Creating an interoperable health IT ecosystem is the key to unlocking the future of health and healthcare. By actively working with the industry, governments are helping to advance connectivity and interoperability of health IT—in the U.S., the Office of the National Coordinator for Health IT (ONC) is responsible for key interoperability initiatives and also international efforts. Through a collaborative approach, we continue to make strides to achieve the vision of a global health ecosystem where health information is accessible when, where, and how it is needed, yet untapped opportunities still exist.
We asked industry thought leaders to share perspectives on what is still needed, major challenges ahead of us and recommendations for spearheading collaboration and continued progress to achieve this shared vision.
The next step is deciding to invest in that ecosystem to confidently convey how that investment will benefit our organizations and the broader good. We’ve poured billions of dollars into interoperability over a decade or more. We’re not lacking technology. The latest rounds of regulatory activity are continuing to spur progress but will not get us all the way there. Private organizations have to commit to move forward in their unique capacities—that’s table stakes. And we have to agree on standards-based approaches that unite our efforts.
The vision is and always has been a moonshot. And a darn worthy moonshot! There’s an extraordinary level of complexity, collaboration and orchestration necessary to make it happen. We need partners to break down that complexity, facilitate collaboration and orchestrate all the partners that will make the moonshot a reality. As part of that collaboration we need to align as an industry on nearer-term, measurable wins that keep us on pace and motivated toward that extraordinary vision.
We can never forget about the patients at the center and why we’re all here doing this work that very may well outlive our careers. Removing unnecessarily complexity from the healthcare system will give patients their lives back, whether they’re’ minimizing time on phone calls getting access to a specialty drug or living longer because the proper treatment was made accessible and affordable. And all of this hits our most vulnerable populations the hardest.
It can be done with focused effort, a bias toward urgency, and the ability to trust and rely on each other. And we can do it while there are massive crises taking place in the world. The industry has achieved many collective wins in interoperability over several decades’ time and we’re just accelerating. We’ve already fundamentally changed how data is used as a part of improving patient safety, quality and cost of care, and I have zero doubts we’ll continue to reinvent this many times over in the next decade.
To move toward a more universal healthcare ecosystem, post-acute and out-of-hospital care must be included to a greater extent in interoperability and policy discussions. Post-acute care was thrust into the spotlight as coronavirus overwhelmed hospital capacities and accelerated the aging-in-place trend. Demand for post-acute care will only continue to grow as the senior population doubles in the next 20 years and overburdens an already understaffed post-acute care industry. With these changes approaching, it’s critical that post-acute care providers are able to connect their systems with providers in other care settings in as close to real time as possible to help maximize limited resources and ensure high-quality care. To accomplish this, interoperability policies, standards and workflow implementations must take into account the unique needs of these care settings. More care in the home and lower acuity settings are our future, but that care must be connected care.
When the U.S.’s interoperability roadmap was being planned, conceived and codified, the focus was on acute and ambulatory care while post-acute care (PAC) and its unique requirements were put on the backburner. Without proper funding and supporting legislation, PAC organizations were left to fend for themselves and consequently, many were ill-prepared for the digital era. This also perpetuated a lack of understanding about PAC providers’ unique interoperability needs and is reflected in the challenges pressing the industry today. As our nation begins shifting more care to the home and lower acuity settings, these settings must be connected to enable visibility into new care pathways. To achieve full interoperability, the industry must shift its focus toward bridging the gap between traditional care settings and post-acute, becoming more patient-centric in how we address the unique needs of this segment.
To put it simply, skate where the puck is going. Care is increasingly shifting toward the home, so naturally it will make sense to prioritize driving interoperability and collaborations between provider organizations and technology vendors that can serve those points of care. Serving those points of care will mean advancing technologies that were proven so valuable during the pandemic, such as telehealth, remote monitoring and interoperability based on modern standards, which will all serve to create a more connected, global healthcare ecosystem. Additionally, the pandemic showed these newer technologies are much easier to implement at scale—even with IT challenges stemming from working from home or dedicating time toward pandemic-response systems. Wide-spread technology use across the continuum will allow all provider organizations to move forward in scale and the industry to move forward as a whole.
Over the past several years, we as an industry have invested tremendously in advancing standards to connect care across all settings and adapting standards for the needs of post-acute providers. We’re seeing many winners come from the ONC’s information-blocking and interoperability rules, and will utilize that momentum. We’ve seen that modern standards and incentives to adopt interoperability matter, but also that interoperability is much more than just standards. It’s about patient identity, privacy and security policies, network effects and all the elements that make interoperability more complex in healthcare than anywhere else. The healthcare world has recognized this and embraced networks to successfully implement patient-centric interoperability at scale. It’s why we’ve seen initiatives like CommonWell and Carequality take off and successfully address healthcare’s scalability challenges. We’ll continue seeing success with collaborations and initiatives that adopt patient-first criteria and continue pushing toward a global, connected healthcare ecosystem.
