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Achieving the promise of health IT: 8 barriers to interoperability we must overcome

Editor’s Note: On July 23, 2015 Paul Black testified before the Senate Committee on Health Education Labor and Pensions, to share his thoughts about how to advance health data exchange. This post is the first in a three-part series that will address aspects of interoperability: 1) overcoming barriers, 2) financial motivation and standards, and 3) information blocking.

Interoperability is of great concern to us, as more independent doctors use our software to treat patients than any other commercially available product. If a stakeholder were to intentionally get in the way of information exchange, there are two main concerns: 1) it would be bad for patients, and 2) it could be anti-competitive. Period.

Several years ago, Allscripts made a decision to invest in an Open approach to connectivity – one that is grounded in the Allscripts dbMotionTM Solution connectivity platform and a large network of certified software developers outside of the company who build apps based on our open APIs.

There are many examples of providers who have worked through the process of establishing connectivity and are making it work, such as:

Holston Medical Group, which has offered to connect all providers in northeast Tennessee and southwest Virginia. The organization is working with Allscripts to facilitate data exchange between 25 different electronic health record (EHR) systems used by two hospitals and 1,200 physicians in more than 50 groups (either already connected or in process).

University of Pittsburgh Medical Center, which has set up a connected network of 22 hospitals, 4,000 physicians, imaging centers, labs and others using dozens of different health information technology systems.

Citrus Valley Health Partners in California, and the list goes on, covering millions of patient lives.

While it is clear there is still effort required, our clients demonstrate every day that information exchange can lead to quantifiable and demonstrable improvements in care delivery.

It is true, however, that today not all stakeholders in the healthcare industry seem to be equally motivated to make information liquidity a reality. While Congressional investments have helped the industry to realize measurable benefits from the rapid adoption of electronic health records – an important success that shouldn‘t be overlooked – clinical data exchange is not where it needs to be.

There are many factors we need to address for us to ultimately be successful:

1. Expand standards development process, building on the real progress underway with guidance from government and allowing the private sector to continuously develop, adopt and modify new standards;

2. Require organizations to follow available standards, such as those for public health registries, labs, state health information exchange organizations and others;

3. Harmonize state laws and regulations, particularly those related to privacy and security, patient consent and other similar topics;

4. Address legal and liability concerns among providers about how the data will be used outside of patient care;

5. Agree on what and how we store data – we need to get beyond the focus on how data is transmitted;

6. Create activation strategies to increase use of health IT by patients and their caregivers, while also generating accountability for their health outcomes;

7. Develop a national patient matching strategy – a way to identify each individual patient. This is a real challenge to both robust data exchange and patient safety, and Congress needs to stop blocking progress on this critical issue; and

8. Achieve greater transparency around interoperability and health IT among virtually all stakeholders.

Beyond all that, though, the sluggish progress we’re discussing today most closely stems from one critical deficit: the lack of a strong business case or a true market driver for interoperability.

Read more in Paul Black’s next post in the series –  Achieving the promise of Health IT: Interoperability needs financial motivation and time to succeed

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