Beyond the interoperability mandate
Experienced healthcare leaders discuss how mandates, COVID-19 and person-centered care are shaping the trajectory of interoperability investments across the healthcare ecosystem.
Interoperability is about sharing data seamlessly across the healthcare industry with patient consent. The industry has been working on this for a long time, and upcoming standards are the result of a lot of work. As mandate deadlines approach, it’s an exciting time to transform how healthcare does business.
I recently spoke with two leaders with many years of experience with interoperability: Greg Caressi, Senior Vice President and Global Business Unit Leader for Transformational Health at Frost & Sullivan, and Anil Jain, MD, VP, Chief Health Information Officer for Watson Health. Here are a few highlights from our conversation, edited slightly for length and clarity:
Q. Regulatory agencies are embracing interoperability policies. Is compliance the main driver for progress towards interoperability? Why or why not?
Caressi: Compliance is an important driver in US and Europe, but it’s not the main driver. Organizations are motivated to get a wider view of their patients and members to help them manage their health risks. [Healthcare payers and providers] have been trying for a long time to get that single view of the patient for better care coordination, to run analytics on health data and to help manage those individuals’ care, health outcomes and cost of care. In markets where there are value-based care arrangements, or provider consolidation, interoperability really has been a requirement to meet both those health and financial goals and remain competitive.
Q. Historically, we’ve tended to focus interoperability efforts on healthcare providers. How is the effort evolving to include other healthcare stakeholders?
Dr. Jain: To go back to the roots of how the 21st Century Cures Act is promoting interoperability, it’s designed to think about the consumer – the patient – who is in the middle of all of this. And they’re not just dealing with a health system or a provider’s practice, but they’re dealing with a health plan and their employer. In many ways, what the interoperability mandates have done is created a floor that basically says we’re going to stop thinking about an individual as a patient one day, and the next day thinking about them as a member of a health plan and another day as a consumer of health apps. Instead, the industry should start looking at how they access of information, and how the usability of that information, and the sharing of that information can drive better models of care.
If you start thinking about some of the thorniest issues – and I’m still fortunate to practice medicine part time – but some of the most burdensome activities our patients and our providers and health plans to deal with are things like prior authorization. It’s about how to best share vital information at a very specific point in time, not just a technical sharing of it – passing bits and bytes around – but a semantic sharing, so that when I as a primary care doctor use the abbreviation “CP,” a health plan knows I’m taking about chest pain, and not cerebral palsy that a neurology colleague would mean, and therefore a stress test is authorized. That semantic interoperability is the new floor.
Q. What should healthcare payers be thinking about as they pick solutions with interoperability in mind?
Caressi: Payers are looking at a shift from sick care model towards healthcare and health. Both members and health plans can benefit from keeping people healthy. That’s ultimately everyone’s goal. But many of the models were built around sick people and sick care…Health plans are becoming more of a partner in bringing together information from multiple sources – things like wearables, or what might be considered “non-clinical” data sources – generate data collected by the individual but it also can have value for the payer and other applications the individual might want to use to help manage their conditions and live their lives.
Dr. Jain: Healthcare payers have to understand that there are some mandates from CMS [Centers for Medicare and Medicaid] will require them to be able to share their members health data if they are asked to do by the member. Health plans will need to make data a little bit more portable and semantically manageable. The tools that will help them succeed are ones that really are focused on understanding how health plans can scale their ability to digest information and then get their members’ consent before they start sharing this information. There are going to be countless apps that all ask for members’ health information, and it’s important to have a secure model to authorize different applications from their various ecosystem players.
Q Where do you see investments being made in interoperability, and has that changed because of COVID-19?
Dr. Jain: Whenever we think about the impact of COVID-19, we should recognize that it accelerated things the industry was already working on. Starting with large organizations, they have a responsibility to create platforms. Platforms that help innovators. How does a level, basic starting point in the platform create new value for those trying to leverage interoperability? For smaller organizations who are innovators, they need a sandbox to rapidly innovate. There has been a digital transformation happening, and COVID-19 will continue accelerate it.
Caressi: This is a currently $4 billion market that we see growing to $8 billion by 2024, so it’s a market where there are lots of organizations making a lot of investments. In addition to payers and providers, you have countries across Asia Pacific and Latin America as well, trying to create an infrastructure for their health systems and making their own investments at a country level, a national level. Those investments are going into interoperability and analytics primarily, but there are other investments in APIs, as well as data cleansing, data normalization, that are a part of this market…The industry is moving from an open API infrastructure to a FHIR-based infrastructure and needs to allow for more data security in that process. We’ve got to get everybody to participate and contribute their data, which is key to this market’s success.