Q&A: Interoperability and COVID-19, Part 1
How the pandemic response intersects with interoperability and requires healthcare providers to decide if they will defer or double-down on interoperability efforts
Q: COVID-19 has caused tremendous upheaval in the healthcare ecosystem. Where does interoperability fit on the priority list today?
Dr. Jain: Let me start by first thanking all the clinicians at the front lines and all those in the back office that remove barriers and enable the extraordinary work that clinicians do to save lives each and every day. I’ve heard two schools of thought expressed regarding the interoperability rules during this crisis. I’d characterize the first school of thought as: “Don’t distract me.” These healthcare stakeholders are singularly focused on COVID-related priorities, and now that there is some flexibility in implementing interoperability requirements1, it is of a lower priority for them. Many providers, health plans and employers probably fall into this camp. Many may continue legacy investments and projects without the full visibility of what the trade-off is in pivoting to standards-based interoperability efforts and access to resources for new projects may be a challenge.
I’d characterize the second school of thought as: “This is a wake-up call.” These stakeholders are more likely to believe that, because the industry has not been interoperable, healthcare is experiencing an undue burden or a tax on their COVID-19 activities within their communities. They feel that instead of slowing down interoperability efforts, they need to find solutions and partners to align legacy projects with standards-based interoperability. I agree with this philosophy; I believe interoperability is an important foundation for several mission-critical efforts in healthcare.
For example, interoperability facilitates accurate understanding of the clinical picture of COVID-19 patients as they move from home to hospital to rehab and back home, or when leaders try to understand what COVID-19 may be doing at a broad community level. But interoperability is not like flipping a light switch; compliance requires investment of scarce resources. Pragmatically, perhaps the best approach could be to accelerate certain aspects of interoperability, while maintaining flexibility.
Q. On April 21, HHS announced “a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the final rules.”1 How might this news affect the acceleration of certain aspects of interoperability?
Dr. Jain: The announced timeline extensions for compliance and the enforcement discretion is recognition by HHS that this pandemic will require all hands on deck. I think most would agree that no stakeholder should have to worry about compliance of new and complex interoperability rules, if it comes at the cost of not fully responding to the needs of sick patients in this new and complex pandemic.
But I think this choice is not impacted solely by compliance deadlines, mandated rules and threat of enforcement. What I’m seeing and hearing is that hospitals, providers and payers recognize the value of interoperability, and that it’s the right thing to do for the individual member or patient, especially now.
Q. What are some of the ways interoperability is intersecting with COVID-19 response?
Dr. Jain: During this crisis, we have seen remarkable collaboration across the health ecosystem and recognition that fragmentation creates significant inefficiencies. Each stakeholder is doing what’s best for their member, employee or patient, but they all have data and insights that complement one another. For example, just understanding the full clinical picture of a typical patient requires stitching together a longitudinal history from home, to the clinic to the hospital and back home. In addition, connecting to public health agencies is critical. This is more efficient when there is a common language for the health data and common sharing mechanisms. That’s what FHIR APIs and open data standards could facilitate when implemented allowing clinicians to focus on care then moving data around.
In other scenarios, interoperability is key to ensure that clinicians, health plans and patients have a unified view of the clinical picture to facilitate access and authorization to essential services for these patients. Lack of interoperability can make this process much more complex and result in delays in care.
Finally, each and every patient with this disease will be studied to enhance our understanding of this disease and ensuring that we learn what works and what doesn’t work. In order to do this effectively and securely, while respecting patient privacy, interoperability standards ensure that data about these patients can be meaningfully aggregated and analyzed and those insights shared with more confidence.
It’s been a challenge for many across the industry and our response with COVID-19 highlights the inefficiencies and potential burden the lack of interoperability can play when every minute counts.