July/August 2021

Inside Interoperability: Cultivating Interoperability in the Next Normal
By Razvan Atanasiu
For The Record
Vol. 33 No. 4 P. 8

The challenges brought on by COVID-19 had nearly every organization across the world seeking accelerated ways to support remote work and provide digital services. For the health care industry, this meant the ability to enable virtual visits. While some organizations had digital transformation initiatives already in place, those that lagged behind were forced to catch up.

More than a year after work-from-home orders were enforced, health care facilities are still feeling immense pressure to provide the best care for patients in the safest possible way, while relying on several key technologies to carry out their work from anywhere. To achieve this, many facilities added new applications to their IT stack while others investigated how to get the most from the investments they had already made—such as their EMR or content services platform—to extend functionality and ensure providers and patients had the information they needed, when and where they needed it.

There were noticeable benefits to this new way of working, both for providers as they continued to prepare for care, deliver care, and share results remotely, and for patients as they hopefully received the care they needed. Despite the progress that has been made in the last year to better align technology and support remote work and patient care, a recent study conducted by HIMSS Market Intelligence healthcare leadership research revealed that interoperability remains a major challenge, with one-half of the leading providers that responded stating there are major obstacles thwarting their progress to reaching interoperability goals.

Connected care is the ultimate goal for both patients and providers. In today’s world, patients expect a digital experience with robust capabilities and immediate results. From the clinician side, providers demand real-time access to comprehensive patient information to ensure they are making more informed decisions and providing the best care.

The HIMSS 2021 State of Interoperability and Connected Care report showcased several integral challenges hindering interoperability, with unstructured data management being the primary barrier to success. However, this isn’t a new challenge for the health care industry; the two previous annual surveys also identified “managing unstructured content/data” as the main roadblock to achieving interoperability goals.

When it comes to structured data, hospitals and health care systems are actually quite good at managing and sharing that information within a standard taxonomy framework. However, when images, notes, and video are incorporated, the process to share that information becomes much more complex and convoluted. Nevertheless, those unstructured data play an important role in providing a complete view of patient records and helping each care provider make the most informed decision. Without access to these data—which more than 62% of respondents reported sits outside their core systems—it’s impossible to fully assess and analyze a patient’s condition. And with more patients participating in telehealth visits, the amount of unstructured data grows at an insurmountable pace, leaving providers in the dark and questioning the best way to manage that information.

Pandemic Highlights Weaknesses
To reduce COVID-19 exposure for patients and staff, health care organizations had to pivot quickly to telehealth and remote work. Rapid scaling of new remote and virtual processes revealed weaknesses in IT infrastructure that underpins interoperability. Health care organizations noted that the top challenges they faced due to the pandemic were the following:

• difficulty incorporating information from telehealth/virtual care components into the EMR;
• reliance on physical (person-to-person) clinical workflows that didn’t work in a virtual world to address disconnected data and processes; and
• maintaining compliance with regulatory requirements related to transparency and interoperability.

In response to these challenges, health care organizations set out on a mission to evaluate and acquire systems to support the current—and likely permanent—need for telehealth. The biggest investments expected over the next 18 months are solutions that enable telehealth, prioritize network enhancements and updates, and support digital interactions with patients and remote work.

Another gap uncovered in the research and reported during the pandemic is the ability to consistently share medical images so that they can be easily accessed at the point of care. Nine of 10 survey respondents agreed that access to images at the point of care is important, but on average only 18% of imaging data is captured and integrated with core clinical systems. Without access to images at the point of care, providers have a limited set of information to determine the best course of care.

In addition, there was limited success in extending patient access to their medical images through a patient portal.

The research found that PACS alone can’t address all medical imaging needs, and by adopting enterprise imaging strategies, health care organizations can deliver a complete view of the patient. Unfortunately, only about 35% of organizations reported they are adopting enterprise imaging strategies, with roughly 31% saying it’s part of a future plan. The HIMSS research showcases that imaging interoperability is a significant part of the 360-degree view of a patient.

Top Interoperability Goals
A majority of US hospitals and acute care facilities reported strong efforts to improve interoperability and connected care experiences, but there are opportunities to advance goals. For example, only one-third of respondents said they’ve reached the highest level of interoperability, which involves two or more systems exchanging, interpreting, and using exchanged data.

Respondents’ interoperability strategies included the following goals:

• optimize clinical workflows (68%);
• improve communication for coordination of care (61%);
• meet regulatory compliance requirements (59%);
• improve patient satisfaction (54%); and
• empower employees to make faster decisions (45%).

What’s standing in the way of health care organizations meeting these goals? Interestingly enough, integrating solutions with legacy systems was the biggest barrier. From there, respondents reported that integrating data from multiple EMRs (56%) and employee resistance to adopting new solutions (55%) were other hurdles to clear on the road to interoperability success.

To overcome these roadblocks, health care organizations should adopt an enterprise imaging strategy, leverage an electronic health information exchange, adopt natural language processing/voice recognition, move to a single EHR platform, and integrate point-of-care imaging and workflows. Taking these recommendations into consideration will significantly increase the chances of achieving true interoperability.

The Future of Comprehensive Interoperability
Interoperability is more than just purchasing and integrating technology to check a box. Planning an interoperability strategy starts with identifying the departments where unstructured data, including content and images, are an essential function within providers’ day-to-day jobs and ensuring that information is integrated for use within existing EMR systems for point-of-care decisions. From there, leaders can extend the content services platform into other departments where better access to unstructured content will benefit other core enterprise processes in human resources, accounting, supply chain, and revenue cycle management.

Vendors should strongly consider participating in Integrating the Healthcare Enterprise initiatives, interoperability profiles, and Connectathons. These resources will allow them to stay up to date on new industry innovations and trends while adhering to interoperability best practices. In addition, they provide invaluable tools to better understand provider pain points and help drive innovation in the space.

At the end of the day, interoperability shouldn’t be viewed as a technology issue. In truth, it’s a people issue in which success is determined by working collaboratively with both the IT department and leaders throughout the organization. Health care organizations need to focus on breaking down technology barriers to bring people together for better collaboration. Ultimately, the enterprise approach to connect people, processes, and systems and get the right information to the right people at the right time while ensuring control and security will become the gold standard for interoperability.

— Razvan Atanasiu is chief technology officer at Hyland Healthcare.