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Healthcare Interoperability Woes: Three Solutions that Create Optimism

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Let’s face it: healthcare interoperability remains an intractable problem, and discussion about it continues without signs of settling down. Both healthcare providers and patients feel unease about limited access to medical data, which results in lower care quality and poor patient engagement.

But what are the major constraints on a highly interoperable healthcare environment? Firstly, it’s the lack of a national patient identifier (NPID), an alphanumeric code used to uniquely recognize patients within a health register or an EHR system. Revoked by US Congress due to privacy issues, the NPID might have given a significant leg-up to trouble-free data sharing.

Another stumbling block is the competitive nature of EHR solutions providers. They tend to implement proprietary technologies and inconsistent interoperability standards, which means a poor data flow and a huge demand for advanced connectivity solutions that present additional revenue opportunities to vendors — at the cost of hampering interoperability.

Although daunting, these challenges aren’t insurmountable. In this feature, we’ll explore what has been and what could be done to foster the creation of an interoperable infrastructure.

Open APIs as a long-sought answer

A number of healthcare institutions, including the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) tout open application programming interfaces (APIs) as a solution to the interoperability challenge. And for good reason.

To start with, an API represents a set of programming instructions and standards that enable communication between multiple sources, namely software applications. In other words, when an EHR system has an open API, a slew of properly authorized third-party applications — such as population health management (PHM) software, mHealth apps, or medical portals — can exchange protected health information (PHI) with it.


Source: commonwealthfund.org

To enable API implementation, there’s a need for unified healthcare data standards — and that is what the HL7 organization is actively working on. In 2014, they released the Fast Healthcare Interoperability Resources (FHIR) standard that leverages CDA, HL7 v3, HL7 v2, and other latest web standards to make medical software systems communicate with each other in a compatible manner.

Apple capitalizes on FHIR to unlock health data for a myriad of possibilities. Their mHealth app integrates with a growing number of US healthcare providers, allowing users to access a wide range of medical records, not just lab results or appointment requests that are usually available through patient portals.

“By empowering customers to see their overall health, we hope to help consumers better understand their health and help them lead healthier lives,” said Jeff Williams, Product Operation Manager at Apple, in a press release.

Another organization that favors open APIs is the US Department of Veterans Affairs. Earlier this year, they announced the launch of their Lighthouse Lab platform that uses FHIR API to aggregate data from an array of sources — including user devices — and put it to good use for better care quality.

The value of cloud-based EHRs

Putting it simply, cloud computing means storing and accessing data and programs over the internet instead of a computer’s hard drive. According to BCC Research, healthcare is already warming up to the benefits of cloud technologies. To wit, in 2017, the worldwide healthcare cloud computing market reached $20.2 billion, and this number is projected to increase almost twofold in 2022. This is no surprise considering the fresh opportunities the cloud offers, with interoperability being the major one.

In a nutshell, the cloud is internet-based and uses standard protocols, which enables straightforward connection among different systems and applications, as well as smooth and secure information sharing. Allowing healthcare providers to connect to IoT and mobile devices at anytime from anywhere, cloud-based EHRs also foster innovation in remote care.

One more area where cloud-empowered EHR systems excel is PHM. Coupled with advanced analytics systems, they leverage various data sources, analyze large data sets, and generate rich insights into population health. This lets clinicians geospatially map diseases, predict epidemic outbreaks, and take preventive measures.

Among the healthcare organizations that have already shifted to off-premise EHR software is Steward Health Care. The hospital operator partnered with Meditech to better coordinate care across ten US states. Apart from ensuring a more integrated care delivery, the cloud gives the provider other benefits.

“It’s exciting to be deploying solutions built for the web to aid in improving quality and population health, while continuing to drive costs down,” explained Julie Berry, Steward Health Care’s CIO  in a press release

The untapped potential of blockchain

To begin with, a blockchain is a decentralized technology that facilitates secure information storing and transferring. Although the healthcare blockchain is still in diapers, it could contribute to the creation of a single source of truth for PHI and give patients more control over their data.

First, blockchain could become a foundation for creating the NPID. As Christian Catalini, Career Development Professor at MIT, puts it: “Blockchain’s use of public-key infrastructure (PKI) provides a centralized identification method — an individual’s public key — that can be used to link that patient’s records across institutions.” This way, patients would be able to retrieve their medical information and enrich EHRs with patient-generated health data (PGHD).

Also, blockchain allows implementing immutable logs and assigning digital access rules, which prevents incorrect modifications and enables data integrity and liquidity

Another useful feature of blockchain is its provenance. By providing properly authorized parties with a detailed history of digital interactions through time and offering audit trails (in case of malicious actors), blockchain-based solutions can significantly minimize the risk of data loss.

Summing up, by facilitating digital information exchange without intermediaries and giving patients greater control over their health information, blockchain is seen as a workable solution for both hospital- and patient-driven interoperability.

Taking stock of proposed solutions

Of course, there’s no quick fix to healthcare interoperability, and the steps we’ve outlined are no full guarantee. However, they might open the door to a smooth health data exchange, in turn, streamlining the transition from volume- to value-based care. And this means improved efficiency, greater collaboration with patients, and more reasonable treatment plans.

About the author:

Yana Yelina is a Tech Journalist at Oxagile, a custom healthcare software development company based in New York. Her articles have been featured on Becker’s Hospital Review, Medical News, Klass Research Blog, Health IT Outcomes, Healthcare Works Collective, HITECH Answers, Medgadget, to name a few. You can reach Yana at yana.yelina@oxagile.com or connect via LinkedIn or Twitter.