How QHINs Can Relieve Inequity in Interoperability

By John Blair, MD, CEO, MedAllies
LinkedIn: A. John Blair, III, MD
LinkedIn: MedAllies

In the wake of the COVID-19 pandemic, the American healthcare system began a long-overdue reckoning with the social and racial inequities that have traditionally plagued the nation and generated significant disparities in health outcomes.

Though not as urgent, the movement toward healthcare interoperability could use a similar push to reduce the inequities in interoperability that exist largely between medium-to-large suburban and urban hospitals (the “haves”) and their smaller, rural counterparts (the “have-nots”).

The story of the haves and have-nots of interoperability belies the real progress we’ve made across the nation towards this elusive goal of seamless healthcare data exchange. For example 62% of hospitals engaged in all four major domains of interoperability (send, receive, integrate, and find) in 2021, up from 41% in 2017, according to a report from The Office of the National Coordinator for Health Information Technology (ONC).

Despite these advancements in interoperability, disparities still exist across the U.S.

Interoperability by location: Behind the numbers

ONC reported that 72% of suburban and urban and 74% of medium and large hospitals engaged in all the four domains of interoperability in 2021, compared with just 48% of rural and 51% of smaller hospitals.

Further, a 2023 study in Health Services Research revealed interoperability disparities between hospitals in areas that treat economically and socially marginalized patients and those that don’t. Specifically, the study found that hospitals that treated patients from zip codes with what the authors defined as “high social deprivation” were 33% less likely to engage in interoperable exchange and 24% less likely to participate in a national network than all other hospitals.

The association between social deprivation and interoperability persisted across metropolitan and rural areas, according to the study.

Indeed, an urban location is hardly assurance of interoperability capabilities, statistics from ONC have revealed. For example, more than 70% of non-federal acute care hospitals in Cleveland, Miami, and Detroit reported interoperable data sharing across four key domains in 2018, compared to fewer than 40% in Philadelphia.

To reduce inequities in interoperability and encourage data-sharing more broadly across the nation, ONC has put its weight behind the Trusted Exchange Framework and Common Agreement (TEFCA). The purpose of TEFCA is to establish a universal floor for healthcare interoperability.

TEFCA prescribes the infrastructure model and governing approach for users in different networks to securely share basic clinical information. It seeks to accomplish this by creating commonly agreed-to expectations and rules for data exchange, regardless of which national network a healthcare organization participates in.

Qualified Health Information Networks (QHINs), which are networks of organizations working together to share data, are critical to the implementation of TEFCA. QHINs, which the ONC announced had become operational in late 2023, connect directly to each other to ensure interoperability between the networks and providers they represent.

How QHINs improve interoperability and reduce disparities

Healthcare interoperability is a worthwhile goal because seamless data exchange among providers can help the health system improve care, lower costs, and gain efficiency. While it’s important to focus on these important objectives, we cannot do so at the expense of leaving behind smaller, rural providers and their patients.

Here are four ways QHINs can improve interoperability – independent of provider size and location.

  1. Improve connectivity: As QHINs streamline the technical requirements and reduce potential legal burdens of data sharing, more health entities will establish connections with national networks.
  2. Enhance data usability: One of the greatest barriers to interoperability has been the messy nature of healthcare data, which is too-often incomplete, inconsistent in terminology, and fragmented across multiple systems. TEFCA and QHINs help solve this problem by providing the technical standards and framework to underpin health data exchange. With more accurate, complete, and up-to-date data, physicians can make better decisions that lead to better health outcomes.
  3. Increase health data use cases: The primary use case of improving patient care and treatment through better healthcare data sharing has been well-understood across the industry. However, QHINs are expected to support several emerging use cases, including individual access service, public health, benefits determination, and payment and operations.
  4. Decrease siloes: When complete and accurate data flows more freely between healthcare organizations, QHIN participants gain the ability to improve care coordination and eliminate many of the siloes that reduce the exchange of information. With more comprehensive patient information at their fingertips, providers can make better diagnosis and treatment decisions, reduce unnecessary and duplicative tests and procedures, and more productively collaborate across different disciplines.

Under ONC’s guidance, hospitals and providers across the U.S. have made excellent progress towards improving interoperability in recent years. However, it’s important to realize that these gains have not been spread across the nation evenly, potentially putting patients at smaller, rural hospitals at a disadvantage. QHINs will help level the playing field, enabling us to reduce many of the inequities of interoperability.

More from John Blair MD

Listen in as John speaks with Tom Foley, host of The Virtual Shift about TEFCA and interoperability.

John also spoke with David Harlow, host of Harlow on Healthcare about QHINs.