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Learning Centre: Ideas

Interoperability in a COVID World

More than a year into the COVID pandemic, we’ve learned a lot. But many of these lessons we learned a decade ago.

Interoperability of health data is now in the news, as more patients than ever navigate the healthcare system for COVID tests, and now for vaccines. People who never thought twice about their local health department, are now interacting with them for contact tracing or vaccination appointments.

Providers are confused, too, with a third of surveyed primary care doctors reporting that they have had no contact with their local health department about how or when their patients will be vaccinated.

This has exposed just how under-connected our healthcare system really is.

As people scramble for vaccines, they often must try several different sources. For someone in the Chicago area, they must consider several local pharmacy chains, 100+ local hospitals and an overlapping and confusing assortment of county and city health departments. 

Many are now asking:

  • Why must I provide the same information in these different systems — especially if I’m already a patient or customer?
  • If my primary care physician is in one health system, and my cardiologist is in another, but both are in the same county – why doesn’t the county already know about my eligibility conditions?
  • Why can’t I (or my elderly parent) simply receive an outreach call to schedule a vaccination appointment across all available places? 

Sidestepping competitive reasons, a lot of the problem lies in interoperability.

The technical know-how, but not the incentives

In a recent clip from NPR’s Morning Edition, host Noelle King discusses electronic health records with Dr. Bob Kocher, who worked on the original Affordable Care Act.

Kocher explained that at the time, his team worried about how disconnected EHRs could create exactly the problem we now face: healthcare systems that don’t talk to each other and, in the process, complicate patient care.

In the decade since, the 21st Century CURES Act establishes more aggressive interoperability goals, with new standards to improve patient’s access to their own records and increase transparency while protecting patient privacy and security.  The data targeted for increased sharing is pretty much the same, but the methods and formats are modernized to support on-demand APIs. 

Every day, IMT helps healthcare organizations comply with integration challenges above and beyond the evolving rules. HL7 transaction processing for Admit, Discharge and Transfer (ADT) events, and enabling APIs support IHE PIX/PDQ queries into enterprise patient index (EMPI) and client registries are a standard part of every implementation we do.  Beyond patient identification, we help customers integrate electronic orders and results for diagnostic testing by leveraging existing registration data in the EMPI, reducing the need for patients to provide the same information again and again.  

But the problem is that even when hospitals can better share their data, they often lack the incentives to do so beyond their walls. 

Outgoing ONC head Don Rucker agrees, noting in an interview with Healthcare Dive, “Because of the incentives we’ve had in the payment system to not share data, delivery systems are very inward facing. But from a consumer point of view, not having interoperability is a huge negative. Where consumers are in control, interoperability these days is pretty much a given — in banking, in airlines, in everything. But in healthcare it’s something that needs to be fought for.”

Do the benefits of interoperability provide enough incentives?

We know the benefits of sharing across organizations can be significant to patients, providers, and regional health authorities. Kocher notes that sharing is “critical for our national security and safety,” suggesting that if analysts had comprehensive access to shared data, they could track specific vaccines to learn:

  • How long each vaccine provides protection
  • How case rates correlate with vaccination rates
  • Adverse events incident rate
  • How distribution and outcomes vary among different populations

Many Health and Human Service departments have spent years tackling interoperability within their own departments. IMT works with state and provincial health departments to identify and classify social health needs and gaps in their populations. In one case, IMT Client:ID™ helps a state Health and Human Services Department identify residents that need health and social services, decreasing enrollment time by 50%.

The opportunity now lies to truly address interoperability across the broader healthcare delivery system.

The technology to streamline the COVID response

Last year, we asked many of our clients how they were using their existing IMT enterprise master patient index (EMPI) to assist with challenges brough about by COVID. Several indicated they could easily add additional source databases with COVID test data, and append results onto existing patient records. Others were exploring contact tracing uses, confident that the EMPI contained their patients’ most current contact information to ensure reliable outreach actions. And one province was using their registry to identify which providers worked at long-term care facilities so they could allocate sufficient PPE. (See other ways our clients are using their EMPIs to drive transformation beyond COVID.)

While many healthcare organizations realize that their single EHR strategies don’t foster the interoperability they need to pivot in a crisis, the EMPI can help overcome those issues.

And as we look forward to transitioning out of crisis mode, let’s hope that we can use these lessons to inspire the change that will empower true interoperability that improves population health outcomes.