The healthcare ecosystem is complex; a constant flux of stakeholder relationships, sector turbulence with a traditionally systems-based vendor approach.
If we look at other modern ecosystems, however, we can identify success factors. Key to these is the need to create value for the customers and the end-users driving the ecosystem. These ecosystems view technology as an enabler rather than only the starting point, and combine people and process innovation.
Industry participants that are able to act with agility, embrace open standards, and be truly collaborative, will be key to enabling interoperability. After all, the complex challenges of healthcare and ecosystem change cannot be not driven or owned by any one single player.
If we take these success factors into account, the healthcare industry will, therefore, need to move away from a single system approach and, instead, adopt a patient- and end-user-centric co-creation and innovation-based ecosystem approach.
Healthcare is a highly scattered and siloed domain. This is visible in many ways. The adoption of open interoperability standards is currently still nascent and limited. At a national level, and sometimes even at a regional level, interoperability standards and infrastructure are missing or, alternatively investments are made in multiple infrastructures in a single country and are not able to be integrated. At the same time, many vendors are still aiming to claim substantial parts of the domain.
It is crucial that the industry embraces a true ecosystem approach. Rather than trying to dominate a system, it should focus on working together with governments and peers to create a pre-competitive foundation that includes full support for interoperability standards, governance, and infrastructure. This will enable an ecosystem that empowers stakeholders to focus fully on creating solutions that deliver true customer and end-user value.
Firstly, all relevant stakeholders need to participate in a constructive and open manner. Secondly, collaboration should address the needs of each participant, enabled by a governance structure and plan as an early stage deliverable. Lastly, these initiatives need to combine with a practical approach to eliciting instant learnings and results.
Organizations including HIMSS, RSNA, HL7 and IHE are leading the way in driving such initiatives. Similar activity is also happening at a governmental level. Ensuring that all health and care partners—healthcare professionals, executives, senior governmental representatives, and industry vendors—are involved in building this new infrastructure is key. And, of course, we also need to reflect the patient voice. All too often patients, the social network and stakeholders in the wider social domain are forgotten. To create a fully interoperable ecosystems, we need to ensure that the needs of the end users are central.
We believe that interoperability is key to healthcare’s successful transformation to value-based care.
Over the last few years, it has become clear that interoperability cannot be approached as a solely technology challenge. Instead, it needs to be seen as an intrinsic capability in the healthcare ecosystem that allows healthcare professionals to work together by providing them with the right information, at the right time, in the right place, on the right device.
It has also become clear that this collaboration should be the driver of any interoperable solution.
The increasing complexity of solutions no longer allows for single vendor solutions based on proprietary standards. With open standards becoming more common, with standardization organizations and governments driving national initiatives, the move to an open standards-based approach will accelerate and result in new ways of working that will contribute to a healthcare system that delivers value in a sustainable way.
As we expand support for core interoperability APIs [application programming interfaces] like SMART on FHIR, we should keep our sights on improving the fundamentals:
“Full interoperability” is an open-ended challenge—it’s important to be specific about what we need and expect from our technology. One big-picture vision is the idea of a “learning health system,” where data collected in the course of everyday patient care can contribute to (and benefit from) the sum total of clinical knowledge. Within this vision, we need to get the technology fundamentals right (e.g., workflows for accessing and sharing data; standardization of diverse data; investments in consumer-mediated identity). Just as important, we need to establish the right social and incentive structures, so technology can be deployed in ways that support the public good while maintaining individual privacy and autonomy.
There’s a virtuous cycle between real-world projects that “get a job done” and standards development projects that improve consistency and scale through interoperability. In practice, this means being thoughtful and creative about how to leverage standards where we’ve got them; and when we hit a limitation, this means imagining what additional standards could help others facing the same challenges. Following these practices, even “proprietary” APIs can be developed with a standardization pathway in mind—e.g., built out in the open, with open source reference implementations and community feedback. Shepherding standards through community review and adoption can be slow work, but it’s extremely rewarding. Tools like chat.fhir.org, and events like the FHIR Connectathons and HL7 Working Group Meetings are a great way to reinforce and expand the worldwide community working on healthcare interop.
We’ve gained a tremendous amount from stable APIs, supportive regulations and open source infrastructure. FHIR R4 has become the stable base for national profiles like US Core, and international profiles like International Patient Summary. Regulations like ONC’s Cures Act Final Rule have provided a common target for EHR technology to turn on API access for patients, clinicians, researchers, and others, with a well-defined core data set and authorization workflow. Finally, the participants in the FHIR community have made a rich set of tools available under open source licenses, lowering the barriers to developing specifications, validating data, and hosting an API server.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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Updated September 9, 2021