On our recent annual interoperability panel discussion with industry leaders, they were posed the question of where are we? If we were a football field how close are we to the goal? Of course everyone wants to put us somewhere making progress right? We are half way there, because everyone knows we are not close and certainly not on the 2 with a a quarterback hurdling the line for the goal! But the most interesting answer (and probably most honest), we haven’t entered the stadium yet! Hopefully we are at least taking tickets. So our quest for interoperability continues. As tradition, we have rounded up the industry leaders that have thoughts and predictions for what we might see in the new year. And join us for the next few weeks as we look at what we might see in 2022.
2022 will be the year for Interoperability as it will be key to both progression and success in the year and years ahead. As interoperability is adopted throughout the industry, it will become a reality for all healthcare stakeholders as barriers around assuring patient access to data are addressed and the need for EHR data to be available in seconds for diagnosis, treatment and care management across the healthcare continuum is met. It is my belief that TEFCA will commence implementation with Qualified Health Information Networks (QHINs) being onboarded by the Sequoia Project – serving as the Recognized Coordinating Entity (RCE) – and ONC who are working together to create a patient EHR digital highway that will facilitate data and information exchange. This patient-centric initiative will serve as the foundation to empower patients, providers and many other healthcare stakeholders to access data in order to make critical healthcare decisions. 2022 will also be a year where we see the adoption and implementation of APIs that are FHIR-enabled by the HL7 standard to provide the connectivity between EHRs, healthcare applications, portals while providing the “fuel” for the digital information highway. The Unified Data Access Protocol (UDAP) provides the capability for FHIR APIs to have the foundation security rigor and scale to assure the broadest adoption and implementation of this standard occurs in the healthcare ecosystem. In addition, interoperability enablement will prove critical in assuring stakeholder-trust by delivering an infrastructure that provides a dynamic framework for privacy, security, identification, authentication and authorization for data exchange to occur. EHNAC and HITRUST have partnered to provide such a framework to assure the highest levels of privacy and security are met to enable stakeholder-trust while aligning with key regulatory foundational components.
In the coming year, we will see ‘interoperability with a purpose,’ which means the industry will be finally moving past disruption and into sustained collaboration. For the better part of the last decade, many healthcare organizations were pursuing interoperability for interoperability’s sake. While it’s a noble cause to try to disrupt the industry with interoperable data, this effort served no actual purpose and did not sustain any value. The main mission that drives us in healthcare, which is consumer-centric personalized care, requires collaboration, not disruption.
Going forward, the healthcare technology industry needs to gravitate towards a consumer-first mentality. Today’s expectations of timely responses require personalized interactions at every stage of the care process and the transformation of significant data sets into actionable consumer-centered information.
Interoperability: – I believe we will see an impetus towards building open, connected communities of health. This means transferring information from one EHR to another will no longer be a pain point—rather adoption of application programming interface (APIs) will enable electronic records to inculcate data from disparate systems and devices in real-time.
The regulatory compliance date for the CMS Interoperability and Patient Access Final Rule came and went in 2021. But we see that the industry is looking beyond compliance dates and understands the need to move project-based integrations to self-service integrations. Changing from a compliance mindset, with an 18-month or six-month project sprint, to a composable ecosystem of built components will help healthcare partners get to an advanced explanation of benefit or price estimator faster as additional interoperability regulations roll out. There is an immense opportunity to transform how healthcare works with its partners – and a more modulable healthcare company is going to be a major competitive advantage.
Given the resource constraints of the last two years, 2022 will see both health plans and providers increasing their efforts to digitize manual processes and reduce staff administrative burden. Government regulations, such as state and federal rulings intended to bring new transparency to the prior authorization process, will accelerate the adoption of digital technologies. The industry-wide focus on the patient experience and health equity concerns will continue to be top of mind. Payers and providers will implement digital platforms that combine machine learning, analytics, and clinical expertise to collaborate on care management initiatives and develop approved, evidence-based care plans to guide appropriate treatment decisions, improve outcomes, and contain costs.
The industry is already abuzz with talk about the ‘post-EHR’ world in which everyone has electronic health records. This is only going to compound the difficulty of finding clinically relevant information in a patient medical record. With the advent of the 21st Century Cures Act, things are about to get even more challenging. Once the floodgates are opened and systems are required to share information and are sending it back-and-forth, the contents of someone else’s system will be added to your own. If interoperability is going to improve outcomes and contribute to the success of value-based care, new tools to support the integration of relevant clinical data with specific documentation, workflow, and reporting requirements are needed.
In 2022, we’ll see a greater emphasis on designing systems based on interoperability standards that connect community stakeholders to healthcare providers – ultimately allowing care teams to better address social, economic and other factors to manage complex needs of at-risk populations. I also predict the expansion of interoperability standards, so that health and human service information can be better shared and made accessible to the care team to enhance person-centered care.
We anticipate payers and providers will achieve greater access to one another’s data in 2022 to support value-based care arrangements and engage members/patients to maximize the benefits available to them. This sharing of big data and the use of advanced analytics will accelerate the identification of member/patient health conditions and risks, thereby helping every participant in the value-based care equation. In addition, timely access to data will increase with the pressure for more shared-risk contracts. Automated workflows will be key both to opening access between payers and providers and demonstrating data accuracy and its fair use, as well as tracking and reporting progress toward value-based care contracts.
