Demystifying the healthcare interoperability mystery

Introduction:
After many hiccups, healthcare industry has started adapting to technology now. Technology has now become a key imperative to transform the existing hospital workflows for improving accessibility and quality of care. Hospitals are now investing heavily in specialized clinical solutions like EHR systems, advanced medical technology; and hospital administration are investing in digitizing the core enterprise systems like patient enrollment and billing for delivering personalized care. But currently, as all these systems are operating disparately, hospitals were not able to realize the complete potential of the generating patient data.

For achieving the goal of integrated patient health record, primary activity is accessing the patient data through a unique patient identifier and sharing the complete patient information to caregivers for continuity of care. But the heterogeneity in the hospital systems is creating complications and limitations to share data between the health professionals. This necessitates an intelligent interoperable solution which use Enterprise Master Patient Index between them to start exchange, infer and display health data in a patient-centric way wherever he receives care.

“As per Gartner, EHR Interoperability is one of the top priority for provider CIOs in 2018.” (1) (2)

Key Trends driving Interoperability:
Push from Government:
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Owing to rising healthcare cost, Governments have started working together with healthcare providers to facilitate seamless data exchange between multitude of healthcare systems to coordinate care effectively and reducing avoidable costs. With healthcare interoperability mandate, government had incentivized the providers to use a certified EHR and provide an open API for automatic delivery of the required authorized requests to access the patient records electronically. And as per the recently shared Nationwide Interoperability Roadmap, healthcare providers should make their system interoperable and give patients the complete access to their health data with the ability to share the data to any healthcare provider. Providers will have to pay a penalty if they are failing to do so.

“Only 4 in 10 hospitals can send, receive and use data from sources outside their system.” (3)

Industry Consolidation through Mergers and Acquisitions:
PictographDue to rising cost pressure and to sustain market position, the healthcare industry is entering a consolidation phase, with some new companies evolving to acquire insurance payers and health providers while the existing healthcare systems merge and acquire independent hospitals. With this new megatrend of Mergers and Acquisition, not just Interoperability, but even Intra-Operability becomes difficult, since system consolidation is not absolutely necessary for a successful merger or acquisition. However, effective care coordination can happen only when interoperability is facilitated between all these disparate systems. To cite an example, the recent merger of Summit Health (Meditech) with WellSpan Health (Epic) with a motive to expand services locally so patients won’t have to travel as much for care. This merger has brought disparate health systems together facilitating better data sharing and thereby improving the Coordination of care.

“Recent trends like Amazon partnership with J.P. Morgan Chase and Berkshire Hathaway, Walmart trying to partner with Humana” (4) (5)


Advancement in Precision medicine requiring coalition of multiple stakeholders:

With the advancement in genomic technologies and eruption of big data powered diagnostics tools, precision medicine for critical disease conditions is becoming a reality now. By combining genomic sequencing data with other clinical data, physicians and researchers can get a better understanding of the patient’s disease condition and provide evidence based precise treatment. However data siloes are preventing big data analysts from taking full advantage of the huge volumes of genomics data for sequencing, mapping, and analyzing. Sequencing multiple human genomes could itself be petabytes of data, and adding to that the data created by analysis of each of the gene interactions would multiply it further.
Interoperability combined with big data analytics is therefore a must have if patients, healthcare providers and precision medicine researchers are to collaborate on a care delivery for severe conditions like cancer.

“As per FDA (US Food and Drug Administration), Interoperability is a core Requirement for Precision Medicine” (6) (7)

Increased need for collaboration due to rise in chronic conditions:
PictographSimilarly, chronic condition patients have their information spread across multiple EMRs and other systems of multiple providers and organizations. And the providers who treat them will be collaborating with specialists and other third party vendors for improving patient outcomes and enhancing the care quality. Achieving true interoperability becomes a herculean task as the out of network specialist and vendors will be using their own proprietary systems. And integrating these new proprietary health applications with EHRs and other hospital systems securely becomes difficult.

“More than half of the industry feels Vendor Incompatibility as biggest pain point in Interoperability as per a HIMSS survey.” (8)

Interoperability – The New paradigm change in healthcare:
In spite of the push from government in form of mandates and other key driving factors, we are realizing many of the existing clinical systems vendors are not be ready to invest in implementing a new open interoperable standard like FHIR into their systems right now. Their primary concern is about the Data security. As the sharing of data through interoperability opens up more potential opportunities for the data to become compromised. With rising cybersecurity crimes or cyber-hacks, healthcare providers are unwilling to adopt interoperability in fear of privacy intervention. Adding to that, the normative version of HL7’s FHIR is yet to be released. As per the update from HL7, standard version of FHIR itself will arrive only in 2019. So the providers are awaiting for the FHIR to become a mature standard before investing in it.
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In order to comply with the regulation mandate and to attain cost optimization, the healthcare providers themselves need to make their clinical system interoperable or they need to partner with innovative digital health companies who operate in the interoperability space. They need to ensure HIPAA (Health Insurance Portability and Accountability Act) and HITECH (Health Information Technology for Economic and Clinical Health) act level of privacy and security compliance with respect to the interoperability exchanged data to tackle data security issues.

PictographWith digitization picking up in the space, some remote health companies are stepping-up to solve the interoperability puzzle by synchronizing the patient record in EMR as a single source of truth for providers. They are integrating the Point of care data from devices with patient historical data from EMR and from other clinical systems, so that the providers can receive real time patient health and vital information. This will facilitate physicians to provide evidence based treatment by making accurate decisions regarding a patient’s health faster.

The seamlessly integrated solution reduce patient record duplication effort by adapting to the existing Infrastructure well and thereby saving unnecessary cost, enabling greater collaboration between physicians. The solution also empowers the Payer and other care management companies to focus on patient-centric care delivery by enabling them to get quick access to needed information securely from multiple digital platforms for decision-making, and leverage modern technologies to obtain advanced insights before the patient visits their office and provide the best care outcomes.

About the author

Guruprasad S

Guruprasad S

Sr. General Manager, Business Domain Healthcare, Robert Bosch Engineering and Business Solutions Private Limited
Mr. Guruprasad S. is currently the Senior General Manager at Robert Bosch Engineering and Business Solutions (RBEI). He heads the Healthcare Practice and is a member of Senior Leadership team. Guruprasad is additionally responsible as Director for Business Unit - Medical Screening Solutions at Bosch Healthcare Solutions GmbH (BHCS), Germany. He has over two decades of professional experience spanning diverse areas of Engineering, Information Science & Corporate functions like Business Development, Sales and Marketing. Mr. Guruprasad has been with the Bosch group since year 2000.

In his current role Guruprasad has been instrumental in driving Healthcare as an intrapreneurial journey within RBEI and is responsible for ground-up strategy evolution for this new business domain. He also plays a lead role in shaping Bosch worldwide strategy in Medical Screening Solutions. A business transformation initiative, led successfully by Guruprasad at RBEI, is captured as a Business Case and published by Richard Ivey Business School of Canada.

Guruprasad is an alumnus of Indian Institute of Management, Bangalore (IIMB) and holds a Bachelor’s degree in Engineering from Bangalore University. Guruprasad is married to a clinical psychologist and has two children. His interests include Music, Science and Nature.

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