Why interoperability is essential for population health success

June 30, 2016   Jacob Levenson/Avi Mukherjee

As published in HealthData Management June 29, 2016

Delivering high-quality healthcare and improving overall outcomes, while simultaneously containing the rising costs of doing so, is a major challenge of the U.S. healthcare system.

Electronic medical records (EMR), health information exchanges (HIE) and patient portals provide valuable methodologies to providers; however, the problems and challenges of those systems have been widely reported. As the value-based model of healthcare continues to gain acceptance among providers and payers, population health management is becoming the future of healthcare delivery.

Importance of population health interoperability

Population health management provides the methodologies for providers and payers to contain and lower their costs, which increases operational efficiencies. With a system that spends almost 50 percent more on healthcare than the next highest-income country, yet has some of the worst health outcomes than any other developed nation, providers must be able to streamline care and improve treatment outcomes. In order to successfully transition to this broader, holistic approach, the integration of interoperability is crucial.

The goal of an increasing number of providers is to expand and extend patient care across the continuum, which requires interoperability. We know when providers have an in-depth and complete understanding of their patient, healthcare delivery, in terms of efficacy and efficiency, improves. The more information a provider has on their patients and can communicate with them, the better care they are able to deliver.

This is significant to behavioral healthcare providers who treat patients with chronic illnesses. In these cases, having access to all patient data, which could include co-occurring disorders, is critical. Without having access to the complete patient record, treatment outcomes cannot be maximized.

While resources such as EMR and HIE have their place, many physicians report feeling over regulated and over measured. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed a rule intended to balance the feelings of over regulation. With this rule in place, physicians are likely to have an increased sense of their engagement level and discretionary authority with regard to their patients’ treatment plans.

Fast Healthcare Interoperability Resources (FHIR) offers an open healthcare data standard from HL7. FHIR is a practical, robust approach to exposing granular data, which is a well-recognized need for developer-friendly APIs. In January 2014, FHIR achieved a milestone by being officially designated as a Draft Standard for Trial Use, as it improves healthcare data standards and focuses on modern web standards and implementability.

A notable advantage to FHIR is its inclusion of multiple reference implementations that are based on representational state transfer (REST). FHIR has been referred to as a “RESTful” API and utilizes the latest web-based standards, including implementing healthcare interoperability.

As the healthcare system faces the challenges of providing efficient data exchange between varying systems, FHIR is a significant advance in enabling the access and delivery of information, offering enormous flexibility and versatility. Its interface can be applied to mobile devices, web-based apps, cloud communication and EHR data.

SMART has an app platform for healthcare that has begun to receive interest from a variety of specialties. The SMART app has a low barrier to entry for developers and is capable of running in systems by different vendors and in different contexts, such as EHR and patient portals. In an effort to make healthcare more accessible, a gallery was launched earlier this year that offers single places to find and try SMART apps. These apps tend to be vendor and license neutral, and are not restricted to a single EHR platform. There are numerous ways to find the apps, such as by category or organization search.

As the healthcare system continues to evolve – and plays catch up with similar developed countries – providers will increasingly benefit from an enterprise-wide utilization of clinical, analytical and financial data. As the quality of this utilization improves, so too will the quality and coordination of patients’ care. Support for outcomes-based reimbursements and quality measures such as HEDIS, Stars, URAC, and NCQA initiatives are beginning to take hold and will have a positive impact.

MAP Health Management, a data-driven, population health management platform organization focused on behavioral health offers a care coordination solution that can be integrated with virtually any healthcare software system, including EHRs and population health management programs. MAP provides the ability to secure real-time clinical data from hospitals and treatment facilities, as well as actionable data in industry-wide adopted formats such as HL7 and FHIR.

Most patients in the behavioral healthcare system either experience co-occurring disorders or have other general medicine treatment teams; therefore, it is even more important that interoperability be effectively implemented for this population. With multiple providers, professionals, treatment plans and care teams, collaboration that focuses on maximizing efficacy and productivity and minimizing duplicative services is essential. Preventable medical error is third-leading cause of death, killing 1,000 people and causing an alarming 10,000 cases of serious complications every day, according to the latest reports.

Critical components to future healthcare platforms will effectively address and include the following:

  • A commitment to FHIR standard adoption across all healthcare specialties.
  • Cloud technology for integrating clinical and administrative claims data.
  • Fully-managed service requiring minimal health plan/treatment facility resources.
  • Experience with 95 percent of all hospital and treatment facility information system vendors.

Effective population health management demands open communication and collaboration through interoperability and an ability to have access to a patient’s entire record. In order to maintain effective communication and encourage collaboration, which will ultimately improve healthcare outcomes, our system must commit to converting all facilities to a single system or incorporate an overarching platform that can aggregate information from contrasting systems and blend the data so it can be accessed by multiple providers across all specialties.

More information can be found at MAP's website here.

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