On Aug. 14, an array of stakeholders told a Health IT Policy Committee task force that an overly broad approach focused on the concept of interoperability as a common good is less likely to succeed than one targeting specific use cases where financial incentives are aligned.
Tim Pletcher, executive director of Michigan Health Information Network Shared Services, said that his organization has succeeded by concretely aligning projects with financial incentives. “For each use case, we identify the policy and financial carrot or stick that goes along with implementing it. If we are unable to pay or punish people, it goes to a lower level in the priority queue.”
The Clinical, Technical, Organizational and Financial Barriers to Interoperability Task Force asked Pletcher and other executives to address financial and business barriers to interoperability that exist in the ecosystem.
Pletcher spoke about his efforts to have hospitals share admission, discharge, and transfer (ADT) system messages with physicians through the HIE. When he approached CIOs directly, he initially had little success. So he asked Blue Cross to make the ADT feeds 10 points of a 100-point scale in its hospital performance ranking, and the insurer agreed to do so.
“Within 18 months, I had 93 percent of the hospitals onboard,” Pletcher said. “Hospital CIOs who had said it would be a cold day were now begging for slots. The only way to get prioritization is to say here is what we are going to pay for or what you will be punished for.” He said they use technology standards underneath the hood to get providers comfortable with data sharing. “That breaks down the barriers,” he said, “and we can then layer one use cases on top of the next.”
In contrast, Pletcher said, his HIE organization has had difficulty getting physicians to query for information about a patient in a CCD. “We can’t get people to pursue that because we don’t have an incentive that lines up well,” he said. “We focus on use cases where they are getting alignment and financial support and they are technically feasible. Those are the home runs. We have to find all three components to get it to advance. We can’t just ask them to do something because interoperability is good. The ocean is so big, we have to be more specific.”
John Blair III, M.D., CEO of MedAllies, which facilitates provider adoption of health IT, described the work his organization has done to connect practices using the Direct protocol. “We are running a national network, bringing on 100 provider organizations a week. MedAllies has connected more than 3,500 ambulatory groups, 300 hospitals, and close to 60,000 providers.
Like Pletcher, he stressed that the uptake has followed from a use case. The business model is driven by the patient centered medical home and advanced primary care networks. “We have incorporated Direct to meet transition-of-care needs,” Blair said. “When it become clinically relevant, adoption becomes a non-issue. It needs to be driven by clinical interest, and there need to be financial incentives to make it work. Ultimately it is driven by a reimbursement model that rewards coordination of care.”
Jitin Asnaani, executive director of the CommonWell Health Alliance, said progress is being made on interoperability and regulators should let innovation thrive in the marketplace. No preconceived or predetermined set of strategies is going to succeed, he said. But Asnaani added that ONC and HHS should provide strong and focused guideposts for behavior. “Make data exchange a part of participation in federal programs, and treat data blocking harshly.” Vendors exploiting points of friction in the ecosystem is unethical.
He said as he is seeking to get vendors to join CommonWell, he sometimes hears reasons that give him pause for concern. He recently spoke with three vendors who indicated that this doesn’t line up with their business model because it intermediates a major source of income — the interfaces. “They said it is not something we want to get into until we have no choice.”