Posted: 12 Apr. 2019 6 min. read

Interoperability promises a superhighway of data, but some hospitals are stuck in the parking lot

By Steve Burrill, vice chairman, US Health Care Leader, Deloitte LLP

Regardless of where I am, interoperable banking systems give me the ability to access accounts, deposit checks, transfer money, and pay bills—all with a few taps on my smartphone. Unlike my financial transactions, which are online and accessible, bits and pieces of my health history are scattered throughout the country. A lifetime of medical test results, drug prescriptions, specialist visits, and diagnoses are sitting in paper files and computer systems owned by physician offices, hospitals, and vendors in more than a dozen cities in which I’ve lived and worked. Similarly, my claims history is owned by a handful of health plans that have covered me during my career. None of these stakeholders can share any of this information with each other or with me.

Interoperability in health care appears to be several clicks behind financial services, and hospital executives regularly tell me they are worried about the impact this could have on quality and outcomes. Imagine if our complete health history existed in one place and could be accessed as easily as we pull up a checking-account balance on a computer or phone. Radically interoperable data promises to let consumers own their personal health information and share it with stakeholders (in real time) through a secure multi-lane superhighway of data.

Data belongs to patients, says CMS chief

At last month’s HIMSS conference in Orlando, US Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma outlined interoperability rules that were recently proposed by the US Department of Health and Human Services (HHS). If finalized as proposed, provisions of these rules would take effect as soon as January 1, 2020, leaving limited time for health care stakeholders to prepare.

Historically, when we have talked about interoperability, it has been among health systems and physicians. Patients, their families, and care teams have generally not been part of the discussion. Verma emphasized that patient data belongs to patients, and health plans, health systems, physicians, and government entities need to make it possible for patients to access and share this information. The idea that patient data belongs to providers or vendors, she told attendees, is “an epic misunderstanding.”

Taking baby steps toward interoperability is no longer an option

Many hospitals are unable to share information across their own software platforms, let alone with other patients, health systems, health plans, or physicians outside their network. Some hospitals and health systems are investing in software add-ons and patches to integrate their various software systems. Others have figured out how to share data with physicians who aren’t on the same software platform, but who are part of their Medicare Shared Savings Program (MSSP). However, there is typically a lag when sharing this information and developing dashboards—rather than the near-real-time data sharing that interoperability could deliver.

While hospital leaders have been taking baby steps to improve interoperability, they should pick up the pace to get to the future of health that CMS envisions. As health systems and physicians enter into more risk-based contracts, they need to be able to seamlessly share data to reduce costs and improve outcomes. All stakeholders—the patient, the clinician, the hospital, the drug and device manufacturer, and the health plan—should be committed to interoperability. Hospital and health system leaders should consider these strategies to improve interoperability:

  • Resolve internal data issues: Disparate IT systems (e.g., EHRs, claims, supply chain, staffing, imaging software systems) are prevalent in some hospitals, which can make it difficult to perform in-house analytics, let alone share data with other facilities. Moreover, technical challenges can keep hospital leaders from using data for clinical or business decisions. Health system leaders should identify the data elements that need to be shared with patients and third parties and work with their vendors to standardize how this information is captured across systems. HHS’s recently proposed rule could push providers to accelerate their transition to interoperability. The proposed rule would require the health sector to adopt standardized application programming interfaces (APIs), which could eventually make it possible for individuals to access health information through smartphones and other mobile devices—and potentially make it easier for disparate systems to interact.
  • Work with vendors and physicians to improve EHR usability and interoperability: EHRs are digital representations of paper charts that are used primarily for billing purposes. The proposed guidance seeks to improve the way EHRs connect, which could make them more useful to physicians. Many physicians are frustrated by the lack of interoperability with EHRs and the burden of documentation, according to Deloitte’s recent survey of 624 physicians. More than 60 percent of surveyed physicians say interoperability needs improvement. We also found that vendors and health systems don’t always seek feedback from the physicians who are using the technology. Including physicians in efforts to improve EHRs could result in a win-win-win for health systems, doctors, and consumers.
  • Relinquish control of data: Before consumers take more ownership of their data, health care stakeholders should give up control. In announcing the proposed rule, CMS said “information blocking” undermines efforts to improve interoperability. The proposal calls for hospitals and other providers to be reported if they limit the availability, disclosure, and use of electronic health information. “Making this information publicly available may incentivize providers and clinicians to refrain from such practices,” CMS said in a statement.
  • Build trust: For health plans, giving consumers access to their claims data could help providers make more informed care decisions, improve safety, and reduce redundancies. But health care stakeholders should trust each other. Health systems and health plans tend to have different goals and historically have not trusted each other. Add life sciences companies into the mix and we have a stalemate in the battle for health information. Moreover, efforts to build a world of interoperability will likely come to a screeching halt if the data infrastructure isn’t fully secure or if patients don’t trust it. Data security and privacy should be at the center of the evolution toward interoperability.

While banking is far ahead of health care in terms of interoperability, medical information is far more complex than financial information. It comes in a variety of formats and typically includes highly nuanced and personal data. However, once interoperability issues are resolved between departments within a hospital and among hospitals in a health system, radical interoperability should be an easier transition. This is becoming increasingly important given the amount of health data being generated through wearable devices, apps, and connected at-home medical devices. As more care is delivered at home—rather than at a doctor’s office or hospital—interoperability will likely become indispensable.

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