Posted on: March 13, 2019

A few weeks ago, several Hixny leaders attended the annual Healthcare Information and Management Systems Society (HIMSS) conference. In addition to sharing photos of sunny Florida with those of us shoveling out from a snowstorm, they relayed that a substantial focus of the conference sessions was interoperability.

For years, those of us working in health information technology (HIT) have zeroed in on how to make health information exchanges (HIEs) like Hixny and the wide variety of private vendor-produced electronic health records (EHR) systems interoperable. That is, how to make sure the data collected or shared through these different platforms can be read and used by people using any of the other platforms.

At the HIMSS conference, though, our team found the focus of interoperability broadening to reflect consumer expectations that have rapidly outpaced the healthcare industry’s rate of technology adoption. For example, some people are conversing with their providers using WhatsApp and similar software—but auto-transcribing those conversations into an EHR and sharing them through an HIE is light-years beyond current capabilities. Besides: Would those chats even be useful to other providers? Or just more noise?

These conversations have been brewing for years. However, as the HIMSS conference began, the U.S. Department of Health and Human Services (HHS) announced that it was proposing new rules to make data from individual health records easier to access for both consumers and providers.

The new rules are complicated—as you might expect from a government agency. In general, the proposal from HHS, through the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator (ONC) for HIT, would standardize the way HIT works to make your health data more transparent and accessible to you.

Ultimately, the goal is to empower you, as a consumer, to take an active role in your healthcare—and at the same time, to influence providers to modernize not only the use of technology, but the way they approach interaction with one another and with you.

The critical issue here is the difference between using technology to support your health choices and using technology in collaboration with your providers to improve your healthcare, as I discussed in last month’s post.

The proposed rules would standardize technology so you could control the use of your data from your computer or your mobile device.

They also set the expectation that all EHRs and HIEs will use the United States Core Data for Interoperability (USCDI) standard language so that all systems can share information with all other systems. Many providers are still working to meet the less-robust Common Clinical Data Set (CCDS), which is currently the basic standard in the industry.

They would also put an end to “data blocking,” when providers only share some of the information in their records instead of the full record, which prevents you and their colleagues from seeing a complete view of your health and introduces other challenges, too. The most common things providers want to block are their notes about you—despite evidence from the Open Notes initiative that shows improvements in health when you have access to those notes.

Much of this, in my opinion, is a decade overdue. Many of these issues date back to the original introduction of a federal program to make sure healthcare providers use EHRs and HIEs in a meaningful way. It succeeded in doing that, but in the process, created (or didn’t prevent) some of these problems. So, the current intervention and course correction is a good thing.

However, it strikes me that the HHS, CMS and ONC are focusing on technology as the solution to the many challenges in the healthcare industry. But for Hixny, as well as many other organizations, traditional technology-specific interoperability is not the problem. Many of our participants contribute data more robust than that in the CCDS, so we are already ahead of other communities. It makes me wonder whether the government would have us adopt technology for the sake of adopting technology or whether there are real problems in other areas of the country.

To me, the problem with interoperability is the content of the contributed data.

If that content is incomplete or the quality is poor, that causes problems. And I’m not even talking about questionable lab results or forgetting to verify smoking status. I’m talking about a misspelled name, an incorrect birthday or out-of-date emergency contacts. You should easily be able to fix these things on your own so that all of your providers receive that updated information. But you can’t, right now. You still have to rely on your provider to make the updates for you—and then hope that those updates are propagated through Hixny and that all of your other providers notice them and act accordingly.

We need to be looking not only at the technology, but at how we increase the speed and accuracy of quantitative and qualitative content generation, regardless of the technology. First among providers. Then to empower you to become an integral part of the healthcare system and your own care.