The outbreak of COVID-19 has posed a huge challenge on the medical infrastructure of most countries. The sudden rise in the number of patients and the need to respond quickly to ensure patient care has put great importance on the need for seamless interoperability in the healthcare industry. Providers and payers alike need to consider interoperability as one of the key challenges to address in their digital transformation initiatives.

Suggested read: Digital Transformation – The gap between the Expectation vs Outcomes

Simply put, interoperability is the facility for quick access to comprehensive patient data records for the patient, providers, and payers in a reliable and secure way. Interoperability puts the patient at the center of the healthcare industry. It can enable the patient to be fully informed of their status at all times and help providers to provide better patient care.

Legal mandate

While interoperability has always been a topic of discussion and has long been a part of the patient welfare Wishlist, the U.S. Centers for Medicare & Medicaid Services (CMS) mandated it through the Interoperability and Patient Access final rule (CMS-9115-F) in 2020. This makes it mandatory for the medical ecosystem to provide patients with access to their health information when they need it the most and, in a way, they can best use it. This means patient data needs to be easily accessible across disparate systems, providers, payers, and third-party apps, while still ensuring data privacy and security – which is surely not a cakewalk.

Challenges for the healthcare industry when it comes to data

The need of the hour is a system that will provide patient data that is live, synchronized, and enables controlled and secure access. Ensuring interoperability is a challenge because there are too many stakeholders and systems involved. There are different types of healthcare providers and payers, several electronic health record platforms (EHRs), and many third-party apps. Ensuring data encryption and security is non-negotiable as patients’ personal data is involved. The legal mandate and the tight timelines mean putting extra load on an already stressed healthcare system. Furthermore, interoperability needs a lot of standardization, automation, and reduced manual intervention. This is not easy to achieve for healthcare providers since using sophisticated technologies is necessary for the process.

Implementing healthcare interoperability

Following are the key aspects to consider while implementing an interoperability strategy in the organization

Patient information standardization

To exchange information effectively, it is necessary that all concerned players follow standard formats. HL7 and FHIR (Fast Healthcare Interoperability Resources) are two conventional standards that can be used. SMART on FHIR is also a great attempt by the US government at getting interoperability right.

Unique patient identifier

Irrespective of the standard and system that is being used, the ability to uniquely identify a patient is absolutely mandatory. This is a requirement that is core to ensuring interoperability. The necessity to avoid any data mix-ups for patients with similar names, birthdates, and other such factors cannot be overstated.

Data privacy and security

The idea behind interoperability is to give controlled and secure access to patient information to only relevant parties. Patients need to be assured that their information is going to remain completely confidential and secure even if it exchanges hands across multiple players, platforms, and third-party apps.

Comprehensive medical records

While electronic health information or records (EHI/EHR) has been maintained by players for several years, there is still a lot of patient data that exists in multiple sources across multiple players. The ability to bring all of this data together in a system that is easily integrable is mandatory to ensure interoperability.

Data integration

The law mandates that patients should be able to access their information using third-party apps. This means systematic integration of data is necessary between providers, payers, EHR operators, and third-party apps. Affordable data integration models are needed to achieve this.
Healthcare interoperability has the potential to truly transform patient care. It can empower patients and enable providers and payers to respond better and faster to patient needs since they will have comprehensive access to patient history. That is why, as challenging as it is to implement interoperability, it is also an opportunity to put the patient at the center of the healthcare system. The success of interoperability will be driven by people and technology coming together and going beyond regulatory requirements. This will help us reach the ultimate goal of significantly improved patient care.

To understand how we can help you implement interoperability, talk to our experts today.