Is interoperability trickling down?

Interoperability seems to be on many minds and cover a wide range of activities from organizations working to improve patient engagement to federal efforts to establish health information exchange (HIE) governance.

More than 1,000 callers listened to a conference call on health information exchange (HIE), indicating the high level of interest in the topic. Farzad Mostashari, MD, ScM, national coordinator of health IT, said that Meaningful Use Stage 2 has been a “big step forward for transport, messaging and content standards” surrounding interoperability. “Software developers are working very hard to implement interoperability standards to reduce cost and complexity. We need to improve the business case for information exchange so that it’s profitable to share information not hoard.”

Mostashari said the industry needs “mechanisms where the rules of the road, interoperability, privacy and business practices are standardized to the extent possible so that information can flow without the need for protracted, painful, expensive contract negotiations.”

However, “the more progress you make,” he pointed out, “the more sharply drawn the challenges and issues.”

The Office of the National Coordinator of Health IT (ONC) is working on HIE governance that establishes a common set of behaviors, policies and standards that enable trusted electronic health information exchange among a set of participants, said Jodi G. Daniel, JD, MPH, director of the ONC’s Office of Policy and Planning. “This is what and how we’re thinking about this suite of activities.”

Following the recent announcement of a grant issued to two organizations to further HIE governance, David C. Kibbe, MD, MBA, president and CEO of DirectTrust, said there already is progress to report. His organization has established an accreditation program in partnership with EHRNAC and they are working on a trust anchor, version 1.0. Kibbe said the top priorities are increasing interoperability, decreasing cost and complexity and facilitating trust among participants using Direct for the exchange of PHI for healthcare improvements. The goal, he said, is to have 50 entities fully engaged in the accreditation program by end of the year. “We’re well on our way but it’s going to take more work.”

The Medicare and Medicaid EHR incentive programs and the ONC’s certification program are insufficient to achieve widespread interoperability and electronic information exchange necessary to achieve true healthcare reform, national multi-stakeholder healthcare organization eHealth Initiative (eHI) told the ONC and Centers for Medicare and Medicaid Services (CMS).

eHI’s letter came in response to the two agencies’ request for information on advancing interoperability and health information exchange published in the March 7 Federal Register.

“A solution for patient matching, development of a consent framework, and variances in privacy rules across states that inhibit exchange of information from one state to another are several initiatives that require attention to complement the work being evaluated, tested, and disseminated to promote the exchange of information,” according to the letter.

Also this month, during the Boston Health IT Summit hosted by the Institute of Health Technology Transformation, speakers discussed how mobile technology is driving patient engagement for increased interoperability. Dan Martich, MD, CMIO, University of Pittsburgh Medical Center (UPMC), said use of patient authentication tools led to a rapid increase in the number of patients accessing their health records through online portals. “Since turning that on, we’ve had a 65-75 percent success rate and our numbers jumped,” adding that currently 14,000 patients use health record apps on their smartphones to access their information. UPMC include birthday alerts reminding patients of annual physicals and other preventive services including mammograms, colonoscopies and pap smears.

Patients also want personal relationships with providers that are private and easy, said Susan Woods, MD, MPH, associate professor, Oregon Health and Science University and director of patient experience, connected health at the Veterans Health Administration. She also encouraged healthcare record systems to be practical and allow for transactions, such as prescription refills or appointment setting, to have true value to a consumer.

“I can’t tell you how many patients I don’t see because we communicate by email,” Woods said. “If we treat people as we want to be treated, they rise to the occasion.”

Are any of these efforts trickling down to impact care and outcomes at your facility? Please share your experiences.

Beth Walsh

Clinical Innovation + Technology editor