For decades, Hal Wolf has watched the efforts of the U.S. healthcare system to effectively share data.
And while most data sharing approaches are still "clumsy," he said the industrywide efforts to address interoperability have "turned a significant corner."
Specifically, the CEO of the Healthcare Information and Management Systems Society (HIMSS) told FierceHealthcare, industrywide efforts to advance an approach to interoperability based on application programming interfaces (APIs) are finally picking up steam.
"We’ve gone from 'I can’t get any data at all' to 'data is being presented to me but there’s no standard to it,'" said Wolf, who steers HIMSS' effort to advance health IT, between sessions during the Office of the National Coordinator for Health IT's (ONC's) two-day Interoperability Forum last week. Now, organizations are using interoperability standards to get access to data, but the process needs to be smoother to get data "faster, cleaner and easier," he said.
During the conference last week, which focused on data access and digital health advancements, many healthcare executives said the healthcare industry has made significant investments in digitizing healthcare—to the tune of $40 billion—as part of federal funding from the Health Information Technology for Economic and Clinical Health (HITECH) Act. But the industry has yet to see a return on that investment with improved interoperability.
Countering this take, Wolf takes a more optimistic view.
"We are moving in the right direction with better velocity than I have seen in the past," he said. "There has been frustration because we put a lot of investment into large back-end systems and also an acknowledgment that we haven’t necessarily used the information to its fullest extent, but I think people see that vision now and are driving interoperability to make it work."
The ONC conference highlighted many examples of progress on the interoperability front, Wolf said, including healthcare organizations sharing data for public health and population health reporting to advancements by electronic health record vendors to enable organizations and patients to have better access to data.
"Healthcare organizations are trying to get larger and larger data sets with higher levels of flexibility to now run reports for analysis and value-based care and that’s deeper and farther than they have ever gone before," Wolf said.
He added, "I think what we heard is that it’s getting better. We haven’t crossed the finish line yet from an interoperability standpoint, but optimism is definitely on the rise."
Wolf noted that the development of Health Level Seven’s (HL7's) interoperability specification, the Fast Healthcare Interoperability Resources (FHIR) standard, is helping drive interoperability progress as a modern interoperability standard that is more flexible and more functional than the standards in current use in healthcare today.
Many industry stakeholders view FHIR as key to developing an application-based approach to interoperability and health information exchange. HL7 announced in January the latest iteration of FHIR, FHIR Release 4, which should allow healthcare organizations to make new strides in data interoperability.
The FHIR standard also is foundational to recently proposed interoperability rules from the Centers for Medicare & Medicaid Services (CMS). In February, the Department of Health and Human Services outlined new provisions around advancing interoperability and giving patients easier access to their health data, signaling that open APIs and FHIR will be core components.
CMS is proposing to require Medicare Advantage organizations, state Medicaid and CHIP fee-for-service programs, Medicaid managed care plans, CHIP managed care entities and QHP issuers in FFS programs to implement, test and monitor openly published FHIR-based APIs to make patient claims and other health information available to patients through third-party applications and developers.
These proposed rules are helping light the flame under the FHIR standard and its use, Wolf said.
During one panel discussion at the ONC Interoperability Forum, many industry stakeholders said there are ongoing challenges with implementing the FHIR standard. Kristen Valdes, CEO of personal health app b.well Connected Health, said the standard is still immature but has the potential to create a push toward interoperability in healthcare.
"We’re starting to see a swing in the maturity lifecycle of data interoperability and its use," Wolf said.
HIMSS, which counts more than 70,000 individuals, 630 corporations and 450 nonprofit organizations as members, is moving forward on several interoperability-focused initiatives. The organization is working to develop an interoperability maturity model to help healthcare leaders assess their interoperability capabilities and build toward more advanced levels, Wolf said.
HIMSS also recently signed an agreement with the Netherlands Ministry of Health to work together to support and advance digital health and interoperability on a global scale. The health ministry and HIMSS plan to leverage their collective resources to advance information sharing in a standardized format to ensure patients, providers and caregivers have access to timely and useful information, the organizations said.
"We're seeing a global movement with multiple countries ready to put stakes in the ground for standards on interoperability because they recognize that we need to move forward on this. That tells me that we have turned a significant corner," Wolf said.