Lessons Learned: Interoperability & Data Sharing - The HSB Blog 7/27/22
Overview:
Since we have written approximately 75 Our Takes in the last two plus years we thought it might be helpful to take some of the summer to look at “Lessons Learned” from our posts. As such, this summer we will be looking at our lessons learned on the broad range of digital health on topics we’ve written about including Artificial Intelligence; RPM and Virtual Care; Value-Based Care, and Mental Health (among others). This week we look at healthcare data interoperability and exchange of electronic medical records with a focus on how new digital tools can change current practices, empowering patients and providers alike.
The Backdrop:
With increased utilization of digital and mobile health tools comes a deluge of data to collect and analyze. As digitization brings increases in the availability and applications of data many patients and providers alike are reporting increased support for such data sharing and demanding better interoperability measures that make their healthcare more efficient and effective. For example, a survey conducted by the Pew Charitable Trusts found that approximately 40% of survey participants reported COVID made them more likely to support data-sharing enabling efforts among healthcare providers and to allow the download of one’s electronic health records (EHR) to their mobile apps. Additionally, between the passage of the HITECH Act in 2009 and 2015, EHR adoption grew from 12% to 72% for hospitals and 22% to 54% for ambulances according to the Office of the National Coordinator for Health Information Technology as government incentives helped drive adoption. More medical data is being generated than ever and there is a need to modernize data processing and sharing to meet this growing demand.
However, the inefficiency due to a lack of data interoperability between medical organizations is adding significant additional costs that the industry must bear both financial and non-financial. In terms of financial costs, according to an “Administrative simplification: How to save a quarter-trillion dollars in US healthcare” by
McKinsey & Co it may be possible to save over $250 billion annually in healthcare spending by reducing and eliminating wasteful practices with over $100B of that coming from improvements in technology platforms like a centralized, automated claims clearinghouse for insurers. In terms of non-financial benefits, the COVID pandemic was one of the first widespread pushes toward interoperability and data sharing on a national scale and international scale for public health, highlighting the importance of open data standards in collecting and analyzing such a large volume of data rapidly. Panelists at the 2020 World Health Summit concluded that global collaboration and data interoperability has the potential to vastly improve responses to similar events in the future, and sharing health data is necessary to coordinate an effective counter to any public health emergency. However, in an increasingly digitized world, data, privacy, and security cannot be neglected and in fact, must be prioritized. Moreover, not only is it extremely important to preserve patients’ privacy, payers, providers, and others in the healthcare ecosystem must follow both the letter and spirit of the law if they are to maintain patients’ trust.
Lessons Learned:
What have been some of the “lessons learned” on contemporary issues surrounding health information exchange from our earlier Our Takes?
There continues to be a need for digital tools to be developed with an emphasis on interoperability for healthcare payers and providers to standardize practices given the flawed and disconnected nature of healthcare data and the inability to share data easily.
According to the Office of the National Coordinator for Health Information Technology (ONC), one of the core issues regarding interoperability is that interoperability is more than just implementing a standard or being able to have two systems exchange data with each other. Healthcare is plagued by the fact that there is no single system of record for interactions with the system and even no single way to identify patients (ex: a national patient identifier).
Often data can be lost between systems or very difficult to exchange between systems. For example, while claims data is predominantly financial, clinical systems have to deal with structured data (ex: coding for diagnosis and testing), unstructured data (ex: physician notes in free text fields), and fields involving different storage mediums and signal processing (ex: blood tests, EKGs, etc.).
There are now over 350K health-related mobile apps, with almost 90K created in 2020 alone, greatly expanding the amount and types of data available and further driving the need for data access and interoperability.
Promoting data interoperability has the potential to significantly reduce healthcare disparities and empower patients to take control of their own health data.
As noted at the Workgroup for Electronic Data Interchange event, studies have shown that minority patients routinely receive inferior care because they may be bouncing between hospitals and clinics and also have higher rates of chronic illnesses like diabetes and hypertension, which research indicates can be better addressed by digital technologies.
Having access to digital technology can empower consumers to make better-informed decisions about their health, provide new options for facilitating prevention, and manage chronic conditions outside of traditional healthcare settings.
A report by the U.S. Government Accountability Office and the National Academy of Medicine states that increasing high-quality data access and transparency can help developers eliminate bias in data by ensuring the data is representative at larger scales. Without such data access mechanisms, AI tools could be vulnerable to bias from skewed data, which can impact the manner by which decisions are made as well as the quality of these decisions. This would have negative consequences for health equity.
Does AI Always Optimize Healthcare? You Need Data Access, Education & Oversight -The HSB Blog 2/8/21
The creation of digital healthcare platforms to address data interoperability and increase operational efficiency can help healthcare providers exchange data seamlessly and lower costs moving forward.
As noted in a 2020 Forbes article healthcare data interoperability solutions can provide the foundation for additional healthcare applications and solutions to be built on. Given the lack of standardization in workflows and custom technology building platforms for software engineers will reduce the cost of custom solutions and support more healthcare innovation.
Opportunities for integrating platforms in healthcare, include improving the transferability of patient data to support care coordination, reducing the administrative costs associated with paying for care to reduce overbilling and improving cost accounting to support the transition from fee-for-service to value-based care.
It is estimated that $191 billion to $286 billion, or 5% to 8% of total US costs could be saved if interventions to reduce waste were implemented and were successful according to a recent study in Health Affairs,
Data security must remain a top priority as healthcare becomes increasingly digitized both for protection and to ensure access by appropriate parties. All parties need to ensure they have comprehensive policies, procedures, and audits in place to protect patient data, and comply with HIPAA both in terms of the rule of the law and its intent.
For example, research done by ONC on individuals’ perceptions of data privacy and security shows approximately two-thirds of respondents remain concerned about unauthorized viewing when data is shared by providers. This will become an even bigger concern as the volume of data grows. One study estimates the global healthcare data storage market is expected to grow at a compound annual growth rate of over 16% between 2019-2026 and will reach over $8B by 2026.
Although moving data to the cloud will help increase availability and decrease costs it could pose additional security risks. A 2016 article published by the Institute of Electrical and Electronics Engineers, found additional security and privacy issues when sensitive data belonging to enterprises and individuals are stored and used by services in the cloud. In addition, there are also significant security issues arising out of malware attacks in the cloud which have access to both data and services of many users and also the ability to propagate to many systems over the cloud infrastructure.
Many consumer-facing apps have found themselves in the news for exposing user information or undisclosed third-party data sharing, the dramatic increase in the use of mobile health apps during the pandemic has only heightened the security risks according to an article from Business Wire.
Eliminating Interoperability Hurdles in Digital Health Requires More Than FHIR-The HSB Blog 10/4/21Telehealth Could Magnify Inequity For Those Who Lack Access-The HSB Blog 2/16/21
Final Thoughts:
COVID dramatically accelerated the use and application of digital and mobile health and with the large volume of data generated and collected by medical providers, the problem of system interoperability and data sharing remains an issue. While recent regulations have put a focus on encouraging interoperability of data and electronic medical records, and the creation of new digital platforms has created ways to speed the development of such systems, healthcare data remains incredibly disconnected and siloed. Alongside this explosive growth in patient data that will increase our ability to improve care and forecast outcomes, comes concerns surrounding data security and privacy which will need to be prioritized. Improving data sharing and interoperability will allow digital and mobile health solutions to fulfill their potential to create new ecosystems that can improve operational efficiency, promote interconnectivity between providers and patients and help tackle historic health disparities. Moreover, this would give patients a greater say and the ability to get involved in and manage their own care which could have meaningful benefits in terms of costs and quality.
