June 29, 2020
Earlier this year, the Department of Health and Human Services (HHS) announced the release of two final rules to promote safe, secure access to patient health data. These rules implement key provisions of the 21st Century Cures Act. Specifically, they give individuals greater control over their healthcare data, promote the use of smartphone applications, and prevent data-blocking practices. These important steps move us beyond simple connectivity, and toward full interoperability in health.
From Connectivity to Full Interoperability in Health
When Office of the National Coordinator for Health IT (ONC) was created in 2004, health data collection was largely manual and paper-based. Luckily, we have moved beyond simply understanding who the key players are to developing the technology to connect stakeholders. The volume and complexity of data we have at our disposal is growing exponentially as connections and technology improve.
To get from connectivity to full interoperability, we need to focus our efforts on making the data useful to clinicians and accessible to patients. The following sections highlight areas of interoperability in health that will have the greatest impact on patient care.
Building Value on Top of Connectivity
Initially, interoperability focused on what technology could do. Now, we are shifting our focus to getting the most value out of the data and standardizing it across platforms and parties. As a founding member of the Da Vinci Project, Cognosante actively engages in refining those standards, and ensuring data is transmitted and organized consistently and meaningfully.
However, moving beyond standardization also means looking at where automation, machine learning, artificial intelligence and natural language processing can add value. As the volume of health information grows, we must ensure that we are teasing out the most relevant data, so that clinicians can focus on data that is relevant to a patient’s overall health. Machine learning allows us to filter through vast amounts of unstructured data and highlight the most relevant elements so that users can make more effective clinical decisions.
Data Analysis Tools Fueling This Progress
- Amazon Comprehend Medical extracts and analyzes unstructured text from provider notes, clinical trials and patient medical records. By identifying relationships, clinicians can improve patient care and makes patient interactions more meaningful through easier identification of important trends or patterns.
- Cognosante’s eSante Clarity takes unstructured data and provides an enhanced clinical view that filters the most relevant data using HL7 FHIR resources so that clinicians can see trends in patient’s history.
- Cognosante’s eSante Inform provides event notification services that allow providers to see where their patients have received, or will receive, care by facility, date and time.
- Outside of the clinical setting, machine learning can be invaluable in identifying factors that negatively affect health outcomes. Data on the social determinants of health (race, geography, socioeconomic status) is not easily collected or shared, for example, but analyzing it can improve our understanding of health disparities, and how best to address them.
Acceptable Use and Data Blocking
Another key issue is data blocking. Though less frequently, organizations still block data they view as proprietary, which can lead to an incomplete picture of patient health. ONC has since clarified reasonable and necessary data sharing activities and established rules to prevent information blocking practices in its Final Rule.
We support this effort through the eHealth Exchange (EHX) by hosting operational dashboards and reporting for all nationwide healthcare interoperability transactions flowing through the EHX Hub. By analyzing where the population is being seen, where information is being exchanged, and where it is not, we gain valuable insight into how data is being shared, and where it is being blocked.
Health Interoperability Gets Personal
The third major opportunity is empowering patients to control and use their healthcare data. Initially, the industry viewed the health information exchange at the center of a wheel, with the patient on the periphery. We have now shifted that perspective, so that the patient is at the center of the wheel, with electronic health records and HIEs as its supporting spokes.
- Through mobile health records and blue button initiatives like the Apple Health Record, patients can control their health data and share it with providers. These tools promote rapidly growing partnerships that allow payers and providers to understand health behaviors outside of a clinical setting.
- Through the 21st Center Cures Act and the Trusted Exchange Framework and Common Agreement, ONC is advancing the framework for HIEs to communicate with each other. This requires data sharing agreements, a trusted exchange framework and a common set of standards and guidelines. Implementing and adhering to this framework can create a comprehensive view of the patient record, while empowering the patient, who can be notified of requests for information and authorize them.
Data Protection For All
Security and patient privacy are also essential for any of these innovations to be successful. As we move forward, reconciling the importance of data exchange and the opportunities afforded by mobile technology while giving patients the confidence that data is only shared where and when it is needed is a requirement for interoperability’s success.
This is an exciting time for healthcare information technology. We now have the knowledge, the partnerships, and the technology to truly drive interoperability forward. The COVID-19 pandemic has added a level of urgency that we expect will yield additional innovation. We look forward to what the future will bring.