By Miranda Crowell
In the health tech world, “interoperability” is a fancy word begging for a hashtag and for acceptance within the medical community. With a continuously growing push for the use of electronic health records (EHRs), the issue of interoperability gained the attention of Energy and Commerce Committee Chairman Fred Upton (R-MI) and Rep. Diana Degette (D-CO). The 21st Century Cures Act (Cures Act) is sprawling, with topics ranging from drug development to clinical trials. And when it comes to interoperability, the Energy and Commerce Committee hopes that the Cures Act, if passed by Congress, might ease the process of sharing research and clinical data by making systems more interoperable.
But what does interoperability mean and why is it important? Depending on who you ask, interoperability has various definitions. In short, it is the ability for one system to connect with another system. The Office of the National Coordinator for Health IT (ONC) defines the term as “the ability of systems to exchange and use electronic health information from other systems without special effort on the part of the user.” The definitional stance taken by ONC and HIMSS, or the Health Information and Management Systems Society, includes various levels of interoperability and stresses the notion that interoperability includes data-sharing between and among various EHR vendors and other health technologies. Moreover, interpretation of data by the receiving system is important, at least to some degree. Consider this banking analogy as an example of an interoperable system: any ATM can facilitate a withdrawal from any bank at any time, and thus, the ATM is interoperable among banking systems.
There is a glaring need for interoperability standards in the healthcare field. For example, a local, independent doctor may have little to no electronic method to share a patient’s health information if that patient visits a hospital. This scenario highlights a common problem where a lack of access to information, or the slow speed of access to information (should such access exist), could lead to a poor patient outcome. To that same point, the Department of Health and Human Services (HHS) states that a lack of immediate access to relevant health information is the cause for 20% of preventable medical errors. These examples and statistics only scratch the surface on the need for interoperable health systems.
Zoning in on interoperability, the expansive Cures bill directs HHS and ONC to set standards for what makes a particular health technology interoperable. In order to be considered interoperable, the technology in question must (i) allow for the secure transfer of the entirety of the patient’s data, (ii) allow access to the entirety of the patient’s data without special effort, and (iii) not be configured to block information. A more detailed description can be found here at page 236, and the specifics surrounding these standards are forthcoming by HHS and ONC. Earlier drafts to the Cures bill did not include any specific language on the topic of interoperability, but the Energy and Commerce Committee responded to pleas from groups such as Premier Inc, a healthcare improvement alliance group.
As sweeping as the Cures bill may seem, there are some issues when it comes to the interoperability sections of the bill. For example, the College for Healthcare Information Management Executives, a professional organization for senior-level healthcare IT professionals, was displeased when the new version of the bill did not include any language on patient identifiers, stating that a standardized approach for collecting and sharing data can only occur when a patient can be positively identified. Moreover, EHR vendors will not be penalized for a lack of interoperability until January 1, 2018. As Fibroblast CEO Scott Vold voiced, “Washington is moving at a glacial pace to increase interoperability; the two and one-half year gap between the present and the implementation of penalties for EHR vendors is too long because the technology could change and the market could shift.” (You can hear Scott’s thoughts on the Cures bill and other topics on here.) The bill received a unanimous 51-0 committee vote on May of 2015. And as the bill makes it way to Congress, all health-tech parties should keep one eye on Cures and the other on the ever-changing world of healthcare technology.