The ability to share data seamlessly has eluded the healthcare industry much longer than other industries. Today, we can go to practically any bank anywhere in the world and check our balance and even withdraw money globally in local currencies against our US Dollar balances. We can use an app on our phones to send money to someone who banks at a different institution. We can call anyone around the world, regardless of which phone company they use. Why have so many industries achieved interoperability while healthcare hasn’t?
The answer is that healthcare is highly confidential and complex with hundreds of private, commercial and government payers, and thousands of hospitals, physicians, specialists and other types of providers. Data systems and technologies vary from one entity to the other. And since most patients see at least a dozen providers in their lifetimes, multiple versions of their patient record, both paper and electronic, exist in numerous data silos across the ecosystem. So, sharing information in healthcare isn’t as simple as sending data from one banking account number to another. In fact, there is no single, central location for all of our healthcare data in most cases. Instead it resides across multiple health systems, insurers, and is often very siloed.
It’s been a long journey to now
As an industry, we’ve been working on the problem of interoperability for more than 60 years. The first major initiatives began in the 1960s with the implementation of electronic data interchange (EDI) for claim adjudication. Then came federal legislation, starting with the Health Insurance Portability and Accountability Act (HIPAA) in 1996, then the American Recovery and Reinvestment Act (ARRA) in 2009 and the Health Information Technology for Economic Clinical Health (HITECH) Act. The latter focused on advancing provider adoption of electronic health records (EHRs).
Since 2008, EHR adoption in hospitals has risen from 9% to 96% in 2021 and adoption by office-based providers has increased from 17% in 2008 to 78% in 2021. While adoption has improved efficiencies and care coordination, they have not achieved genuine interoperability—or data fluidity—between providers. In fact, most hospitals have at least ten EHR systems in place, further inhibiting seamless data sharing.
The fax machine—outdated in most industries—remains as a common form of data sharing among providers.
Where we are now
Today we have the Trusted Exchange Framework and Common Agreement (TEFCA) initiative, which was born of the 21st Century Cures Act. TEFCA aims to create a “secure, nationwide, interoperable health information exchange across health information networks by providing a common trust framework and standardized rules.” The basis for this network of networks is the qualified health information exchange (QHIN). A QHIN is similar to health information exchanges (HIEs) but with national reach. Most HIEs are bound to specific geographic regions. As of February of 2023, six companies had applied to become a QHIN.
One thing is certain: Providers and payers have spent enormous sums building hospital information systems (HIS). These legacy systems are clunky and do not always play nicely with newer technologies. Interoperability solutions that leverage Fast Healthcare Interoperability Resource (FHIR) hold promise in facilitating better interoperability between systems, but they’re still sitting on top of outdated infrastructure. This means data fluidity still relies on a network of single-use point-to-point connections, which can be a burden to implement and maintain.
Interoperability of the future
In a genuinely interoperable healthcare ecosystem, providers won’t have to build and maintain numerous point-to-point connections with each trading partner. They won’t have to rely on third-party aggregators because data won’t have to be aggregated. It will be accessible where it is housed, which will allow it to remain in the control of the data originator. Blockchain and other advanced technologies will provide complete immutability and traceability of data, eliminating issues with trust and the need for constant validation. FHIR creates a standard for seamless data exchange.
How will this be accomplished? Through a single, decentralized network where all stakeholders—payers, providers, and innovators—can easily collaborate, send transactions, and share data in real time. With this type of interoperability, all participants on the network can connect with any other network participant without having to build multiple point-to-point gateways. Imagine having a single connection that enables connectivity and data sharing with hundreds or thousands of other providers, payers, and innovators.
One of the most significant benefits of this type of network is that it enables innovators to work together easier, connect with stakeholders, and deploy new solutions faster, easier, and cheaper. Today, it can take years for new technologies and solutions to reach scale in the marketplace. By promoting more effective innovation and collaboration, this type of network can further healthcare innovation across the ecosystem.
We don’t have to wait
A new decentralized network of the future exists and is in operation today. Large payers and providers are already beginning to use it for administrative transactions, although clinical transactions are also envisioned. As more organizations decide to participate, the network will expand to include near-unlimited use cases and data pathways that can be easily customized and implemented for any organization. This network is highly secure and enables the existing silos to be broken down to enable data to be accessed at the right time, by the right person or system, to enable improved care experiences and lower transaction costs.
We don’t need to be bound by the technologies of the past or large legacy systems. It’s time to reimagine what healthcare interoperability could look like.
Photo: JamesBrey, Getty Images