Interoperability Part 1: Addressing Complex Data Challenges Across the Healthcare System


April 10, 2020

One of the most complex data challenges in healthcare is interoperability. Data standards can improve the way we experience healthcare, but that means taking numerous stakeholders, multiple data standards, and transmission of large amounts of clinical and administrative data into consideration.  During these emergent times of COVID-19 pandemic management, it’s critical to ensure data moves as easily through the healthcare system as possible. Initiatives like the Da Vinci Project continue to gather healthcare industry leaders to provide the foundation for the work to proceed.

In 2018, the Da Vinci Project was created. Cognosante is a founding member of this initiative and the first health IT company to participate.

Principal and Senior Advisor for Health Data Standards, Mary Kay McDaniel, represents Cognosante at several healthcare Standards Development Organizations (SDOs). Because she focuses exclusively on how standards development can solve complex data challenges in healthcare, she has been actively engaged in the Da Vinci Project since the beginning.

More about the Da Vinci Project

The Da Vinci Project focuses on setting the rules by which data is recorded and used in our national healthcare system. Historically, three different organizations have defined data standards. The HL 7 domain was clinical, the X12 domain was administrative, and the NCPDP domain was prescription drugs.

Mary Kay McDaniel moves among the three organizations to ensure that data is shared between users without losing context. For example, how many data points are needed to provide relevant information associated with a patient’s temperature? Correctly applying data standards means seeing whether an elevated temperature is a fever or simply an overheated patient.

As a co-chair of the Financial Management Workgroup (FM) at HL7, McDaniel works with three other co-chairs, subject matter experts. and program management staff to develop implementation guides (IGs) that determine how the standard is used to meet a particular outcome. To date, this workgroup has sponsored most of the Da Vinci Project implementation guides.

How does the Da Vinci Project differ in solving complex data challenges in healthcare?

The Da Vinci Project builds on the work of previous groups but adds a specific focus on bringing payers, providers, and vendors together. This means multiple organizations are now dedicated to solving problems for the industry, rather than a single payer, provider or vendor.

Thanks to the Project, organizations are working together more closely than ever before. They are problem solving, resolving intellectual property constraints, and reconciling inconsistent vocabulary. Independent organizations are co-learning and going beyond legislative mandates in a commitment to solving these critical challenges to patient care.

Why is it important for companies like Cognosante to be engaged?

In short, it’s the right thing to do. For interoperability to work, data must come across all standards with the same contextual understanding. Each SDO may do it differently, but information must ultimately mean the same thing to all parties. The DaVinci Project brings people together to make this happen. As a health IT solution provider, Cognosante offers an industry-wide perspective that adds value.

Healthcare’s most significant achievements in improving access to clinical data

Twenty-five years ago, there were no clear-cut guidelines for who had what data and how they used it. Even getting a handle on all the players (payers, providers, pharmaceutical companies) was a challenge. Projects like Da Vinci have made strides in understanding who is involved in accessing and sharing data , and in building the relationships and the framework that allow for exchanging knowledge and best practices.

Biggest challenges to achieving interoperability

There was a time when we couldn’t even print medical records, let alone have medical information transmitted electronically so there have already been huge steps forward. In addition to this progress, there remains room to improve on  back-end processes to make the data useful. Things like validating data and inbound messages consistently and de-duplicating and updating existing information where it is stored.

Each time a state, payer, SDO, and provider defines gender differently, it creates an opportunity to affect health outcomes at the point of care. We also must decipher who should lead the resolution of difficult issues like a single vocabulary for gender, easy and transparent licensing for vocabularies across the SDOs and applying solutions consistently across Standards.

What’s next?

Cognosante is currently participating in a project that will allow a prior authorization request to be approved and reviewed in real time, with all necessary, related records. Working with stakeholders to map what is needed across the various data standards to smooth out and speed up authorizations is an important next step in the interoperability journey.

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