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Improving Patient Safety Through Healthcare Interoperability

Thursday, December 27, 2018   (0 Comments)
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December 27, 2018, ASCA News Digest 

EHR Intelligence, (12/17/2018) 


With healthcare organization leaders facing federal pressure to increase health data exchange, many stakeholders are focused on developing the business case for healthcare interoperability.

Achieving the level of connectivity described in the 21st Century Cures Act will require healthcare organizations and health information exchanges (HIEs) to make significant investments.

Experts anticipate participating in the Trusted Exchange Framework and Common Agreement (TEFCA) may be especially disruptive, requiring organizations to change their business processes and adhere to strict health data exchange standards to seamlessly share information as part of an industry-wide network-of-networks.

However, these investments will ultimately save healthcare organizations money, time, and effort in the long-run, according to Intermountain Healthcare CMIO Stan Huff, MD.

The business case for interoperability goes hand-in-hand with use cases for interoperability that will ultimately lead to improvements in opioid prescribing and patient safety, Huff told

“There are a large number of applications or clinical decision support that you can imagine could be applied to opioids,” said Huff. “Programs could help clinicians create the correct dose of the medication and choose the correct opioid for the task, or review the clinical situation to say whether an opioid was necessary, or whether you can get by with anti-inflammatory drugs or Tylenol.”

“The challenge we have is that all the systems are so different,” he continued. “To use those systems, developers would have to write a program for literally every enterprise or facility that was trying to implement that kind of knowledge. But interoperability would allow that to be scaled.”

If all healthcare organizations supported application programming interfaces (APIs) that leveraged Fast Healthcare Interoperability Resources (FHIR) to store and access data related to opioids, developers would only need to write clinical decision support programs once.

“The program could run anywhere that the system was compliant with FHIR standards,” said Huff.

“Becoming compliant with interoperability is a lot of work,” said Huff. “At the same time, that work is one hundredth or one thousandth of the work of recreating every clinical decision support program at every facility.”

According to Huff, the ability to scale solutions capable of achieving significant improvements in opioid prescribing and other areas will make upfront investments in interoperability well worth it.

“Interoperability makes it possible to scale share those kinds of programs as executable knowledge as opposed to a written protocol that somebody then has to implement and make into software and write a program for at every single facility that wants to do that,” he emphasized.

Ensuring healthcare organizations adhere to safe opioid prescribing practices is a top industry priority, and widespread interoperability could help providers across the industry exchange data related to opioid use and implement the same best practices through clinical decision support tools.

In the same way, achieving seamless interoperability may help healthcare organizations reduce instances of preventable medical errors.

“Best estimates right now are that somewhere around 250,000 people die each year across the country from preventable medical errors,” said Huff. “The magnitude of that is astounding because the number of people who die from auto accidents is 40,000, roughly, a year.”

“The only way we're going to fix that is to provide better tools, better information, better decision support for clinicians, and there's no way we can do that at scale unless we're interoperable,” maintained Huff.

Increasing the use of FHIR across the industry is key to enabling health IT innovation and allowing providers to leverage artificial intelligence (AI) and other burgeoning technologies for improved clinical decision-making.

Huff adamantly supports ONC’s efforts to promote the use of FHIR and other standards across the healthcare industry. However, he is concerned other strategies the federal agency plans to pursue may cause more harm than good.

“The thing that I worry about in the legislation is the information blocking,” said Huff. “There is no commonly held view of what information blocking is, so to me that will be a challenge to define. A lot of what I hear don’t meet what I view as information blocking.”

A clear definition of information blocking is slated for release soon. The rule will outline which activities by healthcare organizations, HIEs, and health IT developers do not constitute information blocking, and penalize organizations that engage in activities that do align with the practice.

In Huff’s view, requiring healthcare organizations to pay a fee to connect to different hospitals should not be considered information blocking.

“That's not information blocking, that's people saying, ‘this is the money that we need if we're going do the work to build the interface needed,’” said Huff. “The other thing you hear is that certain EHR vendors won’t connect to each other, like that Cerner doesn't want to hook up to Epic. I've never seen that. If companies are willing to provide the money that's needed—because enabling that connection is not an easy thing—then those EHR vendors will hook it up for them.”

“They just need the financial support that allows the work to be done,” Huff added.

Overall, Huff is concerned strict information blocking regulations could inhibit rather than enhance health data exchange.

“In some odd, perverse way, what people are actually worried about now is that if information blocking is defined in the wrong way, people may stop sharing data,” said Huff. “They don't want to be convicted of information blocking, and so they'll basically get out of the business.”

“They'll stop trying to share information for fear that they're gonna be convicted of a crime when they had no intent of harming patients or keeping information sequestered,” he added.

While information blocking regulations have the potential to cause problems for health IT developers and healthcare organizations, Huff believes TEFCA will have a positive effect on health data exchange if it is drafted in a way that promotes standardized implementation.

“I would like to see a version of TEFCA that is a pattern that everybody can adopt in terms of creating the legal and ethical basis for information sharing that truly makes information sharing secure,” said Huff. “It would be nice if there was a standard national policy for what you needed to do so that you could legally and ethically share data for the benefit of the patient.

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