In the coming months and years, we’ll have the advantage of 20/20 hindsight to assess how well our nation responded to the COVID-19 pandemic, allowing us to be more prepared for the next public health crisis.
No doubt we’ll address the shortage of personal protective equipment (PPE) and figure out how to improve our testing processes.
But another important growth opportunity that will come out of this experience is the imperative to significantly improve our data-sharing capabilities—sooner rather than later.
Healthcare has struggled with interoperability issues for years, but our current battle with the novel coronavirus has exposed the depth of our data-sharing deficiencies. Clinicians and researchers have never had a greater need to share information about test results, pre-existing conditions, symptoms and therapies—yet the lack of interoperability between clinical systems has impeded efforts to identify outbreaks, track mortality rates and deliver efficient patient care.
As we move past the immediate crisis and work to develop vaccines and effective treatments, we will continue to have a heightened need to share critical health information.
In the best of times, clinicians struggle to access patients’ medical histories. Even when a patient sees providers within the same network, records are often stored in multiple EHRs that don’t necessarily “talk” to one another. If a patient goes to the emergency department (ED) at a hospital that doesn’t have access to the patient’s medical records, clinicians may scramble to find the relevant details they need to safely and efficiently deliver care.
If a patient with COVID symptoms seeks treatment at a crowded and understaffed ED, clinicians don’t have the luxury of time to manually search through various databases to find the medication histories and identify any underlying health conditions.
The impact on lab reporting
We are also seeing interoperability issues that are impacting data-sharing between labs and physicians and labs and public health officials. We lack consistent standards in terms of the type of data collected and what details labs can share and with whom. Testing results are not necessarily sent to patients’ primary care physicians, nor to regional health information exchanges.
If a patient with COVID-like symptoms seeks care at an ED, and then one week later goes to their doctor’s office, the primary care physician may not know if the patient was tested or if the results were positive or negative. Before the doctor can make an accurate clinical assessment and prescribe appropriate therapies, staff must first spend time trying to locate the missing information.
Because labs use a variety of different clinical systems, each one may use a different reporting format when sending their testing information. The labs’ reports are typically uploaded in an unstructured format, creating additional challenges for local and state health departments and other entities as they attempt to create aggregated dashboards and reports. Adding to the inefficiencies is a lack of standardized reporting requirements across health departments. At a time that many labs are overwhelmed with a surge of new testing, they are being asked to create multiple types of reports, which adds to their administrative burden.
In an effort to improve epidemiological surveillance and identify potential hot spots that might need additional supplies, the Centers for Medicare and Medicaid Services (CMS) is now also requiring labs to share COVID-19 testing data on a daily basis. Because of the lack of standards in how testing data is stored and shared, CMS is asking labs to send information in a spreadsheet format—which is highly inefficient for both labs and CMS.
We’re overdue for interoperability improvements
CMS and the Office of the National Coordinator (ONC) released the long-awaited interoperability final rules on March 9, just as COVID-19 began its rapid spread across the country.
The rules, which focus on driving interoperability and giving patients better access to their healthcare data, include many important regulations to prevent anti-competitive behaviors and facilitate the seamless flow of information between patients, payers, and providers—something that would be tremendously beneficial if it were already in place today.
While the subsequent delay to implement the rules is disappointing, it is certainly understandable.
Many providers are flooded with patients and simply don’t have the bandwidth to implement new technologies and workflows. Ironically, the lack of interoperability is making clinicians even busier because they lack immediate access to patients’ medical histories. Because of data-sharing limitations, clinicians are often forced to wade through pages and pages of notes to identify relevant health conditions or medical therapies that could impact outcomes.
The pandemic has placed a spotlight on the country’s clinical data-sharing deficiencies. As we move forward in the coming weeks and months and prepare for future pandemics, fixing interoperability must be one of our highest priorities.
Jay Anders, MD, is the chief medical officer of Medicomp Systems, which provides physician-driven, point-of-care solutions that fix EHRs.