Healthcare IT systems are becoming increasingly convoluted. More data, more connected devices and more regulations require more systems, which ideally can communicate and exchange data — not just within a healthcare organization but among organizations. This is the idea behind healthcare interoperability. According to HIMSS, interoperability is about the extent to which systems and devices can exchange data and interpret that shared data. For two systems to be interoperable, they must be able to exchange data and present that data so that a user understands the information and can use it in their treatment and operations decisions.
HIMSS goes on to describe three progressive levels of health IT interoperability. First is “foundational”interoperability. It enables one IT system to receive a data exchange from another and does not require the ability for the receiving information technology system to interpret the data.
The next step up is “structural” interoperability. It determines the structure or format of the data exchange (i.e., the message format standards) where there is uniform movement of healthcare data from one system to another. Structural interoperability ensures that data exchanges between information technology systems can be interpreted at the data field level.
The final and highest level is “semantic” interoperability. It this situation, two or more systems or elements can exchange and use information. Semantic interoperability takes advantage of both the data exchange structure and the codification of the data. This level of interoperability supports the electronic exchange of patient summary information among caregivers and other authorized parties via potentially disconnected electronic health record (EHR) systems and other networks to improve quality, safety, efficiency and efficacy of healthcare delivery.
Interoperability becomes optimal when it includes data processing and interpretation, with the goal of delivering actionable information to the end user, such as clinicians and the patients themselves.
The premise of interoperability is making patient care and data safety better. Other goals include improved care coordination and experiences for patients, lowered healthcare costs and more robust public health data.
But how does interoperability accomplish these objectives? Here are the five key benefits of healthcare system interoperability through better information data exchange:
In this day and age, medical errors should be rare. A Johns Hopkins study determined that 44 percent of medical error deaths were preventable. By creating and implementing advanced interoperability, with the aim to capture and interpret data across systems and applications, healthcare organizations can better prevent errors due to missing or incomplete patient data. If an error does occur, advanced interoperability enables healthcare organizations to pinpoint the cause.
Healthcare providers might not be able to exchange data with external affiliates and systems even if they have excellent interoperability within their own enterprise. Lacking data on a patient’s vital signs and history — including allergies, medications or pre-existing conditions — healthcare organizations may be prone to fatal errors.
However, if these organizations can exchange and examine data, care providers can analyze the exact cause of a medical error to detect trends in the decision making leading up to the error. Once a pattern has been identified, healthcare organizations can begin remediating these issues to prevent future errors.
The healthcare industry provides a stunning example of inefficiency in today’s digital world. The multiple providers who may be caring for a patient do not have their care coordinated. Patients must often do administrative tasks like search for documents, fill out multiple forms, re-explain their symptoms or medical history and sort out insurance (both before and often after receiving care). In fact, the Office of the National Coordinator for Health IT revealed research that suggests only 46 percent of hospitals had electronic access at the point of care to the patient information they required from outside providers or sources.
Interoperability can vastly improve this process, giving patients faster, more accurate and coordinated treatment and enhancing their overall experience.
Where interoperability is present, IT systems can interact in such a way that faster and more accurate collection and interpretation of public health data are possible. This can help organizations answer pressing questions for both patients and providers. The opioid crisis provides an excellent example of why healthcare needs more robust public health data to understand the scope of that problem and continue ways to more effectively address and resolve the crisis. By facilitating the sharing and interpretation of such data, interoperability allows healthcare organizations to collectively educate one another on predicting and preventing outbreaks.
Improved care and hospital safety are outcomes of system interoperability. This ability to exchange data could save the U.S. healthcare system more than $30 billion a year, according to an estimate from the West Health Institute (WHI), which recently testified before Congress. Interoperability also gives organizations the opportunity to save time with every patient encounter by getting the right data to the patient, the provider and affiliate at the right time, every time.
Patient privacy and security are the primary care and regulatory issues to consider when implementing interoperability. This is not an easy task, but it can help enhance the privacy and security of patient data by requiring organizations to fully assess where their protected health information (PHI) resides and with whom it needs to be shared. When organizations enter data into systems that cannot communicate with one another, for example, it becomes difficult to track all systems that touch PHI, as required by the HIPAA Security Rule. It can be even tougher to track users with access to an EHR or affiliated applications: In a study of 1 million FairWarning users, 26 percent of users were found to be poorly known or unknown to the care provider.
By promoting the interoperability of human resource management systems such as Lawson or Peoplesoft with your EHR, though, you can better identify users, track their access and more effectively manage access rights. When PHI is entered into secure, interoperable systems, organizations gain a better idea of where their data live and who has access to it, helping them secure patient data and protect privacy.
The American Hospital Association, the Association of American Medical Colleges and several other organizations released a report in January that called for interoperability, arguing that it gives patients peace of mind because they know their providers’ decisions are based on the best, most complete information possible. Interoperability could form the foundation for a significantly improvement in both patient care and experiences. Healthcare processes would become streamlined. It takes work to achieve true healthcare systems interoperability, but it’s a worthwhile undertaking.
Hospitals and health systems across the U.S. are seeking ways to better engage patients with a variety of handheld and home-based technologies to improve patient experience and health outcomes.
This begs the questions: How does one use technology to transform the hospital bedside? Or to increase medication adherence for hypertension? What about controlling diabetes, or reducing distress in patients with cancer?
