The Executive Suite: Advancing Interoperability: More work to be done

As we transition to a new administration, interoperability must remain a top priority for CMS leaders.

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In one of her last speeches as CMS Administrator, Seema Verma noted that her agency’s record on interoperability under her leadership “reveals an unsurpassed record of accomplishment.” Thanks to Verma’s vision and direction over the past four years, the country has made great strides, most notably:

The launch of Blue Button 2.0, a developer-friendly FHIR-based API that gives Medicare beneficiaries secure access to their claims data on their phones or other devices.
Passage of the CMS Interoperability and Patient Access final rule, which includes a requirement for all health plans doing business with the federal government to deliver something like Blue Button 2.0 for patients in CMS-regulated health plans. The rule also requires hospitals to send admission, discharge, and transfer notifications to patients’ doctors to improve care coordination.
The start of the Data at the Point of Care pilot, which gives providers direct access to patient Medicare claims data within existing workflows.

The promotion of FHIR APIs to support interoperability initiatives.

These efforts have led to improved patient access to clinical information, especially claims data. Yet as Verma admits, “there is more work to be done” including improvements that deliver more usable clinical data to clinicians to drive better patient care.

As the Biden team builds on previous administrations’ efforts to advance interoperability, policy makers must prioritize initiatives that facilitate data sharing between providers and give clinicians easily accessible information that substantially improves patient care.

The current state of interoperability

Consider the current state of interoperability. Despite good progress in recent years, the lack of interoperability between clinical systems and provider organizations continues to impede patient care. In a recent KLAS-CHIME study, for example, just 44% of providers reported being able to automatically access and easily locate clinical data in their EHRs. In addition, just 15% said that the retrieved data had an impact on patient care.

One reason healthcare still lacks deep interoperability is because shared information is often incomplete or includes an overabundance of irrelevant data. For instance, claims data includes procedure and diagnosis codes, but lacks specifics about a patient’s overall health, treatment plan, test results, etc. In addition, to preserve their competitive edge in the market, some health IT vendors and providers engage in data blocking and share only the bare minimum required by state or federal law. If the exchanged information includes too few details, the recipient may not have an adequate overview of a patient’s health.

Alternatively, a sender may dump too much information into continuity of care documents (CCDs). If a CCD includes every bit of information on a patient, a clinician may need to wade through an unwieldly amount of data to find specific information that is meaningful for the current encounter.

In short, persistent interoperability gaps make it difficult for clinicians to access the information they need for clinical decision making.

Interoperability that serves the needs of clinicians

To make a substantial impact on patient care, clinicians require deep interoperability that is bidirectional and supports the automatic parsing of data so that users can easily locate meaningful information. From a policy perspective, this will require rules that authorize significant incentives to encourage data sharing and levy substantial penalties for organizations that fail to comply.

Rather than wait for mandated changes, healthcare organizations can advance interoperability now by embracing solutions that work with existing EHRs. By adopting FHIR APIs or other technologies, providers can enhance the integration and usability of shared data and facilitate the transfer and exchange of clinical information.

Organizations can further enhance the usability of data and facilitate clinician-friendly workflows with the integration of clinically intelligent mapping tools that link relevant concepts within an EHR. Such solutions give clinicians ready-access to patient- and problem-specific diagnoses, medications, and other critical information, regardless of where the concept originated. Instead of jumping from screen to screen to find relevant details, clinicians have immediate access to the information they need to make informed decisions about the patient in front of them.

As we transition to a new administration, interoperability must remain a top priority for CMS leaders because there is more work to be done. With deep interoperability as the goal, we can empower clinicians with more complete patient information and cleaner workflows that optimize the delivery of patient care.