What Role Will Compliance Play in Interoperability?
When it comes to data, the U.S. healthcare system is composed of many walled-off fiefdoms. Health plans, hospital systems, pharmaceutical companies and medical device manufacturers all possess their own sets of patient data and information.
Interoperability — or the ability of different information systems, devices and applications to access and transfer data — promises to ensure that each healthcare sector will lower its walls to exchange patient data and information. This freer flow of data will improve the quality and efficiency of care, and it will help patients make more informed decisions about their own care.
Within the past couple of years, the Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology have established a new set of interoperability standards and rules, including a requirement that payers must give their members access to their own data via application programming interfaces (APIs).
It’s part of a larger worldwide drive toward healthcare interoperability — whose global market value will grow from $4.17 billion in 2019 to an expected $7.96 billion by 2024, according to Frost & Sullivan.
In August 2019, Deloitte released a report that assessed interoperability approaches by health plans and systems, and whether they would simply meet the new compliance bar or aim to go beyond it. The survey of health plan and system leaders found that the new compliance standards for interoperability will be a useful baseline for health systems — but by no means the endpoint.
For these leaders, meeting the minimum compliance regulations and deadlines won’t be enough. Their organizations will need to realize the greater strategic value of interoperability to achieve a competitive edge with insights, affordability and consumer engagement.
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Making Accessing and Sharing Healthcare Data Easier
According to the Deloitte report, most health plan leaders (63 percent) and almost half of health system leaders (43 percent) plan to use the compliance requirements as part of their broader interoperability strategies. The majority of health plan leaders (60 percent) and health system leaders (55 percent) say they’re building their own API solutions or are doing so while working with vendors to build solutions.
The recent push for interoperability has been a long time coming, says David Chou, senior vice president and CIO of Harris Health System.
“The healthcare industry has been struggling for some time with interoperability, and we’re still battling the challenge of sharing information,” he says. “Without interoperability, it takes a lot longer and it’s a lot more expensive to provide patient care.”
The new federal guidelines will finally provide the much-needed mandate for all health systems to work together toward a common goal. “It’s not a technology problem; the technology is there,” Chou says. It’s about leveraging the technology — especially by the larger enterprise systems.
Compliance will affect health systems differently based on their size, Chou says. Unlike the larger systems, many of the medium and smaller ones don’t have the financial and talent resources to meet the guidelines themselves. So, they’ll rely more on third-party commercial vendors to create APIs that allow for the easier exchange of patient data and information.
And while the COVID-19 pandemic has pushed back the enforcement of many (but not all) of the interoperability standards, the health crisis also has shed light on the importance of seamless data sharing.
The pandemic “exposed a lot of inefficiencies” in the healthcare system, particularly around data sharing and access, CMS administrator Seema Verma said at an event in July, according to Fierce Healthcare. For instance, data access is vital for patients seeking care for COVID-19 and for contact tracers tracking the spread of the virus. The problem, however, is that the “data is often trapped in electronic silos,” said Verma.
Come the compliance deadline of Jan. 1, 2021, those silos will at last begin to break down.
