Despite large investments in technology, healthcare still early in interoperability journey, BCBSNC executive says

health IT
Increased use of open APIs and the move toward alternative payment models will help to push interoperability forward, industry leaders say. (eggeeggjiew/Getty Images)

Payers and providers have made significant investments in digitizing the healthcare system but have yet to see a return on that investment with improved interoperability, according to industry leaders.

On a positive note, industry stakeholders have laid the foundation for interoperability with initiatives like CommonWell, Carequality and other data-sharing efforts.

"We're starting to make data interoperable, but we have tremendous work ahead" to make it easier for physicians, payers and patients to access and use data, said Philip Parker, CEO of Coral Health during a panel discussion on Wednesday at the Office of the National Coordinator for Health IT's third annual Interoperability Forum.

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In discussing the current state of interoperability, Patrick Getzen, senior vice president, chief data and analytics officer for Blue Cross Blue Shield of North Carolina, said the industry is still early in the journey for interoperability between payers and providers. Data sharing is largely in the form of claims extracts that payers send to providers monthly and quarterly. "The information we're getting to providers is not actionable enough, not real-time enough," Getzen said.

"On the member side, it's more limited with access gained through patient portals," he said.

RELATED: Patient handoffs to post-acute care providers still largely a manual process, hindering effective care coordination

A survey released this week found that fewer than 40% of hospitals can successfully exchange data with other health systems and these ongoing interoperability challenges are limiting strategic efforts to improve workflow, improve population health and reduce the cost of care.

To advance interoperability to a more mature state, the industry needs to address several issues around standardizing data and data quality. "There are not consistent processes to certify data as high quality. If the data is not trusted between data exchange partners then it won't be used effectively," Getzen said.

 "We also need to focus on clarifying the roles and responsibility around who owns this data once it has been exchanged," he said.

Getzen, along with HIE leader Morgan Honea, CEO of the Colorado Regional Health Information Organization, both said the move toward alternative payment models was critical to pushing interoperability forward. Payment reform would push healthcare providers to use interoperability tools to do things like identify diabetics and rising-risk patients, Honea said.

RELATED: CMS launching pilot program to give providers direct access to claims data

Providers moving to take on more risk in value-based payment arrangements need high-quality, accurate data, and actionable insights, Getzen said. "We need the pipes to get them that information so they can deliver a different outcome at the point of care delivery. We can’t hold providers accountable for the total cost of care and quality without giving them these three things," Getzen said.

Some industry leaders in the audience took issue with how panelists' pessimistic view of the current state of interoperability. During a question and answer period following the panel discussion, John Kansky, president and CEO of the Indiana Health Information Exchange, a regional HIE, said the panelists were describing the "lowest common denominator on interoperability."

"The most efficient approach is when you get HIEs, EHR capabilities and national networks working together," he said, noting that are large markets in the country where those efforts are happening. "What you are describing as future state is now the current state is some areas." 

The role of APIs to advance interoperability

Jim Barnett, director of strategic intelligence analysis at AARP noted that consumers face significant barriers with current data sharing approaches.

"We see a lot of money invested in systems talking to systems, and that's where it needs to begin, but the current state is not great for consumers. The consumer is becoming the ultimate point of integration and the last mile and they are not ready yet. We need new tools to make things more consumer-friendly," Barnett said.

RELATED: Fewer than 4 in 10 health systems can successfully share data with other hospitals, survey finds

The use of open application programming interfaces, which federal policymakers are pushing as part of recent interoperability rules, will go a long to reducing barriers to data sharing, according to Honea.

But current smartphone apps that provide consumers with health information are not easy to use and the information is not in a format that's easy to understand, many industry leaders say.

Healthcare consumers need a digital storefront to go in and pick the apps and digital tools that they want to use, Getzen said.

The goal is to create a more patient-centric healthcare system, Barnett noted, and the industry should focus on developing best practices around transparency and accountability. "If you don’t develop those best practices voluntarily then we're going to see more regulation. It behooves this industry to get ahead of that," he said.

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