If anything, the pandemic has emphasized the need for the seamless exchange of health records. Earlier this year, the Department of Health and Human Services passed sweeping rules to improve interoperability and give patients better access to their records. But what is the current state of interoperability in the U.S.?
Three experts will address this in a panel discussion at MedCity’s INVEST Precision Medicine conference, which is open to the public.
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There’s plenty of progress to be made. As of 2018, only half of hospitals were considered “interoperable,” meaning they could send, receive, find and integrate information outside of their health system.
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The new regulations, whose compliance dates have been pushed back due to the pandemic, are expected to help with this effort. They’re not only designed to improve the flow of information, but also make it easier for patients to access their health data.
“Covid and the shift to telehealth has reinforced the need for interoperability over all providers and sites of service,” Kevin Chaney, senior program manager for the Office of the National Coordinator for Health IT, wrote in an email.
For example, both patients and clinicians providing telehealth services should have access to information on pre-existing medications, allergies and problem lists. But that’s not always the case.
The pandemic has also highlighted holes in public health data, and challenges to sharing records in a swift and consistent manner. One potential remedy is the use of health information exchanges, which are designed to share near-real time information between clinicians and EHRs.
“Most parts of the country are served by state or regional HIEs and these HIEs have built out impressive well-connected networks,” Chaney wrote. “ONC is currently working on ways to get HIEs more involved with the national Covid response.”
Emphasis on applications
Another important component of the incoming rules is the emphasis on APIs, which would make it easier to exchange information with third-party apps. The idea is to foster the development of tools people can use to manage their health data, similar to tax preparation and finance apps that have cropped up in the last decade.
This idea has captured the attention of a multitude of stakeholders in healthcare, both with excitement for the possibility of patients being able to carry their health record, and privacy concerns that come with sharing it.
Redox Co-Founder and President Niko Skievaski, whose company maintains more than 1,000 integrations between software vendors and health systems, said his company had seen increased interest from EHR vendors and payers, now that they are required to supply APIs for the digital health community.
“I’m bullish on enabling patients to be the brokers of their own data,” he wrote in an email. “The newly mandated patient-authorized APIs have the potential to create a landscape of B2C healthcare applications that allow patients to draw down on and engage with their health data like never before. Some of these apps, inevitably, will enable patients to organize their health data and share it with their care teams and other applicable stakeholders as they wish.”
Before, it had been difficult and costly for third-party applications to access EHR data, making them less useful and separate from the health system, wrote Dr. Ida Sim, a professor of medicine at the University of California San Francisco. Now, she sees a huge opportunity for that to change. But for patients to adopt these applications, they will need to trust that their data will be shared appropriately, with transparency around how it is used.
She also cautioned against focusing exclusively on EHR data when there are other important sources, such as wearables, home monitors and patient-reported outcomes.
In UCSF’s work with the Commons Project, a nonprofit that is developing an Android equivalent to Apple Health, they partnered with local organizations to get feedback from patients of all demographics, including a safety net population at Zuckerberg General Hospital.
“An important innovation that hasn’t been sufficiently focused on yet is to increase digital literacy and accessibility for all populations — addressing language, numeracy, technological literacy, etc.,” she wrote. “We need a combination of training, education, support and technical innovations to make using tech and health records turnkey. We are very, very far from that.”