Four healthcare organizations, including UC San Diego Health, Ochsner Health System, Sutter Health and Stanford Health Care, have developed answers to these questions. All have created diverse models of care that incorporate use of patient-centered technologies with measurable outcomes, and these results were recently published in Health Affairs.
There are a few examples of these projects and the effects they've had.
Ochsner Health System used its online patient portal to help treat hypertension with a new digital medicine program that combined patient-reported blood pressure data, clinical data and coaching.
Outcomes showed that medication adherence among patients improved 14 percent, while 79 percent achieved greater blood pressure control. Overall, clinicians saw a 29 percent reduction in clinic visits.
Sutter Health used its patient portal to help patients self-manage their diabetes. Online reminders of hemoglobin A1c monitoring among patients with diabetes improved the rate of A1c test completion by 33.9 percent. Overall, patients with previously uncontrolled diabetes had a significant reduction in HbA1c at six months compared to usual care.
Stanford Health Care, meanwhile, used its patient portal to help patients with cancer manage stress. Patients were surveyed before clinic visits to identify unaddressed symptoms, and about 40 percent of those who responded reported experiencing distress. These responses led to more than 6,000 referrals for psychotherapy, nutrition and other services.
WHAT ELSE YOU SHOULD KNOW
In 2016, UC San Diego Health opened Jacobs Medical Center, a 245-bed hospital that offers advanced surgery, cancer care, cardiac rehabilitation, and birthing options. To put patients in direct control of their experience, an Apple tablet was placed in every patient room.
The tablets enabled patients to control room temperature, lighting and entertainment options from their beds. The tablets also enabled access to personal medical information, such as test results and schedules of medications or upcoming procedures. Photographs and biographies of their care team were also available.
What researchers found is that a big chunk of patients said the tablets were contributing to a positive patient experience, and engagement in medical care, determined by accessing their medical record, was higher.
Consumerism means customers have expectations of convenience, flexibility and ease of use. In healthcare, the customers are the patients, and healthcare organizations who want to attract business are increasingly looking to technological innovation to bring patients into the fold.
Aditya Bhasin, chief of web systems and vice president of software design and development at Stanford Health Care, spoke at HIMSS19 in February about his organization's attempts to do just that, emphasizing the importance of innovating from the inside -- to better create something that fits a provider's specific ecosystem.
Physician informaticists adjusted workflow, optimized EHR documentation and built new tools to improve depression screening, diagnosis and management.
UCLA Health has earned a HIMSS Davies Award for its comprehensive efforts rethink the way it uses information and technology to screen for depression in primary care patients.
WHY IT MATTERS
In addition to its work on depression, UCLA also was recognized for other innovative applications of IT. It made adjustments to its electronic health record to save two million each year in denials, for instance, and improved appropriate red blood cell utilization thanks to a collaborative project among its hospitalists, nurses, transfusion staff and the IT department. Read about these use cases here.
But it's the new approach to depression screening that won particular attention and could impact the most patients. More than 300 million people suffer from depression; each year 26 percent of adults and 20 percent of children have a diagnosable behavioral health disorder, as HIMSS points out.
And with most Americans getting behavioral health care from their PCPs than from mental health specialists, many cases of depression remain undetected in primary care settings – including at UCLA Health, which recognized a suboptimal depression screening rate among adults seen in its primary care offices.
Among the many ways they health system used to address this was to have its physician informaticists work alongside its IT and operational teams to review and revise existing EHR workflows for depression risk screening – including the deployment of new tools, such as an online platform, "Behavioral Health Check-up," developed by the UCLA Division of Population Behavioral Health.
Building on the insights from a series of plan-do-study-act cycles, UCLA rolled out new clinical workflows, created new training programs and continuously monitored how the new tools and strategies were working. This led to a better universal depression screening rate; more accurate diagnosis and management of depression comorbidities; increased referrals to appropriate specialists; more discrete and trackable data and improved risk-adjusted coding and appropriate charge capture, officials said.
Even better, "the depression risk screening rate at UCLA Health increased four-fold within one year, with more than 70 percent of adult patients screened for depression in the primary care setting and more than 90 percent rate of completion of additional follow-up diagnostic evaluation when patients presented positive depression risk," according to HIMSS. "Additionally, UCLA Health is anticipating to recuperate over $80,000 of revenue as a result of the project implementation."
THE LARGER TREND
The HIMSS Davies Award of Excellence recognizes high-achieving health organizations that harness health information and technology to boost patient outcomes and value. Other winners this past year include Hospital for Special Surgery, California Correctional Health Care Services, Banner Health, Open Door Family Medical Centers, TriHealth and Mercy Health.
ON THE RECORD
"Behavioral health is a critical component for risk-adjusting patients to ensure they are receiving the proper level of care," said Jonathan French, senior director of quality and patient safety initiatives at HIMSS. "UCLA Health has leveraged technology to ensure that its providers are receiving a clearer picture of their patient's mental health, which allows them to intervene more effectively and improve the overall health of their patients. For this, HIMSS is proud to recognize UCLA Health as a Davies Enterprise Award recipient."
"Because UCLA Health continuously seeks to optimize patient care using health information technology, the HIMSS Nicholas E. Davies Award of Excellence provided us an opportunity to recognize and highlight some of our recent successes," said Kevin Baldwin, informatics portfolio manager, UCLA Health. "We're thankful for the experience and look forward to continue applying health information technology to enhance our health care system."