Is 2021 Interoperability’s Big Breakthrough Year?

Take an academic, a technologist, a doctor, and a nonprofit leader and what do you get? Agreement that 2021 could be the breakthrough year for interoperability in healthcare. In a lively conversation at the end of last year for the Fierce Health IT Virtual Series, “The future of interoperability—will we ever get there?”, we were all optimistic that regulatory changes, urgency created by COVID-19, and new interest in value-based care will unlock new momentum and progress. Now we’ve got nine more months to make it happen.

The good news:

COVID-19 has created new urgency — In 2021, states and the new administration will focus on building public health data systems to support a vaccination campaign of unprecedented scale and future public health needs. Done right, these systems can support data sharing across clinical and public health stakeholders and reduce burden on over-taxed hospitals and clinics. Robust health information exchange organizations that aggregate demographic, clinical and administrative data from many sources are an important partner in these efforts. In recognition of that potential, California and other states are launching new legislative efforts to require data sharing and establish statewide health information exchange infrastructure.
New interest in value-based care — Ambulatory providers will now move more rapidly to risk-based options, having seen that participation in these models was economically protective during the pandemic. The move to value-based care will drive greater participation in data exchange. Providers participating in these models know they need data from outside their own systems to care for patients proactively. As my friend Farzad Mostashari, MD says, value-based care is the business case for health information exchange.
The focus on social determinants of health (SDOH) is broadening the need for collaboration — In California, Medicaid now covers one in three residents. Medicaid plans are transitioning from being medical plans to being medical and social plans. They are taking on deeper and deeper levels of support for patients, including housing and food and other social services. There is an increasing need to exchange information not just across clinical providers but also with a broad set of community organizations. In order to partner effectively, they need a shared backbone of data and tools that accommodate wildly divergent technical capabilities.

The bad news? There are still large obstacles remaining that we need to address. Some of those challenges include:

Hospitals still don’t have enough reason to share — Hospitals are exchanging data through national networks like CareQuality but often don’t engage in deeper forms of data sharing needed for population health. They are moving towards value-based care, but not fast enough to make a real case for more data sharing. Jacob Reider, MD from the Alliance For Better Health likened the durability of fee-for-service to an addiction. “The people, products, and processes of these organizations have been entrenched in maximizing fee-for-service revenues for decades. To change that is really hard.” Julia Adler-Milstein, PhD from University of California San Francisco noted there are “some glimmers of hope” around bundled payments, but otherwise not much to celebrate. In this environment, it will take a combination of data sharing requirements and incentives to move the dial. The upcoming CMS ADT data sharing requirements are one example. States like North Carolina, New York, and Arizona have established their own state-level data sharing requirements and incentives.
We’re not investing in equity and trust — Information exchange has traditionally focused on generating trust among providers, but we need to shift to thinking about how we build the trust of patients and the trust of our communities. Also, in the pandemic we realized that gaps in race and ethnicity data were seriously hamstringing our efforts to identify disparities early and act fast to fix them. These are urgent challenges we must tackle.
We must avoid boiling the ocean — Dr. Adler-Milstein urged health leaders to focus on the basics, not to “boil the ocean” — suggesting that the most successful progress on health data sharing has occurred around specific use cases like ADT alerts and looking up a patient record at the point of care. Health data leaders should invest energy in making these basics dependable and ubiquitous.

We’re ignoring the data janitors — As the sector moves to support value-based care and even broader constituents, healthcare organizations need shared capabilities to manage and make sense of data. Moving data from point A to point B is only the first step of exchange. The “data janitor” work is integrating and managing records coming from many different places, including matching, de-duplicating, normalizing, and attributing data. Only a few large organizations can do this on their own today. Many states are investing in their HIE networks as shared “data utilities” to address this gap. Edwin Miller from Audacious Inquiry made a case for this investment: “[the work comes down to] normalizing the data and then scrubbing it, and then going back to the data source and saying, ‘Oh, you’re missing three fields,”… and the hospital thought they were done when they built the interface.”

Even with these challenges our sector is at an invigorating tipping point for interoperability. Building public health data systems can lay the broader foundation for the healthcare system patients and providers want—one that is inclusive, transparent, and generous. Let’s make 2021 the year we get it done.