Healthcare’s IT Priority: Interoperability Is the New Meaningful Use

When Andy Slavitt told conference attendees in January that the Centers for Medicare & Medicaid Services (CMS) was effectively ending meaningful use and shifting focus to interoperability, his talk was short on details. “The meaningful use program as it has existed, will … be effectively over and replaced with something better,” said the CMS acting administrator. “We are deadly serious about interoperability.”

The details followed in April when the U.S. Department of Health & Human Services (HHS) released the new proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), including a simpler version of the meaningful use program. The proposal describes interoperability as “a key priority for the healthcare industry” and puts companies that engage in data blocking on notice.

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From duplication to interoperability

The Office of the National Coordinator (ONC) defines interoperability as the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user. “Think of it as helping to make sure health information flows to where and when it is needed the most,” an ONC spokesman wrote in an email exchange with Cardiovascular Business. “Clinicians like cardiologists will be able to access a patient’s health information—from any number of other providers—at the time of care.”

That lofty goal is hardly the case now. It’s obvious to most any cardiologist how much time and money are wasted on the duplication of efforts because little data are easily transferrable between different electronic health record (EHR) systems, says Tyler Gluckman, MD, medical director for clinical transformation for the Oregon region of Providence Heart and Vascular Institute.

“We really need to demand as care providers the ability to transfer that data in a way that’s reliable, in a way that’s safe and protected and a way that’s oranges to oranges, apples to apples,” he says.

Interoperability is especially essential in cardiology because the specialty shares patients with other doctors, hospitals, pharmacies and many more providers, says Cathie Biga, MSN, president and chief executive of Cardiovascular Management of Illinois in Woodridge. Cardiologists don't want to order a new lipid panel every time they see a patient, she says, but the current system makes it easier to duplicate a test than to share results across platforms. “EHR interoperability is a hot issue for us,” Biga says.

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Interoperability in cardiology

“The ultimate vision is to have a system that’s patient focused, patient centered, and that the data would flow freely, yet be secure and private,” says Michael Mirro, MD, senior vice president at Parkview Health System in Fort Wayne, Ind. “I do think interoperability will make the workflow easier.”

That’s what the ONC thinks, too. “An interoperable healthcare system reduces the administrative burden to compile and combine records, reduces errors resulting from incomplete or inaccurate information, and allows for real time information to be shared among care teams in an accessible manner,” wrote the ONC spokesman. He said cardiology has already seen some success by expanding the use of interoperable health IT. The Million Hearts initiative, for instance, uses health IT to link clinical decision support to clinical quality measurement. “And the ability to review and analyze patient data electronically in real time,” he says, “has the potential to allow public health and population health registries focused on heart disease and hypertension to dramatically reduce the research, analysis, and innovation cycle for quality improvement and clinical practice improvement initiatives related to high priority health conditions.”

Obstacles & solutions

Yet there are obstacles on the path to increased interoperability. Privacy and security are particular areas of tension, says Mirro, who testified before the U.S. Senate Committee on Health, Education, Labor and Pensions on data blocking and interoperability. He prefers structured data—organized data that could easily be moved from one data field to the next. Entering structured data might appear to be more upfront work, but it would foster better interoperability in the long term.

Unstructured data can reduce efficiency, Mirro adds. For example, the PDF, which is basically a photograph, is not easily exchangeable. “People don’t realize that there are technologies out there that slow things down.”

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There are solutions, he says. One will be the adoption of unique patient identifiers, or numbers that are distinctive to each patient. Another is to insist that all vendors adhere to common data standards. (A common cardiovascular lexicon that’s used by all also would be helpful.) Continuing to promote health information exchanges and application programming interfaces to connect mobile app data to EHR systems is another step in the right direction.

Because the interoperability burden will fall primarily on vendors, they are working together on shareable solutions, despite the competitive environment, Mirro says. There’s enough pressure from inside the Beltway, and vendors don’t want the federal government imposing solutions on them. “The large vendors definitely are working together better than they ever have been to bring this to reality,” he adds

In the meantime, individual cardiologists and practices can move toward interoperability, Gluckman says. They can, for example, advocate for greater work by their professional medical societies to define the discrete data elements that should be captured by EHR systems. And because even large vendors need to be accountable to their customers, Gluckman recommends advocating to them as well.

The path to interoperability can start at your own office. Much of Gluckman’s work at Providence Health has been to standardize workflows. “I can’t tell you the number of practices where they may have purchased an EHR system—it doesn’t matter who the vendor is—but you have seven, 10, 14 different workflows,” he says. “As large as interoperability sounds on a grand scale … I would say there’s a lot of cleanup that occurs at home that is still required today.”