HIMSS 2022: Boost interoperability to survive in value-based care, healthcare execs say

ORLANDO, Florida—Interoperability has been a hot topic in healthcare for over a decade, with the industry turning to digital tools for everything from capturing patient data to claims and billing.

Recent regulations, like the Centers for Medicare & Medicaid Services’ interoperability rules and Fast Healthcare Interoperability Resources standard enforcement, have helped promote progress in efforts that were previously slow-moving.

But the transition to value-based care models demands a greater push for open data exchange.

To maximize the potential for better outcomes, providers need access to a patient’s complete medical history, executives told Fierce Healthcare at the Healthcare Information and Management Systems Society Global Conference in Orlando this week.

Shayan Vyas, M.D., Teladoc Health's vice president and medical director of hospitals and health systems, said that in his own practice, that idea of “whole-person care” is critical. 

“When I see a patient, I’m trying to put this puzzle together. The more jigsaw pieces I can put together, the closer I can get to a diagnosis,” he said.

Providers need data aggregated across multiple sources to create a holistic view of the patient and to perform analytics on those data to surface insights, a concept that Bhaskar Sambasivan, CEO of CitiusTech, said all players in the healthcare ecosystem are warming to.

“(Previously) there were trust issues and no real economic alignment for data transfer,” Sambasivan said. “That is changing with the notion of value-based care. Payers need access to provider data, and providers need access to payer data because you won’t be able to successfully administer a value-based contract if the baseline is not the same.”

What sounds simple enough and beneficial to all parties in theory, however, faces plenty of barriers in practice.

For one, many companies have economic incentives for holding onto proprietary data, since they can monetize that exclusivity.

Halting those practices would probably require federal intervention, Vyas said, which is unlikely in the current environment.

Many organizations enable data exchange via application programming interfaces (APIs) but in a pay-per-click model, like paying tolls to cross the API bridge.

There’s also a certain security risk with opening up all these channels. While electronic health record (EHR) systems tend to be more secure, APIs have been shown to be vulnerable to potential hacks.

As such, some patients may not want to share their data, and they have the right to keep them siloed if they choose, Vyas said. 

Even with improved data exchange, a greater volume of information without data standardization and analytics won’t make the shift to value-based care easier, according to NextGen Healthcare President and CEO David Sides.

“It’s hard to do the calculations without an automated system to even know, are you closing these gaps in care or not?” he said.

Sides emphasized that those analytics have to produce insights providers can actually act on, a sentiment echoed by Aashima Gupta, director of global healthcare solutions at Google Cloud.

Gupta noted that those insights must be integrated with the technologies providers are already using, too, to reduce provider burden rather than putting an extra task on their already overflowing plates.

“Physicians don’t need more data. They need insights,” she said. “Those insights, if they’re not in the clinical workflows—and that’s where APIs come in—it’ll be very hard for them to become mainstream.”

More companies are bringing analytics tools for value-based care to the market. Those technologies can also help control costs, since they can assist providers in areas like avoiding duplicative services or deciding where to send a patient for a procedure. 

“Without bringing that data in, it is impossible for the person who ultimately makes the decision, meaning the physician, to actually control the cost,” said Nele Jessel, M.D., chief medical officer at EHR company Athenahealth. “It is not helpful to have that data in population health tools or in some care manager’s Excel spreadsheet—it needs to be in front of the provider, because otherwise the provider can’t provide value.”

The 21st Century Cures Act made data exchange table stakes for all healthcare organizations, said Jessica Sweeney-Platt, Athenahealth’s vice president of research and editorial strategy. 

But data exchange on its own between an individual practice and a hospital, for example, isn’t enough. 

For value-based care, doctors need integrated information from all possible sources including post-acute care, at-home care and even retail care plus analytics capabilities for those data in order to succeed in value-based reimbursement.

Otherwise, the promise of whole-person care remains out of reach.

“Interoperability is the only thing that enables that single patient story to exist,” said Sweeney-Platt.