Industry Voices—Interoperability can cut health costs by $30B. But this needs to happen first

The COVID-19 pandemic has shed more light on the pressing need for health information technology (HIT) interoperability.

With a surge in patients at hospitals and emergency rooms, providers and support staff are constantly under stress with limited time to gather patient health information. Interoperability would enable providers to quickly and seamlessly access a patient’s medical record either through their electronic health record (EHR) or directly from the patient’s phone. 

Interoperability is meant to streamline care, promote patient-centered care, and is also an opportunity to reduce healthcare costs by an estimated $30 billion.

But to make this cost savings a reality and happen effectively, it is now up to healthcare providers, payers, and third-party app developers. These entities will have requirements related to implementing interoperability by 2021 under the HIT interoperability rules recently finalized by the Office of the National Coordinator for Health IT (ONC) and the Centers for Medicare & Medicaid Services (CMS).

RELATED: CMS' new interoperability rule requires major changes for payers, hospitals. Here are 6 key elements

Compliance flexibility has been announced by the federal agencies due to the intensive attention required to address COVID-19, but it is still a priority and the pandemic itself exemplifies the urgent need for interoperability.  

At the same time, we need to realize regulatory requirements are only one component on the road to achieving the interoperability goals of coordinated and patient-centered care. P

olicies and rules are providing the tactical to-dos and once implemented do not guarantee that intended outcomes for patients and the healthcare system as a whole will be realized. Below we outline three patient-focused concepts providers and insurers can incorporate in an interoperability implementation strategy to ensure shared decision-making with patients is accomplished. 

 1. Enable patient empowerment through effective communication of health information

consumer healthcare study found that 69% of patients surveyed don’t feel empowered to control their healthcare journeys. Empowering patients requires making information both accessible and comprehensible. Access to health information alone is an insufficient solution to empowering patients in being the stewards of their health data. 

RELATED: Americans will have 'access to their health information on their smartphones': Trump admin on HHS rules

This is where comprehensibility is key—data shared with patients should be user friendly and easily understandable to promote knowledge building. The value for patients is receiving their health data and being able to comprehend what it means to meaningfully work with providers and payers on healthcare decisions.  

Data shared with patients will also need to strike a balance of providing enough detail while being concise. This involves thinking through how data will be structured, displayed, and personalized for patients.

For example, annual blood work results shown simply as numbers do not provide the patient with any ready insights; they are simply numbers on a screen. However, adding indicators on whether a data point is abnormal or normal, showing trends over time, and identifying whether a number is within the average based on the patient’s demographics, such as age, are more useful. Patients will then be empowered with the knowledge to make better informed decisions on any behavioral or therapeutic changes in consultation with their provider.  

 2. Improve patient experience through stakeholder collaboration  

Payers, providers, electronic health records vendors, and third-app developers all play critical roles whether they directly or indirectly interact with patients. How well these entities interact and coordinate to deliver a patient’s health data is critical to the patient experience and ultimately their buy-in on the sharing and accessibility of their data. There are three major areas requiring stakeholder collaboration to ensure a smooth patient experience: 

Security and privacy  

The increased flow of data across these healthcare stakeholders and finally to the patient means increased risk of data breaches and potential gaps in security and privacy. This risk and its impact are already a concern for patients and therefore must be properly addressed to drive patient adoption. A Software Advice survey found that 54% of respondents would change healthcare providers as a result of a data breach. Additionally, 21% indicated their level of concern with data breaches results in withholding personal information from their doctors.  

Privacy and security are also a critical issue that must be resolved under today’s Interoperability Final Rules. Third-party apps will not be required to follow data blocking policies nor are they covered under HIPAA.

Until new privacy laws are enforced, privacy and security concerns will need to be managed responsibly by developers; providers and payers will need to advocate for patient protections and all stakeholders should align on anti-fraud strategies.  

Synchronizing data across platforms  

Third-party apps are now entering the game to provide a platform for patients to access their data while both provider patient portals and health insurance portals will still be available. Establishing frequency of data refreshes across platforms will ensure there is synchronization and patients get their data in a timely matter using any platform. Without this collaboration, the patient experience can be negatively impacted. 

For instance, tech savvy patients who access data on their provider portal, the site from their insurer, and on a third-party app may notice if there are any delays when their data is updated. Patients who rely solely on a third-party app may be oblivious to a delay resulting in inaction on getting the information they need when they need it. This can cause confusion for patients, or worse, lead to disuse out of disregard for the usefulness of these platforms.  

Accuracy of data  

Similar to synchronization, accuracy across platforms is essential to build trust in the usefulness of data sharing. Inconsistent data, whether it be fundamental errors or differences in the interpretation of data, can cause confusion and frustrate patients.

Similar medical terminology to communicate for laypeople and consistency in data mapping across platforms will ensure accuracy for patients. This alignment will allow patients to have confidence in the data and be able to make decisions based on a clear understanding of their health information.  

3. Enhance patient engagement through marketing and education campaigns  

Creating platforms for patients to access to their data is only useful if patients are actually putting them to use. The “build-it-and-they-will-come” approach should be avoided by all means. For example, while patients have expressed a need for cost transparency in healthcare, adoption of healthcare cost-estimator tools are still low. A Public Agenda survey indicated that 63% of respondents say there is not enough information about how much medical services cost; however, Catalyst for Payment Reform estimates that only 2% of consumers use their health plans’ cost-estimator tool.

There are several reasons why this lack of adoption might be including not knowing where to find cost information, not knowing such a tool even exists, or not trusting the tools that are available. Regardless of the reason, they all can be addressed through a concerted effort on marketing and patient education. Stakeholders can learn from the healthcare cost-estimators case study as they take on interoperability. Effective outreach and messaging means building awareness around the channels where patients can access their data, how they can access their data, and what they can get out of doing so. 

Thinking strategically now means greater success later  

Realizing the intended outcomes of interoperability requires a patient-centric strategy that goes beyond simply following regulatory requirements. Success weighs as heavily on the people component as it does on the technology component. While this means incorporating an extra layer of complexity when planning and implementing interoperability requirements, the results are paramount. Together providers and payers can meet the ultimate goal of improved health outcomes for patients.   

Kim Huynh is a healthcare and life sciences expert, and Nazim Dzabic is a healthcare expert at PA Consulting.