Healthcare Technology Featured Article

October 18, 2017

Interoperability and Standards Will Be Areas of Focus Through Year End

While there are many uncertainties in health care, interoperability and standards will undoubtedly be areas of focus through the end of the year. Everyone wants and needs health information technology (health IT) to be, well, more interoperable and useful. To that end, work will continue on refining existing standards to address interoperability challenges. That work includes federal policies and ongoing efforts by standards development organizations (SDOs) and electronic health record (EHR) vendors.

Federal policies. The Office of the National Coordinator for Health IT (ONC) will be active in this area. Although its fiscal year 2018 budget is likely to be considerably smaller than in previous years, the agency says it is committed to interoperability and standards as main areas of emphasis. As part of that commitment, ONC is putting the finishing touches on its Proposed Interoperability Standards Measurement Framework, the final document for which will be issued this fall. Results will inform the agency’s Interoperability Standards Advisory  and updates to its Health IT Certification Program.

The newly created Health Information Technology Advisory Committee will also be influential with regard to standards and interoperability. This committee will soon convene for the first time and it’s pretty much a given that its recommendations to ONC will be translated into rule making and policy.

Industry Progress. The next few months also should see continued progress by SDOs in refining standards for interoperability with a focus on practical use cases by vendors.

One example is FHIR (Fast Health Interoperability Resources), which is one of the newest standards from Health Level 7 (HL7). Vendors are beginning to embrace the most recent iteration of the standard for various clinical use cases and FHIR is being used to extract relevant clinical data from EHRs. The goal is to facilitate data sharing among physicians, hospitals and payers, which in turn will improve patient care, enhance public health and hold down costs. 

Also, the National Council for Prescription Drug Programs (NCPDP) is refining the SCRIPT standard to facilitate the transition to electronic prescribing of specialty medications. Today, specialty prescribing is largely a manual process, which isn’t easily adapted to existing electronic prescribing workflows. An NCPDP task group is looking at ways in which new data elements could be added to the SCRIPT standard to handle enrollment for specialty medications, which accompanies the prior authorization that is required for nearly all such medications. The goal is to enable enrollment and electronic prior authorization (ePA) for specialty medications. Changes to the standard will enhance the ePA functionality, which EHR vendors have already built for non-specialty medications.    

Challenges. There are still obstacles that must be overcome to move health IT interoperability down the field. Three come to mind:

  1. Lack of a national patient identifier. One of the biggest interoperability challenges is the lack of a national patient identifier. Currently, there is no single way to identify individual patients within and across the health care system. While industry solutions are being developed, they are one-offs that are not totally standards based. True interoperability cannot be achieved unless this problem is solved.   
  2. Business Models. A second significant challenge is the lack of focus on the business model underlying health care delivery. Interoperability is not so much a technology challenge as a business one. The competitive nature of the business of health care delivery is primarily what prohibits the exchange of clinical information — competitors don’t want to make it easy for patients to seek care outside of their networks. Making access to clinical data a cumbersome process is a compelling reason for patients to stay in network. It is a convenient red herring to point the finger at the “evil” EHR vendors for colluding to prevent systems from talking to one another, but the real issue is supply and demand. When there is demand among customers to connect systems, software vendors respond by building and selling connectivity solutions. The most successful of these solutions rely on standards that have been created and vetted through SDOs.  
  3. Variations in Standards Implementation. Other interoperability challenges are created by variations in how standards are used in application program interfaces (APIs) with EHRs. Sometimes these APIs rely on technology that is not standardized, thus adding to the complexity and inconsistency in how data are exchanged among EHR platforms. The goal of using standards to achieve interoperability can only be met when standards are interpreted, implemented and used consistently. The use of APIs is required under both the 21st Century Cures Act and the Medicare Access and CHIP Reauthorization Act (MACRA), which will accelerate the use of APIs and possibly exacerbate interoperability challenges. 

Edited by Mandi Nowitz
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