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Health interoperability with purpose: TEFCA’s impact & (maybe) the beginning of the end of impersonal care

Recently, the ONC revealed its most ambitious healthcare interoperability effort to date with the Trusted Exchange Framework and Common Agreement (TEFCA). It outlines a common set of principles, terms, and conditions to support the overarching goal of establishing a universal floor for health data interoperability across the country.

The first real strides toward healthcare digital transformation in the United States occurred back in 2009 with the Meaningful Use provisions included in the Health Information Technology for Economic and Clinical Health (HITECH) Act. This initiative motivated more than 96% of U.S. hospitals to digitize health data using certified electronic health record (EHR) technology, but it fell short of creating an environment where health data could be freely and securely shared among providers throughout the country. The reason? While health data was now available digitally, it was still siloed in proprietary formats that made interoperability and integration overly complicated and expensive. 

Fast forward more than a decade, and the U.S. still faces the same predicament when it comes to health data interoperability. The Office of the National Coordinator (ONC) has long realized that a shift in focus is required from health data “digitization” to “interoperability.” So much so, that it changed the name of “Meaningful Use” to “Promoting Interoperability” in 2018. Recently, the ONC revealed its most ambitious healthcare interoperability effort to date with the Trusted Exchange Framework and Common Agreement (TEFCA). TECFA outlines a common set of principles, terms, and conditions to support the overarching goal of establishing a universal floor for health data interoperability across the country.

TECFA couldn’t come at a more opportune time for healthcare industry. Digital health data includes much more than the electronic health record (EHR) nowadays. Electronic health information is readily captured and accessible from a multitude of sources, including consumer-facing applications and connected Internet of Things (IoT) devices. Many healthcare organizations today don’t have a shortage of digital health data. Instead, they are inundated by it and struggle to find ways to isolate the most important pieces of data, share it throughout the care continuum, and transform that data into actionable information that improves decision making. 

A Black Book survey released in 2020 found that 95% of hospitals and physician group executives have access to data analytics applications. Yet despite the widespread popularity of data analytics in healthcare, 80% of leaders said their use of data analytics for decision-making and strategic planning is “negligible.” Data overload and the absence of a common set of data standards and schemas is a primary reason for this gap.

Having access to valuable data and failing to utilize it to its highest capability is simply unacceptable at this juncture. The fact that so many healthcare organizations allocate valuable resources to analytics technologies that ultimately aren’t being used to extract actionable information from data is symptomatic of a much larger problem. One that TECFA can help solve.  

Data analytics is only one component of a larger need to bolster IT infrastructure. The industry must establish a foundation for data interoperability so it can analyze data on a larger scale, as opposed to the current siloed approach. Furthermore, it must prioritize understanding consumers and their expectations, and pursue meaningful innovations that drive value. 

Health tech with a purpose

Technology is undoubtedly a core component to the future viability of healthcare organizations both large and small. However, simply throwing more money at technology is not the answer. Technology solutions must be carefully evaluated to ensure they will address both short-term and long-term goals. This includes ensuring they are built with interoperability in mind.

TEFCA stresses the importance of open technology and industry standards, such as HL7 and Fast Healthcare Interoperability Resources (FHIR), to ongoing healthcare interoperability. A technology infrastructure built on open standards enables information exchange while allowing healthcare organizations to continue using existing systems and evolve their landscapes rather than requiring systems to be ripped and replaced.     

Healthcare organizations should stop investing in technology for technology’s sake and instead develop clear, interoperability-enabled goals and allocate capital accordingly. The simplest advice for an executive would be to not spend a dime, dollar, or moment on data-related technology without having this plan in place. 

Being “data-driven” means more than acquiring and storing large amounts of healthcare data. It requires the ability to quickly access, exchange, and analyze the data necessary to drive action and outcomes. It also requires an organization to balance the desire to be innovative with the need to be sustainable. Luckily, there are numerous examples of countries that are transforming massive amounts of data into usable information about their patient populations.

Moshe Bar Siman Tov, who previously served as the Director-General of the Israel Ministry of Health, has written at length about the country’s emphasis on turning decades of medical data into “digital health gold.” In 2021, Israel earmarked more than $17 million for a new program that will allow health organizations to build the digital infrastructure required for anonymized data-sharing and research and development collaborations with healthcare startups.

American healthcare leaders should look around the world to examine countries where things are done differently, and act accordingly. Healthcare executives, many of whom are industry stalwarts and adherents to traditional ways of operating, must look at the possibilities of innovative technology not as a threat but as a welcome wake-up call. By embracing these unorthodox ideas and seeing things from an outsider’s perspective, real change can occur. 

Using data to understand consumers

The ultimate goal of interoperability should go beyond improved data analysis and outcomes — it should be to better meet the needs and expectations of healthcare consumers. As consumerism continues to influence the future of healthcare, executives are in a unique position to evaluate and subsequently change what is happening and where it’s likely headed. 

As Press Ganey noted in a survey released in 2021, consumerism is increasingly influencing the healthcare industry. For example, most patients now turn to the internet when seeking a new primary care physician and rely on search “almost as much as they do doctor referrals,” according to the report.

Indeed, consumers are taking the same tech-driven approach to healthcare that they have adopted in other industries, namely banking and retail. Consumer expectations center around the immediacy of services and technology ensure that this trend will accelerate. 

Healthcare organizations should recognize that the ground is moving beneath them and that the same old way of doing things will not suffice going forward. Instead of just collecting sizable quantities of data and patting themselves on the back for a job well done, healthcare companies need the ability to make actionable decisions with the information available to them. 

Consequently, anticipating consumer demands and responding with data-supported solutions that fit their needs should be a key goal for any healthcare organization. 

TECFA has the promise to help the U.S. finally realize the concept of a nationwide health information network the ONC originally envisioned when it was formed in 2004. It also provides healthcare organizations with the perfect opportunity to rethink the standard way of operating and move towards an achievable ideal. The right technology can be the bedrock for building a new system that promotes better outcomes, lowers costs, and establishes a more dynamic healthcare landscape for all stakeholders.

Photo: LeoWolfert, Getty Images

Damon Auer is Chief Executive & Managing Director of North America, Dedalus, provider of healthcare IT data and interoperability software systems that support clinical processes.

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