Without a doubt, there is a confluence of market, government and industry forces that are accelerating improved data exchange and ultimately true interoperability.
Market Forces Driving Data Exchange
- Consolidation and Vertical Integration: Traditional and non-traditional entrants as well as retail players are merging and partnering with the potential for significant disruption and innovation. To name but a few, there is Haven, the partnership of Amazon, Berkshire Hathaway and JPMorgan Chase, Amazon’s other healthcare acquisitions such as PillPack, CVS/Aetna and Walmart Humana.
- Value-Based Care and Population Health: The evolution to value-based care continues and the payment model is expected to account for 59 percent of healthcare payments by 2020. Large payers like Aetna and United are aggressively moving their provider contracts to value-based care and the Centers for Medicare & Medicaid Services (CMS) remains committed to value-based programs.
- Care Coordination Need for Data and Insights: The amount of data and the number of data sources – for example, the addition of critical social determinants of health (SDoH) data – are increasing to develop patient risk profiles, cohorts, populations for case and disease management programs and more as well as to drive patient engagement.
- Physician Burnout: Geneia’s Physician Misery Index, a tool we created to measure national physician satisfaction, has increased to nearly 4 out of 5. At the same time, a study published in the Annals of Internal Medicine calculated a baseline of about $4.6 billion in annual costs from turnover, reduced productivity and other burnout-related factors.
Government Forces Driving Data Exchange
Rulemaking associated with the 21st Century Cures Act is advancing interoperability:
- Office of the National Coordinator for Health Information Technology (ONC) Notice of Proposed Rulemaking (NPRM) Information Blocking: Based on feedback from stakeholders and consultation with other federal agencies, ONC has proposed seven categories of practices that do not constitute information blocking.
- ONC NPRM Trusted Exchange Framework and Common Agreement V2 (TEFCA): TEFCA has three primary goals:
- Provide a single “on-ramp” to nationwide connectivity,
- Enable electronic health information (EHI) to securely follow the patient when and where it is needed and
- Support nationwide scalabilty.
- Centers for Medicare and Medicaid Services (CMS) NPRM to Improve Interoperability and Patient Access: This rule proposes that interoperability means, with respect to health IT, such health IT that:
- Enables the secure exchange of EHI,
- Allows for complete access, exchange, and use of all electronically accessible health information for authorized use under applicable state or federal law and
- Does not constitute information blocking.
- Patient Access: ONC proposes to promote policies that would ensure a patient’s EHI is accessible to that patient and the patient’s designees and that meet the United States Core Data for Interoperability (USCDI) standard.
Industry Forces Driving Data Exchange
There also are a number of industry-led initiatives promoting interoperability:
- The Argonaut Project is an industry-driven effort to accelerate Fast Healthcare Interoperability Resources (FHIR®). The Argonaut Project is currently focused on clinical notes, bulk data access: flat FHIR®/backend services authorization and simple assessment.
- The DaVinci Project, a private sector initiative of industry leaders – 13 payers, 12 health IT vendors, three EHR companies and nine providers – and health IT technical experts working together to accelerate the adoption of HL7® FHIR® as the standard for value-based care data exchange. The project is focused on 12 use cases with the goal of helping payers and providers improve clinical, quality, cost and care management outcomes.
- SMART on FHIR® is an open, standards-based technology platform that enables innovators to create apps that seamlessly and securely run across the healthcare system. The SMART platform is composed of open standards, open source tools for developers building apps and a publicly accessible app gallery. SMART clinical applications are being used to provide clinical care at healthcare organizations such as Boston Children’s Hospital and Duke Medicine.
I wholeheartedly believe the market, government and industry forces driving data exchange are strong evidence of the groundswell of activity and demand for true interoperability. After all, holistic and impactful patient care – that which is incented by value-based care reimbursement models but more importantly, the kind of integrated and coordinated care we all want for our loved ones – requires integration of clinical data along with wearables, social determinants and much more and on-demand data exchange at the precise moment and location a patient and her care team need it.