reach out to the network to pull in the right information, at the right time, into the right workflow, he added.

“You can think about this as ‘pull driven’ interoperability enabled by a dynamic ‘knowledge delivery service’ based on specific needs to fulfill quality and contractual obligations delivered in a timely and convenient manner,” he said. “This is one way to save time, improve the patient’s life and, when done correctly, increase the quality/contract bonus achievement for the practice.”

These are the “why’s” that most practices would appreciate and how interoperability can be elevated from the realm of just a technology to a leading business tool to help improve practice operations and deliver better care at lower costs, he stated.

“From a CIO’s perspective, we can engage in new ways to continually optimize the business, the experience, the results and the care through smarter technology,” he said. “We can now start with 'why,' so we can end with ‘This makes a difference.’“

Interoperability that delivers better patient outcomes

CIOs need to understand that clinicians do not want interoperability technology simply to have more data; instead, they want interoperability tools that help them to deliver better patient care and outcomes, said Lareau of Medicomp Systems.

“Clinicians need solutions that deliver clean, organized and actionable data that enhances their understanding of the patient’s health without having to search through clinical spam to find the precise information they need for clinical decision-making,” he said. “Interoperability solutions that deliver clean data give users the ability to leverage the use of AI-based solutions, such as advanced business intelligence systems.”

If the interoperability technology delivers data from another EHR in an unstructured, free-text format, then finding the specific information that clinicians need to improve care is a manual and tedious process.

“But if the interoperability tool delivers and stores the information in a structured format, clinical details can be easily extracted and available for advanced analytics or to create clinical dashboards,” Lareau explained. “When clinicians have clean data that can be fed into dashboards, for example, they are better equipped to improve patient care and outcomes because they have a visual representation of patient populations, as well as a longitudinal view of a patient’s disease activity.”

This is especially beneficial when treating patients with chronic conditions such as diabetes or arthritis because they provide at-a-glance insights into a patient’s current condition and a better understanding of the ongoing care needed to optimize clinical outcomes, he said. Such tools can drive greater physician productivity, improve clinical decision-making and give clinicians more time for direct patient care, he added.

Underleveraging interoperability tool investments

Lack of interoperability in the healthcare industry can be easily illustrated by one fundamental issue: One-fifth of healthcare CIOs say at least one patient suffered an adverse event due to mismatched records, said Singhal of CitiusTech.

“With the advanced technology available today, systems should be able to reliably, not only match patient records, but readily share data necessary for decision-making,” he said. “For today’s healthcare CIOs, there [is] a plethora of technology options available in the market for large health systems to meet their interoperability needs, but there is also more than one right approach.”

Hence, CIOs often find themselves juggling two operational problems, said Singhal. First, many organizations actually under-leverage their interoperability tool investments. Second, they miss opportunities to leverage those tools because their IT shop lacks the standards to define interoperability guidelines as well as it does the standard operating procedures for smooth ongoing operations.

Interoperability technology, he said, should be optimized in two key areas:

1. Data formats. There are many data format standards to accommodate. For example, claims data follows the X12 structure. Lab data follows the HL7 structure. EHR data may follow HL7/CCDA/FHIR structure. On top of that, each “standard” format may be customized. A robust interoperability practice needs to manage different types of interfaces and file formats as well, including HL7, FHIR and X12.
2. Frequency and volume. In order to effectively manage a wide range of interoperability projects, an organization should define standard approaches to managing the frequency and volume of interfaces, including daily, monthly and batch versus real time.

“For many years, the common approach was to build point-to-point interfaces based on each project’s specific needs, which then snowballs into an ecosystem that has too many unique interfaces,” Singhal explained.

“This results in interfaces that are redundant, unoptimized and difficult to manage,” he added. “To alleviate these common problems and position healthcare organizations for the future, CIOs can put in place an enterprise-wide healthcare data management strategy that includes a well-defined interoperability practice.”

Twitter: @SiwickiHealthIT
Email the writer: bill.siwicki@himssmedia.com
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