Sally Buta

Viewing patient data as a commercial asset hinders health IT interoperability

January 22, 2020
By Sally Buta

In any discussion of healthcare IT and electronic health records (EHR) systems, nothing sparks more contention than the “i” word: interoperability. That this is the case after five decades of computer usage in healthcare delivery represents a sad state of affairs indeed; it is well past time for the health IT industry to clean up its interoperability act.

The first large-scale EHR system deployments occurred in the early 1970s, most notably the U.S. Department of Veterans Affairs VistA system. Today, nearly all U.S. hospitals and most medical practices have moved to using a certified electronic health record (EHR). This is a nine-fold increase in EHR usage since the HITECH Act became law over 10 years ago. So healthcare is well down the path toward “digitization”.

Still, interoperability – widely recognized as a key to unlocking the value of digitization – remains elusive. Interoperability in health IT has been discussed forever, yet last year ONC reported this sad news to Congress:

“Health care providers often lack access to patient data at the point of care, particularly when multiple health care providers maintain different pieces of data, own different systems, or use health IT solutions purchased from different developers…”

Virtually everybody agrees that, conceptually at least, interoperability is a good thing. It will contribute to patient safety and continuity of care – by enabling patients to manage their health better, and putting current and accurate patient data in the hands of every healthcare provider when and where they need it – as well as promote cost savings for provider organizations and the overall healthcare ecosystem.

Technologically, however, interoperability is complicated. And in the marketplace, the proprietary commercial interests of EHR vendors and healthcare networks still stymie health information exchange, and reports of information blocking are common.

As a result, the process of creating interoperability standards has become highly political. As proof, consider that the very definition of “interoperability” is set forth in federal legislation -- section 4003 of the 21st Century Cures Act:

Health information technology that "(A) enables the secure exchange of electronic health information with, and use of electronic health information from, other health information technology without special effort on the part of the user; "(B) allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable State or Federal law; and "(C) does not constitute information blocking as defined in section 3022(a)."

What’s more, a federal government entity, ONC, is tasked with advancing connectivity and interoperability of health IT on a national basis, via the Interoperability Standards Advisory (ISA). ONC’s current standards initiative, the Trusted Exchange Framework and Common Agreement (TEFCA), “is designed to scale electronic health information exchange nationwide and help ensure that [healthcare networks], health care providers, health plans, individuals, and many more stakeholders have secure access to their electronic health information when and where it is needed.”

For now, the interoperability landscape remains cluttered and confusing. Where interoperability currently exists, it is usually within a healthcare network -- but even that is limited. A survey by the Center for Connected Medicine of technology executives at U.S. hospitals and health systems found that nearly a third say their data-sharing efforts are insufficient, even within their own organizations, and fewer than four in 10 say they are successfully sharing health care data with other health systems.

There are several industry initiatives seeking to advance interoperability, including the CommonWell Health Alliance, and the Sequoia Project and its offspring, Carequality and the eHealth Exchange. There also are local and regional HIE entities taking incremental steps to extend their reach. For example, Michigan Health Information Network Shared Services recently announced it will integrate Great Lakes Health Connect, a Michigan-based health information exchange by the end of the year. And New Bedford, Mass.-based Southcoast Health System joined the Department of Veterans Affairs’ health information exchange program to streamline the sharing of patients' medical records between the two organizations.

But nationally, there’s a long way to go to achieve the Holy Grail of ubiquitous EHR systems interoperability and ready patient data access that would be so valuable to patients and clinicians.

What will it take to achieve this? For starters, a culture of collaboration instead of competition, among both health IT vendors and provider organizations.

Easy to say; hard to do. It requires a mindset of putting patients first, and an acceptance that patient data is not primarily a commercial asset to be hoarded and siloed. Rather, it is a clinical asset for individual patient care, as well as for population health research and analysis, which can be applied to developing a deeper understanding of illnesses and how to anticipate and treat them.

Ubiquitous health IT interoperability will result in clearer communication from and within a patient’s care team, and better coordination of care for patients. When clinicians have a holistic view of patients’ healthcare needs and treatments, they can avoid ordering duplicate tests, and ultimately deliver higher care quality and better health outcomes.

All of us in the health IT industry have a shared responsibility to make interoperability a practical reality. For years, vendors like PatientKeeper have integrated patient data from multiple systems within a hospital or health system into a single platform -- a “system of engagement” enabling physicians to access and act on patient information conveniently. One might think of this as “micro-interoperability.” The broader goal – let’s call it “macro-interoperability” -- still lies ahead and demands the focused attention of all industry players, for the good of patients, clinicians and society at large.

Given all we in the healthcare IT industry have accomplished to date, I am confident we can do this, too. But it will require that we wake up and recognize that patients’ interests ultimately trump any narrow view of our proprietary commercial interests, and that our companies will fare better by delivering better, collectively, for clinicians and patients.

About the author: Sally Buta is the chief technology officer and co-founder of PatientKeeper, Inc.