With the information blocking rule in 21st Century Cures Act seeking to open data-sharing channels between all stakeholders, it is my belief in 2022 that we will see more and more providers adopt information sharing technologies as we continue to move from paper fax machines to digital documents and then from documents to insightful data. Digital Cloud Fax Technology (DCFT), which does not require a fax machine, toner, paper, or a team of administrators to manage the workflow, allows providers to securely receive, review, and send faxes entirely online. However, these digital documents are usually still unstructured and are integrated into a patient record as images. Providers can access and view this data, but to become actionable, it must be manually entered into a patient record, a time- and resource-consuming endeavor. When data-capture technology such as optical character recognition (OCR), natural language processing (NLP), and artificial intelligence (AI) is used, data can be extracted from the digital document to provide actionable information for the receiver. More electronic data can bring better decision-making at the individual patient level, among cohorts of patients with similar conditions or comorbidities, and at the population health level. But the industry must move with deliberation to ensure that true data interoperability is achieved, acknowledging that each healthcare organization is unique in terms of technology maturation and technology adoption.
Looking ahead to 2022, our team predicts that interoperability will shift from promise to reality in the patient experience. The COVID-19 pandemic has amplified patients’ needs for access to their medical records. The 21st Century Cures Act puts patients in the driver’s seat while holding vendors and providers accountable to ensure pertinent information is not withheld.
A data management plan is essential to interoperability’s success. Healthcare systems have, on average, up to 18 EHRs with data in disparate locations. Active archiving eliminates data silos, fulfills patient requests for information, and helps healthcare organizations achieve compliance and optimal revenue.
As we look ahead, these trends will drive advancements in interoperability:
- Health plans engage more assertively on clinical data acquisition – Plans will focus data acquisition strategies on breadth of connectivity, depth of data types, and quality of the data necessary to satisfy their use cases. Plans will begin to prune away connectivity that doesn’t meet data quality thresholds.
- Health Information Organizations collaborate and place emphasis on public health – As HITECH-era funding ends, HIOs will seek scale through collaboration (and mergers) on shared technology and services and will focus energy on areas they serve uniquely well, including Medicaid and public health agencies state and federal levels.
- National networks continue to gain traction and see deeper use – eHealth Exchange, Carequality, and Commonwell will continue to ramp up both scale of participation and scale of use. Challenges associated with leveraging the networks at scale will be addressed by both 3rd party services and the networks themselves. The networks will accelerate work toward supporting FHIR-based exchange, but the preponderance of data exchange will continue to be document-based.
- FHIR will continue to garner excitement but will be a slow burn in production – FHIR is seeing continued uptake, but as shown in MITRE’s very cool FHIR endpoint dashboard, there is a lot of work ahead on adoption/deployment and updating to more current versions. Importantly, large scale use of FHIR will require progress on central infrastructure concepts through ONC’s FAST Task Force.
- ACOs and providers in risk-bearing arrangements will demand greater insight into hospital care – Provider organization that have taken on risk will focus energy on real-time access to clinical data, especially acute care services. Many at-risk providers and ACOs are proving they can control patient flow, forcing hospitals to respond to demands for greater insight into acute care. The ability to engage a patient during or immediately following a hospital encounter will become table stakes to perform within these payment models.
- The Information Blocking Rule begins to have an impact but will be ignored by the largest entities – The rule will begin to accelerate data exchange purposes beyond treatment (i.e. healthcare operations and payment) but, absent strong enforcement, many of the largest offenders will continue to go unchecked.
The healthcare industry is rapidly being re-contoured by the forces of digital innovation and testing the limits of traditional health industry, technology platforms, and surrounding applications.
Legacy payer and provider core platforms have been optimized to drive value in an industry ecosystem created in an era of proprietary data silos, walled-off adversarial market segments, and closed architectures requiring extensive custom code and manual workarounds to interact with external systems and devices. Recognizing the limits of legacy health industry technology, in 2022, we will see some large healthcare industry players re-evaluating strategies and investing in new core systems and platforms that can support frictionless end-to-end consumer experiences across payer, provider, physical and digital.
To that end, standards-based APIs will help providers and payers overcome process gaps and inefficiencies by enabling real-time automated transactions. APIs also will democratize data and functionality, enabling innovation marketplaces for third-party apps and developers. Imagine an App Store or Play Store specific to healthcare. Apps could range from FDA-vetted clinical functions including diagnostic protocols. Additionally, the adoption of new payment models is aligning payer and provider incentives and inspiring new business and care delivery models that are breaking down traditional adversarial silos.
The final rule from the Office of the National Coordinator for Health Information Technology (ONC) regarding the 21st Century Cures Act finally went into effect this year. This new regulation on interoperability and information blocking has already been a huge focus for vendors and providers moving toward simpler forms of electronic information sharing and will continue to be a major focus as we head into 2022.
In addition, the Common Agreement and QHIN Technical Framework (QTF) for the ONC-sponsored Trusted Exchange Framework and Common Agreement (TEFCA) will be published in 2022. The development of the operational details for TEFCA-based exchange dominated 2021 and will also drive headlines next year as the first Qualified Health Information Networks (QHINs) are selected and begin exchanging patient data.
Also, look for improvements in areas such as image exchange and push notifications in 2022.