During the first day of the HIMSS18 conference in Las Vegas, national HIT leaders discussed the current drivers advancing interoperability in healthcare, and debated whether a great leap forward, or incremental steps, represents the best way forward.
Opening the HIMSS (Healthcare Information and Management Systems Society)/SHIEC (Strategic Health Information Exchange Collaborative) Interoperability and HIE Symposium on Monday morning was Micky Tripathi, Ph.D., president and CEO of the Massachusetts eHealth Collaborative, who also is a project lead of the HL7 Argonaut Project and on the board of directors of The Sequoia Project, an organization working to advance interoperable nationwide health information exchange. Joining Tripathi was Ruben Amarasingham, M.D., president and CEO of Pieces Technologies Inc., a clinical artificial intelligence company.
During the morning keynote panel discussion, which was moderated by Jess Kahn with McKinsey and Company, Tripathi and Amarasingham discussed what the end goals for interoperability should be, as well as the business drivers and current efforts to advance progress on interoperability.
Conversely, during the closing keynote session for the HIMSS/SHIEC interoperability and HIE symposium, Aneesh Chopra, president of CareJourney, (formerly NavHealth), an analytics company, and Christopher Ross, Mayo Clinic’s CIO, had a lively debate about the best way to advance sustained interoperability—a great leap forward or incrementalism.
To kick off the morning session, Kahn noted that interoperable health records are still not one of the basic tools of healthcare and asked the panelists what they saw as the ultimate goal for interoperability.
Tripathi noted that until about five years ago, there was not widespread use of electronic health records (EHRs) in the healthcare industry. “It wasn’t until 2013 that we had about 50 percent of providers, hospitals and eligible professionals using EHRs. You can’t have real interoperability until most people have the ability to electronically document and exchange with each other. We started at a very low level, so we’re doing pretty well compared to other industries. Our end goal? We will never really have an end state; it will never be, ‘We got interoperability and its done.’ We’re always going to be moving the goal line,” he said.
He continued, saying he asked a friend who is a physician, “If we had a nationwide system where most providers, 80 percent of providers, had the ability to securely send any EHR (electronic health record) to most other providers and had the ability to securely request and retrieve a medical record, would you consider that nationwide interoperability? She said yes,” he said. “In the next two to three years, because of efforts by CareQuality, we are going to be roughly there.”
He added, “I’m not saying it will solve every use case; it’s important to have realistic expectations. There are significant weight points along the way, and the first one is just here on the horizon through current efforts.”
Amarasingham says he sees the healthcare industry moving toward a more consumer-centric version of interoperability with the end goal of giving patients and end users control of the data. However, he noted that the next stage would be semantic interoperability. He also said he was excited by the entrance of Apple and other consumer-based companies into healthcare, and the potential for these companies to adopt the FHIR (Fast Healthcare Interoperability Resource)-based standard.
“I think one of the challenges for consumers has been, it’s difficult to get their records and incredibly difficult to store it and interpret it; they don’t have the semantic part. If you have 20 million phones that people can say, ‘I want my EHR,’ then press a button and get it, then there is a technological way to keep the data, and then you can have AI (artificial intelligence) systems running on the phones to interpret the data for them. That’s a total change in the power of consumers. That is creating a frictionless environment,” he said.
And, he added, “I predict it to be a milestone event. Soon mobile devices can request electronic medical records.”
Discussing the business drivers, Tripathi says value-based purchasing, in the near term, presented the best use case for interoperability as it relates to sustainability and value. “We’ve seen in just the customer base we have, organizations turn on a dime as soon as they sign an ACO (accountable care organization) contract. We get phone calls from newly launched ACOs, they want to build a ADT (admit, discharge and transfer) event notification service, they are motivated by value-based purchasing.”
Amarasingham agreed, noting that value-based contracts, which have a significant emphasis on care coordination, are one of the most manifest use cases for interoperability. “I’m encouraged by the continued movement in the government to focus on things like accountable health communities and it’s being recognized that health is not just a product of clinical care. That’s going to be significant for interoperability.”
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