MedCity Influencers

Inequity in Interoperability: The Haves and Have-Nots & How QHINs Can Help

Interoperability is moving ahead, but major health systems and hospitals in large population centers must ensure they don’t leave their smaller and more rural counterparts behind.

The future of interoperability is already here. It just hasn’t been evenly distributed

Certainly, the healthcare interoperability movement has made strides in recent years, but there is still significant progress that needs to be made. For example, in 2021, 62% of hospitals engaged in all four major domains of interoperability (send, receive, integrate, and find), up from 41% in 2017, according to a report from The Office of the National Coordinator for Health Information Technology (ONC).

However, a breakdown of those numbers reveals a divide between the “haves” (medium-to-large, urban and suburban hospitals) and the “have-nots” (smaller rural hospitals). Specifically, 72% of suburban and urban and 74% of medium and large hospitals engaged in all the four domains of interoperability in 2021, compared with just 48% of rural and 51% of smaller hospitals. 

ONC has endeavored to advance interoperability with several measures in recent years, but none may be more impactful to small, rural hospitals than the Trusted Exchange Framework and Common Agreement (TEFCA).

TEFCA to the rescue?

By establishing a universal floor for interoperability across the nation, TEFCA stands to increase the number of hospitals and healthcare providers that are connected to national networks, although by how much remains an open question. At its essence, TEFCA is intended to describe the infrastructure model and governing approach for users in different networks to securely share basic clinical information with each other. The regulation does this by creating commonly agreed-to expectations and rules for data exchange, regardless of which national network a healthcare organization participates in.

For the U.S. healthcare system overall, TEFCA creates a unique opportunity to connect providers, public health groups, and healthcare consumers by establishing a universal floor for interoperability. The promise of TEFCA is to help providers expand care coordination and care quality while decreasing delays in patient data exchange, ultimately delivering on interoperability’s potential to finally give patients real control over their health data. 

Essential to the implementation of TEFCA are Qualified Health Information Networks (QHINs), which are networks of organizations working together to share data. QHINs will connect directly to each other to ensure interoperability between the networks and providers they represent.

Four ways QHINs can help improve interoperability

Establishing interoperability among healthcare providers is critical for delivering appropriate care, reducing costs, and making healthcare more efficient, according to ONC. However, it’s important that the benefits of interoperability are extended to rural patients and smaller providers, not just large urban and suburban providers. 

Following are four ways QHINs can help improve interoperability across the nation, regardless of provider size:

Creating more connections:  As QHINs streamline the technical requirements and reduce potential legal burdens of data sharing, more health entities will establish connections with national networks. 

Making data more usable: Among the greatest barriers to widespread interoperability has been the challenge of dirty healthcare data, which is often incomplete, inconsistent in terminology, and fragmented across multiple information systems. TEFCA and QHINs will help solve this problem by providing the technical standards and framework to underpin health data exchange. With more accurate, complete, and up-to-date data, physicians can make better decisions to generate better health outcomes. 

Providing more use cases for data:  The major use case of improving patient care and treatment through better healthcare data sharing has been well-established to date. However, QHINs are expected to support several emerging use cases, including individual access service, public health, benefits determination, and payment and operations. 

Reducing siloes: As more complete and accurate data flows more freely between healthcare organizations, QHIN participants will improve care coordination, breaking down many of the siloes that continue to affect the industry. With more comprehensive patient information at their fingertips, providers can make better diagnosis and treatment decisions, reduce unnecessary and duplicative tests and procedures, and more productively collaborate across different disciplines. 

Interoperability is moving ahead, but major health systems and hospitals in large population centers must ensure they don’t leave their smaller and more rural counterparts behind. By delivering a technical roadmap for data sharing, QHINs and TEFCA will create a more level playing field for interoperability among different provider types.

Photo Credit: wigglestick, Getty Images

A. John Blair, III, MD, F.A.C.S., III, MD, F.A.C.S. is the CEO of MedAllies, a national healthcare connectivity services provider. He is a health care and technology executive with broad experience across the health care industry including clinical practice, hospital planning and governance, revenue cycle management, managed care, public health and health care informatics. Prior to establishing MedAllies in 2001, Dr. Blair worked as a general surgeon for twenty years before becoming the President of the Taconic Independent Practice Association (TIPA), a network of over 5,000 physician members