Interoperability in Healthcare: A Patient-First Framework

The healthcare industry has long pursued an interconnected health information ecosystems that give patients and providers a way to access and use electronic health data across providers, payers and platforms.

Ideally, patients could instantly access a 360-degree view of their health while doctors and other health providers would have immediate access to all of a patient's records regardless of who they last saw, at what facility and under what insurance.

Unfortunately, many healthcare payers are still apprehensive about interoperability and its impacts on the industry. For that reason, we’ve put together some handy information that provides more clarity around the concept of healthcare interoperability, its importance in healthcare best practices and how interoperability will work. In addition, we go into more detail about different resources that help organizations take interoperability from a vague idea to a firm reality.

What is Healthcare Interoperability?

Interoperability is more of a concept than a tangible thing. In an interoperable framework, applications, systems, and devices are coordinated to provide standardized methods of accessing, exchanging, and using data. This framework can be implemented across all healthcare platforms to create a global environment where all healthcare payers and providers have a shared understanding of data elements and their definitions. This information would then be shared and accessible to both patients and providers and would facilitate more comprehensive and thorough patient care.

In addition, healthcare interoperability allows the patient to have a voice in their care. For example, Health Information Exchanges (HIE) enable healthcare professionals to provide patients with direct feedback and cost information about their recent treatments. Patients are then able to make transparent, informed decisions about their care.

One group that also benefits from interoperability is healthcare customer service representatives. Working with applications and systems that integrate with HIEs allow customer service representatives to be more productive and work through consumer issues faster, because they have a full view of the customer experience.

Why is Interoperability Important to Healthcare Payers?

Improved interoperability in healthcare helps payer organizations gain a 360-degree view of patient care. First, they’re able to look at how individuals involved with a patient’s care access the patient’s information. From there, they can build better care models that drive improved adoption of best practices and a better overall experience.

When healthcare payers and providers have issues with a patient’s health data, they are often the ones who deal with the consequences, including:

  • Failing to get health claims paid promptly
  • Poorer health outcomes because of a lack of information coordination
  • Higher costs for healthcare payers

Having timely access to health data through an interoperability resource offers benefits like:

  • Improved patient care coordination — Healthcare payers can quickly and securely review data from all providers involved in a patient’s care. Having secure interoperability in place could reduce the need for conducting unnecessary tests, increasing the quality of care provided to patients and reduce the number of visits required to adequately treat a patient.
  • Reduced administrative overhead — Healthcare interoperability helps payers cut down on administrative overhead that can delay reimbursement for patient services. For example, instead of waiting days or weeks for proof of authorization, payers could access the patient’s history in an HIE and review it for themselves.
  • Fewer data disconnects — Instead of accessing information in disparate systems, healthcare payers could get a holistic, consistent view of a patient’s health records within the recognized interoperability resource.
  • Seamless payer information exchanges — A healthcare payer could quickly compare notes and payment histories with other payers when a patient switches plans.

In addition to HIEs, other resources that make healthcare interoperability possible include Fast Healthcare Interoperability Resources (FHIR) and Blockchain technology.

How FHIR ties into Interoperability

Think about the haphazard collection of systems and applications relied upon by some of the largest healthcare payer organizations. Trying to move information through that maze can feel like trying to make your way through a labyrinth of poorly stacked packing crates. One ill-timed movement can bring the whole thing down on your head.

Many healthcare payer organizations have moved toward digitizing healthcare records to avoid that fear of imminent disaster. That way, they can more easily exchange information with other healthcare entities within the industry. In addition, a standardized electronic format makes it easier to pass data over a trusted digital platform.

The FHIR framework systematically standardizes how healthcare payers collect, format, and organize patient data. Once it is in an easily understood format, they can integrate the information into other organizational platforms. That way, organizations can have all administrative, clinical, research, and payer information accessible from one place.

Resources represent the essential components of an FHIR, things like patients, provider, and procedures. They contain the most exchangeable data, including elements that most FHIR implementors have in common. That way, you have the most common information points with the least redundancies. Essentially, resources allow healthcare payers to speak in a common language when connecting on and sharing healthcare data.

Understanding HIE and Interoperability

Health Information Exchange is a specialized network that rely on interoperability systems to share electronic health information securely and seamlessly. Everyone from doctors to pharmacists can quickly share essential health information, improving the quality and safety of patient care. An HIE makes it possible to form a more complete picture of a patient’s health history.

There are three different forms of HIE currently in place:

  • Directed Exchange — Lets healthcare payers securely send and receive electronic health data from other sources.
  • Query-based Exchange — Lets healthcare providers search for information about patients from other providers.
  • Consumer Mediated Exchange — Lets patients create aggregated sources for health information, controlling how it gets used by providers.

HIEs help facilitate healthcare interoperability in many ways, including:

  • Providing faster access to clinical results and medical histories
  • Facilitating the exchange of uniform data between different healthcare entities
  • Giving providers the ability to review a patient’s pharmaceutical history before writing out a new prescription

How Blockchain relates to Interoperability

Most people automatically think of cryptocurrency when they see the term blockchain. The technology is simply a distributed database capable of recording and storing transactional data in time-stamped blocks that link together. That way, no one else can make alterations to the information within.

Blockchain plays a vital role in healthcare interoperability by preventing anyone from tampering with patient health data. It relies on public key cryptography to create time-stamped, immutable records. Because changing each node in a blockchain record is nearly impossible, it’s one of the most reliable ways of housing data.

With the growing use of interconnected devices within the healthcare industry, organizations must do everything possible to ensure the security of patient data. The smart contract feature of blockchain technology makes it possible for healthcare payers and providers to provide selective access to health and payment information.

Moving toward Healthcare Interoperability

Better integration of health information systems would make it easier for:

  • Health plans to understand utilization rates and the demand around services
  • Government service providers to access population data to detect trends and help citizens
  • Life science organizations to leverage robust datasets to drive quicker, more informed research projects

The Centers for Medicaid and Medicare Services (CMS) issued a ruling in 2020 requiring healthcare providers and health insurance entities to make it easier to quickly access patient information. For that reason, health plans should identify ways of incorporating HIEs, FHIR, and blockchain into their current data processes.

At Data Ideology, we have tremendous experience working with Healthcare Payers. Our expertise and proven framework have helped these organizations establish secure interoperability capabilities in an accelerated manner. This has allowed stakeholders to fully realize insights associated with their patient’s data while also improving HEDIS and Star ratings. Schedule a quick discovery call and let us start helping you close the gap on quality and patient care.

Written by Toby George

Co-Founder & Chief Executive Officer at Data Ideology

Toby George is the CEO and Co-Founder of Data Ideology with over 16 years of experience in developing and executing data management strategies, Business Intelligence methodologies, and complex analytic solutions.


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