Addressing Interoperability in Health Care

^{By Julie Gould} 

Drew Ivan, executive vice president of product and strategy at Rhapsody and Corepoint Health, discusses interoperability challenges and highlights best practices health care organizations can utilize in order to ensure seamless data integration and increase data sharing.

Integrated Healthcare Executive:  Can you please tell us a little bit about yourself and your background in health care?

Drew Ivan:  I'm Drew Ivan. I'm the Executive Vice President of Product and Strategy at Rhapsody and Corepoint Health. I got into health care in 2000 on the EMR side. One of the challenges we faced as a small EMR company was how to integrate our software with other systems in the hospital.

We tried building our own solution for moving HL7 data back and forth, in and out of the EMR. What we found was that it was possible to embed an integration engine into the EMR. The engine that we chose was Rhapsody. I was actually a Rhapsody customer before I joined the company.

I joined Orion Health in 2008, started in the product management department of the Rhapsody product for Orion, and then went on to do engineering pre-sales for Rhapsody, followed by pre-sales for the population health management platform at Orion.

Back in November, Orion split off Rhapsody as an independent company. Along with that transaction is when I moved into the role of EVP of Product and Strategy. I've been around health care for almost 20 years and always in the software side and, for the most part, on integration side.

Integrated Healthcare Executive:  What interoperability challenges are currently faced in the health care sector? Why do you believe these challenges arose?

Mr Ivan:  Interoperability will always be a problem for health care. It's because it's not a single thing that can be solved and then you move on from that. It's part of the background. It's part of the environment in health care.

As new trends in health care, new products and concepts in health care emerge, you need to figure out how they interoperate with the rest of the health care ecosystem. There will always be new interoperability challenges.

In the past, there has been a challenge just getting systems within a hospital to talk with one another. That problem was well-solved by HL7 version 2 messaging and technologies like Rhapsody that act as an integration engine, a hub or traffic cop for getting the data where it needs to go.

We've moved on from that. Today, there's a lot of emphasis on moving data in between organizations, either from one care setting to another or between, let's say, providers and payors, providers and public health. Any kind of cross-organizational interoperability is the type of challenge we're tackling today.

That has different data flows, different repeating patterns, different message formats and standards than we see within the hospital. It's a different kind of interoperability.

The other place where we're seeing interoperability problems emerge is in terms of getting the data to the consumer or the patient. Now that data is largely captured in electronic medical records, that's a change since early in the 2000s, when almost none of the data was captured electronically.

Now that the data is electronic, consumers are wanting to get copies of that more easily and in a format that's convenient for them, on their mobile device or on their computer. They don't want printouts and faxes and CDs. That's another place where interoperability problems are getting solved.

Integrated Healthcare Executive:  Can you highlight the new interoperability rule that aims to address the gaps left by the 21st Century Cures Act?

Mr Ivan:  Yeah. There's a trajectory there. The first piece of that equation is the meaningful use rules that came with the funding to subsidize EMRs in hospitals and in outpatient settings. That first compliance project of meaningful use was intended to get records off of paper and into electronic systems.

The assumption was that when they did that, the data would automatically become interoperable across care settings. That turned out not to be the case. Just because the data is in an electronic format doesn't necessarily mean that it's easy to transmit from place to place.

21st Century Cures came out. In part, it addressed a number of things in health care. Part of it was to patch up the gaps left by meaningful use, by introducing concepts such as information blocking and saying that there's no good reason to block information when the patient wants it to move.

The rules that have come out earlier this year from CMS and ONC deal with implementing some of the concepts that are in the 21st Century Cures Act, around making sure that the data moves from place to place in accordance with the patient's instructions...

Making data available to the patient themselves, and then also making sure that data can follow patients as they move from one insurance carrier to another. Really, what the new rules are doing is going back and repairing some of the things that were left unspecified in the Cures Act and in meaningful use.

As those rules mature and become finalized and get implemented, we're going to see a lot better flow of information between systems.

Integrated Healthcare Executive:  Some organizations will be forced to shift how they operate. How will these organizations be impacted by the new rule?

Mr Ivan:  When a rule like this comes out, it means that there's a new compliance project for the IT department. If interoperability is mandated by the government, then it has to be in a certain way, according to certain rules. There has to be certain documentation. That all adds up to a compliance project.

