Interoperability: The New Paradigm of Value-Based Healthcare...
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Interoperability: The New Paradigm of Value-Based Healthcare Management

By James Hellewell, Medical Director - Informatics, Intermountain Healthcare

James Hellewell, Medical Director - Informatics, Intermountain Healthcare

In the healthcare industry, it is crucial to possess the ability to connect varied sources of data to provide a comprehensive view of each patient’s history to the clinical team and to the technical systems supporting that team. For an individual patient, relevant data may exist in multiple healthcare system electronic medical record (EMR) systems, claims data sets, pharmacy systems, public health databases, and other sources. Sharing data with preserved meaning between systems can be accomplished using standards-based interoperability practices.

A Sneak Peek into Healthcare Trends

Multiple factors are prompting healthcare organizations to enhance the usability and functionality of their technical systems. One of these forces is a shift from fee-for-service payment models to value-based care. Success in this new environment requires greater adherence to best practice clinical guidelines and population-level interventions. To achieve this aim, healthcare organizations are looking to third-party vendors for advanced technical solutions. While core EMR vendors may find it difficult to extend their code base with new functionality and enhanced user-interface design, third-party vendors are promising to fill this need. The challenge remaining is that of interoperability. Without widespread adoption of interoperability standards in our current environment, integrating external technical solutions into the EMR requires considerable effort, and the effort must be repeated for each new integration. As EMR vendors incorporate standards-based data access services, third-party software will integrate with much less required effort. These advances in interoperability will eventually place advanced technical solutions designed to support value-based care initiatives in the reach of even the smallest of healthcare systems.

Initiatives Impacting the EMR

At Intermountain Healthcare, we are addressing regulatory requirements tied to the Protecting Access to Medicare Act (PAMA) legislation expected to come forth next year. This legislation requires providers ordering some advanced imaging studies to use computerized decision support. Regulatory requirements like PAMA are another driving force that will emphasize the need for interoperable systems.

"As technical systems become truly interoperable, our opportunity to effectively implement best practice standards across the healthcare system grows tremendously"

To meet the needs of our employed providers, we are building required imaging decision support modules directly into our core EMR system, thus bypassing the need for integration of an external product. At the same time, we also plan to make a third-party solution available to our affiliate providers that order imaging services for their patients at our facilities. This third-party solution will require integration.

Challenges and Evolution in the EMR Sphere

Interoperability enabled collaboration between healthcare organizations, EMR vendors, and third-party technology companies will help usher in the next wave of breakthroughs in the healthcare technology space.

Healthcare organizations bring several key factors to the table. Using data, continuous improvement principles, and implementation science strategies, they can help ensure efforts are focused on well thought out initiatives that are most likely to introduce a large positive impact on outcomes that matter. This work is much larger than simply choosing which technical solutions to implement. Successful evolution requires focus on people and process before technology. Many technical solutions fail because they introduce more burden than value to their audience, or they are dependent on a change to non-technical processes that have not yet been adequately addressed.

Like healthcare organizations, EMR companies also have opportunities and challenges ahead of them. EMR systems have complex technical architectures with many interconnecting functions. This can make incorporating the latest advances in functionality and user interface design difficult. Care must be taken to ensure changes in one area won’t negatively affect another area, and if a significant shift in the underlying technical architecture is needed, that presents an even larger challenge. Yet EMR systems must evolve to maintain relevance in a rapidly advancing healthcare technology environment. Adopting interoperability standards and partnering with third-party technology companies will allow EMR vendors to evolve more quickly.

With interoperable data access services in place, third-party software companies can connect specialized technical solutions to existing core EMR systems. These technical solutions can be made to be highly effective by collaborating with healthcare organizations with rich sources of patient data and expertise in best practice implementation. Solutions may include population-level interventions that enhance value by prompting patients and their healthcare team to adhere to important preventive practices. They may also include precise prediction models and highly tailored treatment algorithms that make it possible for front-line caregivers to intervene earlier in the course of a patient’s disease process, avoiding costly emergency and hospital-based encounters.

Advice for Fellow Healthcare Professionals

Data are the keys.

We can use data to identify our greatest opportunities, to inform our interventions, and to study their effect. Interoperable systems open more data sources for these purposes.

Keep interventions precise.

Front-line caregivers have little tolerance for onerous technical processes. We must avoid scope creep that goes beyond the well-defined problem space and introduces extra steps with uncertain value. With interoperable systems in place, well-built technical solutions can be implemented broadly, across varied healthcare organizations.

Promote the adoption of interoperability standards.

As technical systems become truly interoperable, our opportunity to effectively implement best-practice standards across the healthcare system grows tremendously. We can influence this space by placing a high value on the adoption of interoperability standards when partnering with EMR vendors and third-party technology companies.

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