Category: Thought Leadership
July 19 2017
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In the digital age of health care, interoperability is an expectation among organizations, clinicians and patients alike. While we’ve seen much progress in recent years through health information exchanges (HIE) and programs like meaningful use, health organizations still have a long climb ahead to reach the peak of interoperable functionality and efficiency.

In this blog, we examine three key areas the health care industry should focus on improving to achieve interoperability goals: patient-centered interoperability, interoperable daily operations and the potential for connectivity through the Internet of Things (IoT).  

1. Patient-centric interoperability 

With the industrywide shift toward value-based reimbursement models, health care organizations are being held more accountable for patient health outcomes than ever before. This doesn’t just apply to the acute setting – it also impacts how hospitals handle patient readmissions and managed care plans. 

To better manage patient outcomes, clinicians need to have as much information as possible about the patient. Interoperability plays a huge role in being able to aggregate patient data from both regional and national source systems. 

Part of the challenge organizations have faced in achieving interoperability is in stitching together the vast and disjointed patient data that exists in regional HIEs and independent, transactional databases like electronic health records (EHRs) into one health record for the patient. The goal should be to get health care to a place where the consumer and health care organizations can share information at will, with whomever they desire – and to do so in a secure manner and with an understanding of how that information is going to be used. 

CommonWell Health Alliance and Carequality’s recent milestone agreement puts patient-centric interoperability at the forefront of national-scale connectivity among EHRs. As CommonWell becomes an implementer of Carequality on behalf of its members, Carequality participants will be able to utilize a custom-tailored form of CommonWell’s Record Locator Service. This means that both services will have access to crucial data that tells a more complete story of a patient’s health. This is one example of how the industry is using interoperability to advance the standard of patient-centered care. 

The recent meaningful use phase 3 legislation dictates that all health care organizations must make health information available to patients via an application programming interface  from the organization’s EHR. This is a monumental step toward enabling the person to be empowered to drive   consumer-mediated or consumer-directed control of their medical record.  

Patient-centric interoperability leads to a better, complete clinical record that can be leveraged to ensure the right people have access to the right data at the right time. With this historical information, providers can make quicker and more informed decisions on the correct course of treatment for a patient. 

Organizations will need to pay close attention to this pattern and consider the opportunities to improve the care of the populations they serve. This will also bring new risks to the table around patient privacy concerns and consumer consent models as consumer application developers look to leverage protected health information data for new use cases. Much like we provide our location information to enable new conveniences, consumers will need to carefully consider how they share and provide access to their health data.    

2. Interoperable daily operations

Recent federal laws, like the 21st Century Cures Act (Cures), demonstrate how the government has made interoperability a priority for the health care industry. Cures targets and penalizes vendors and providers for “information blocking” of clinical data. It also seeks to improve interoperability efforts within health care organizations’ daily operations by providing significant support for a trusted, network-to-network exchange framework on a national scale. 

Enabling Interoperability more native to the workflow will be key for the industry to make this vision a reality. Interoperability must become more than having the right plumbing of systems in place – it needs to be integrated with the workflow to be assumed in all experiences. Caregivers need fast, easy and smart experiences that enable for clinicians to easily see outside data, reconcile it and contribute to the consumer’s longitudinal health record. 

This is part of a broader strategy to maximize the throughput for all involved stakeholders by optimizing the efficiencies and processes in the health care organization. For example, in the acute setting, there’s a need for organizations to provide scheduling services in an efficient and effective manner. When organizations have more insights and data available, they can better understand where a patient is in their health journey and can better facilitate not only the scheduling of people, but also the flow of tools, processes and events through the health care ecosystem. In turn, this should empower the patient to more effectively navigate through the operations of a health care facility, leading to an improved patient experience. 

3. IoT as a path to universal connectivity  

The health care industry has been laser-focused on EHR interoperability. This will empower  the person to move across the continuum of care seamlessly with their clinical record. The next frontier of medicine, which will include personalized medicine, will require higher fidelity data exchange and will be most powerful when harnessing a person’s longitudinal record in combination with the power of connected systems and the Internet of Things (IoT).  This will enable the smart exchange of data between care teams, the technologies they use each day to deliver care and their patients. The value and insights extracted from this flowing river of data will become more instrumental in the care process of today and tomorrow. 

For example, consider remote patient monitoring for chronic condition management powered by wearable or monitoring technology in your home or other venues of care that we’ve traditionally not had. These monitoring devices enable organizations to receive near real-time observations about a patient and their condition, rather than waiting for that person to come into a clinic. 

Not only can clinicians monitor the health of the individual, they can use analytics and intelligence to understand that patient’s trends and patterns, whether their condition is digressing or improving and if they are taking the necessary steps to manage their care. In this way, organizations can better facilitate the ongoing management of that patient’s health and intervene where necessary, and the patient can have a better support system and more information about their progress. 

How does this work in a real-world setting? Consider a person with diabete s who is prescribed real-time  glucose monitoring device and other wearable devices to track vitals and other critical health measurements. Say that over the course of a week, this person has logged some negative trends and there’s a digression occurring. By analyzing trends from multiple data sets (including device measurements), trends over time and more, we can intelligently predict a digression occurring, recommend dietary changes and perhaps even trigger a recommended order change to the person’s insulin to their care management team. At that time, the team could engage the patient to help them manage through the new insights and proactive care plan adjustments.  

In that example, remote patient monitoring comes down to the clinician’s ability to intervene and keep a negative pattern from being a critical event resulting in a trip to the emergency room. This has benefits not only from the perspective patient outcomes, but also from a cost standpoint. Both the patient and health plan are spared a potentially costly – and avoidable – expense. 

With this emerging trend in IoT taking health care by storm, a new generation of interoperability standards and governance frameworks will be needed. IoT is requiring EHR developers to learn how to incorporate the net-new types of data at volumes never seen before. From an end-user perspective, providers will need to exponentially grow and advance their perspectives of care delivery with the flood of new data due to monitoring of patient activity.

Cerner’s open platforms, open technology and culture of openness are driving collaborative efforts focused on advancing health care. Learn more here.

John Gresham,Vice President of DeviceWorks and Interoperability

John Gresham Vice President of DeviceWorks and Interoperability Cerner

@John_Gresham

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