Organizations are going to find themselves in a place where right now they may be making data available, consuming or producing information in accordance with whatever their business requirements are, but in the future they're going to be producing and consuming, especially producing, information in accordance with what the compliance directives say.

That's going to mean making sure that the data is available, that it's complete, that it's in the specified formats. That's going to be a lot of work for the providers who currently have that information in their systems.

I foresee a lot of activity around taking data that's already being generated and managed within systems like EMRs and making it available in a more consistent, more complete format to patients and the places the patients want to send the data.

Integrated Healthcare Executive:  Can you briefly highlight the steps and best practices a health care organization can take in order to ensure seamless integration and increase data sharing?

Mr Ivan:   Since the rules are still being finalized and it's not exactly clear what they're going to look like in their final form, the best you can do today is get ready by establishing tools and expertise in the common standards.

We know that the data will be sent using a combination of existing standards, things like HL7 version 2, HL7 CCD documents, HL7 FHIR, IHE-style integrations. These are established patterns in health care that have been used to varying degrees by different participants in the health care system.

We know that the future is going to look like a standards-based data interchange. We don't know exactly which of those standards will be used for which use cases. We don't know exactly which versions of those standards might be specified, not for certain at least, but getting good at building standards-based integrations is going to be a useful skill as soon as those rules go into effect.

That would be my number one piece of advice, is to build up your expertise and tooling around those types of standards-based interchanges.

Integrated Healthcare Executive:  What gaps will still exist following the rule going into effect?

Mr Ivan:  Health care integration will never be finished. It's not a project that we have to tackle and get done with. As new concepts in health care emerge, there'll be new integration needs.

Some of the ones that are not completely addressed by today's regulations include things like transferring across care settings. The groundwork is being laid in today's rules around what data needs to travel with the patient, but it's not entirely clear what the workflows and the patient flows will be.

That'll have an impact on what the eventual interoperability solution needs to look like. There'll be more work to do there once we get the data moving along with patients.

There's also not a lot of information in the rulings about things like analytics or risk scores. These are important things for payors and ACOs. They'll be able to do a better job of producing those once they can get the data more easily, about their patients and members.

In a lot of cases, it might be useful to generate those and transmit them as part of the data set. In other words, it's not the basic medical records that we care about. It's the synthesized, analyzed scoring based on those medical records.

It could be for a single patient. It could be for an entire population. That's a second area where I think there'll be some more work to do, is around this aggregated type of information.

The third place is around public health. There's already mandates in most states and jurisdictions to send certain types of data to the public health department. What we see is a very uneven implementation of these, in terms of electronic data capture at least.

There may be a requirement to transmit, let's say, immunization information to the local Department of Health, but it's not always transmitted electronically. If it is, it's not always in a consistent format.

There'll be a lot of attention paid to public health reporting. That's the type of infrastructural issue that we can get a lot of traction, a lot of return on investment, by investing in that type of interoperability.

Integrated Healthcare Executive:  What are you most looking forward to after this rule goes into effect?

Mr Ivan:  For us, we're in a pretty unique spot. We make tools to just help solve the interoperability problems as they emerge. For a long time, we've been focused on solving that problem of getting data to move around within a hospital. In the past several years, we've also been expanding beyond the hospital walls and addressing those challenges as well.

What I'm most looking forward to is once the basic patient record data is more consistent and more freely moving, what comes next? We don't know what that'll be because it hasn't been invented yet. The idea that there's always something new on the cutting edge that's coming in the future is what's most exciting to us.

Integrated Healthcare Executive:  Finally, is there anything else you would like to add?

Mr Ivan:  Interoperability is something whose time is overdue. It's been treated as almost like a science lab project. Every time you need to build an integration, you build it for that specific case. We need to move away from that model of building these ad hoc integrations and move toward a more standardized type of integration.

This can be standards around data formats, code sets. It can be around transmission protocols, security. We're starting to see some of this emerge in the new FHIR standard. That's really where we want to apply a lot of attention and effort, is as an industry's getting better at those repeatable types of integrations.

Disclosure: Mr Ivan is a company executive employed with Rhapsody.