In·ter·op·er·a·bil·i·ty — it’s not just a difficult word to say, it’s a difficult subject to master. Between the complex landscape of the healthcare world, the extensive history of electronic health records (EHRs), and the technical components of housing and accessing patient data, there’s a lot to cover. Here’s what you need to know about interoperability in healthcare without getting lost in the weeds.
First things first: what is interoperability? Interoperability is the connectivity of patient data across systems — a state to be achieved, not a process. The process, the steps taken to reach a state of interoperability, is the piecing together of interoperability layers.
Compare interoperability to fitness. You can take steps to become fit, but fitness in itself is the end result, not the actions you take to become fit. Interoperability layers in this analogy are the incremental actions taken to reach a state of fitness. Think consistent exercise, healthy eating, and drinking water — all small actions that when pieced together help achieve your desired state of fitness. Without one of these pieces, true fitness wouldn’t be possible.
Likewise, systems become interoperable when technical, legal, organizational, and semantic interoperability layers work interdependently — each layer relying on the others. Until all these pieces function cohesively, a system is not interoperable.
Yes, healthcare organizations working independently are able to make great strides towards achieving interoperability, however, interoperability is a global mission that requires interdependency of healthcare data. Providers, payers, health systems, and digital health vendors can all make independent efforts to facilitate this larger mission, but without the successful participation of all stakeholders in health data exchange globally, interoperability cannot be achieved.
This is where interoperability layers come in. Such a massive mission can only be achieved by segmenting initiatives — interoperability layers. While there are different modes of thought when it comes to defining necessary layers to interoperability, the general healthcare IT public will typically recognize four key layers:
Technical – The Roads: What infrastructure do we need to have data pass between systems? Think of the technical layer as a road. In order for vehicles to get to their desired location, there needs to be a pathway.
Legal – The Rulebook: How will we regulate patient data exchange with numerous legal systems involved? Imagine driving on a road where everyone follows their own set of rules. Chaotic to say the least. The legal interoperability layer ensures that everyone is operating from the same rulebook. Meaningful Use laws fall into this category.
Organizational – The Roadmap: Which workflows will data pass through? Similar to a roadmap, the organizational layer defines the best path for the data to take. Of course, instead of turning left or right, this roadmap instructs data where to go and when.
Semantic – The Street Signs: How can we make sure that everyone interprets information correctly? The semantic interoperability layer defines how information will be communicated and interpreted. Compare the semantic layer to road signs. In order to avoid traffic hazards and inefficiencies, all drivers and pedestrians must be reading from the same language. For instance, if green means go, you want everyone to be on the same page.
As John Steinbeck once argued, “Anything that just costs money is cheap.” Healthcare is no exception. Healthcare costs should reflect value beyond the dollar — high-quality, outcome-driven, patient-centered care. Where does this mission start? With accurate, accessible patient data from admissions, to discharge, to follow-up.
Adding value to the patient journey starts during the admissions or patient transfer process. As the patient moves beyond the admissions process to receive treatment or care, the accessibility of data collected during admissions or transfers impacts patient satisfaction. Why? Patients, like consumers of any industry, want convenience without sacrificing quality. Connected patient data at the point of care helps providers deliver the convenience patients want because it takes the pressure off the patient to continually communicate the same information.
Beyond a positive patient experience, accurate data at the point of care empowers providers to treat patients more effectively by reducing manual data entry errors, expediting the treatment process, and removing screen time from provider-patient interactions. Rather than having attention pulled in several different directions, physicians with immediate access to patient data can focus on what they do best — treating patients.
Have you ever written something down, put it aside with the intention of coming back to it later … and forgotten to return to it? If you’re human (and we have a strong suspicion that you are), the answer is probably yes. Unfortunately, this sort of common experience carries much more weight in healthcare than the average “lost post-it note” moment. Patient outcomes depend largely on providers to be clear-minded when delivering care, which can be difficult to do when patient data lives in different places.
Patient data at the point of care not only mitigates risk, but also frees up time for physicians to practice their craft — medicine. Physicians are high-value assets, which means that their skills and time should be treated as such. Connected patient data gives physicians the opportunity and time to practice medicine with undivided attention, increasing physician job satisfaction, cutting down on costly operational inefficiencies, and driving focus back to patient-centered care.
Physicians are busy — that’s no secret. The secret, rather, is finding a way to generate and sustain provider interest in healthcare tech. In the eyes of many physicians, adopting another piece of technology means yet another point of data entry — another device that consumes hours of time to operate. Even for the most innovative digital health vendors, armed with the right tools to transform the patient experience, selling disconnected digital health technology is an uphill battle.
While digital health vendors certainly face challenges like target market tech adoption, the unique nature of the healthcare industry offers tremendous opportunity to those able to integrate patient data with data management systems like EHRs and CRMs. By offering a product that improves patient care without requiring additional administrative time and efforts, tech market suppliers increase product value within target markets, making the product easy to buy and difficult to let go.
In addition to providers and digital health vendors, interoperability in healthcare also serves the best interests of health insurance carriers, also known as payers. To understand why, let’s first take a look at the healthcare revenue cycle, specifically the movement of patient data from the pre-certification process through billing.
Each of the stages in the revenue cycle — claims management, reporting, verification of benefits, copayment, denial management, claims submission, payment posting — represents a point where patient data needs to be accessed to ensure proper billing and coverage. With so many stakeholders and contributors from the beginning of the patient journey to the end, it is common for errors to occur in the process.
For instance, in order to generate an accurate medical bill, payers depend on physicians to report procedures and services provided to each patient with a set of codes. If a mistake is made when manually entering this code, then the end medical bill will reflect this error. Connected data in this scenario would remove the need for manual data entry, reducing the risk of errors that result in inaccurate billing.
Many healthcare organizations take the first step towards interoperability by coming up with a game plan to integrate patient data between systems. Diving a little deeper into that technical interoperability layer, healthcare organizations most commonly take one of two approaches for developing health data integrations: buy or build — outsourcing or building in-house.
When deciding between building integrations on a legacy platform or hiring a full-service integration partner to do it for you, be sure to evaluate the cost and return of each approach for your business specifically. This evaluation should consider available expertise, business workflows, compliance and security standards.
Interoperability in healthcare is a nuanced, intangible, and a constantly evolving concept that can be difficult to fully grasp. With so many intricate layers at play — and 8 tongue-twisting syllables — interoperability is a massive mission that will require extensive time and effort globally.
Here’s the good news: once achieved, interoperability stands to make a real impact in healthcare by improving patient care, relieving physicians of unnecessary administrative burden, increasing adoption of innovative technologies, and removing errors from the billing process.
How does interoperability come to play in your life as a healthcare professional, digital health innovator, or patient? Share your story with us through Twitter using #InteroperabilityInMyLife.