The Meaningful Use program, alternative payment models, artificial intelligence and technical and policy shifts have spurred innovative approaches to data exchange. However, hospitals are finding that there is more than one way to achieve interoperability, and some are experimenting with several different pathways at once.
SSM Health, a 24-hospital Catholic not-for-profit health system in the Midwest, has pursued multiple avenues to facilitate data exchange by joining health information exchanges (HIEs) in Missouri, Oklahoma and Wisconsin, tapping into Carequality’s Interoperability Framework, and using Direct Messaging. It was the first health system to go live with Surescripts’ national locator service and shares patient data with both the Department of Defense and the Veterans Administration’s virtual electronic health record program, known as VLER.
The system has also begun to capture patient-generated information such as blood pressure data and when a patient receives a flu shot through its Epic MyChart portal and apps.
In 2016, SSM Health exchanged more than 15 million records, involving all 50 states, which included records from more than 1,000 hospitals, 1,500 emergency departments and 25,000 clinics. As a result, SSM Health was able to add more than 1.2 million pieces of medication data and 100,000 pieces of allergy data to its patient charts.
“We’re a national leader, taking on risk-based contracts and population health,” Richard Vaughn, M.D., SSM Health’s vice president and chief medical information officer. “We need to have this ability because the patients are not all with us. We need to aggressively pursue [their information].”
HIEs provide a pathway
Smaller systems are taking a similar approach. The University of Missouri Health System, with five hospitals and a network of more than 50 clinics in central Missouri, is leveraging multiple interoperability pathways, especially as the available options evolve, according to Mike Seda, director of regional operations at The Tiger Institute for Health Innovation, a private-public partnership between the University of Missouri and Cerner Corporation.
For example, the health system initially used Direct Messaging—a DirectTrust framework—to exchange transition-of-care summaries required under Meaningful Use Stage 2, but also found value in using Direct messaging for referral management and to support telehealth. Using the Tiger Institute Health Alliance, a private, query-based HIE connected to CommonWell, the system is now sending event notifications to primary care physicians.
Seda has also found that the vendors have improved the technology supporting interoperability.
“In 2010-2011, not a lot of vendors could provide query-based exchange, so the fees were astronomical," he says. "But over time the vendors developed that capability. Now the challenges [to data exchange] are more related to value.”
A hybrid model takes hold
Interoperability is progressing in fits and starts, with standards and methodology still evolving.
“We’ve accomplished a lot with interoperability, but still need improvement,” says David Kibbe, M.D., president and CEO of DirectTrust.
In the meantime, stakeholders should continue to leverage various pathways and standards, each of which complements various stages of the evolution.
“You can’t replace everything with one standard because some [health IT products] don’t adapt, and it’s expensive to replace,” Russell Leftwich, M.D., HL-7 co-chair of clinical standards and senior clinical adviser for interoperability at InterSystems. “Yet new concepts like genomics will use newer technology. They’ll coexist. We’ll live in a hybrid interoperability environment in the foreseeable future.”
For the moment, hospitals will have to navigate an often complicated interoperability ecosystem. At the same time, the industry is moving toward a more cooperative atmosphere than in the past when EHR vendors were reluctant to cooperate.
“Collaboration between vendors and clinicians is really important right now. We need tools capable of knitting vendors together,” says Kibbe.
Steven Posnack, the Office of the National Coordinator for Health IT's director of standards and technology, agrees.
“EHR adoption records are high. We’ve got connections. Now we pivot to ramp up usability and productivity,” he says.
Meanwhile, some hospital executives are encouraged.
“I’m optimistic about the direction we’re headed in,” Vaughn said. “With risk-based contracting providers, the government and insurers have aligned incentives. It’s all forcing us to open systems up.”
“Healthcare is an immature place without a single source of truth, and we’re not fully connected,” he added. “Not even the patient knows all of his information. But we’re working on it.”