Nitor Infotech Blog
Nitor Infotech is a leading software product development firm serving ISVs and enterprise customers globally.

In the ever-evolving world of healthcare, the pursuit of accessible and cost-effective patient care has been a cumbersome endeavor. You could think of it like searching for your car keys in the morning rush – vital, sometimes frustrating, but always worth it.

However, in 2010, a game-changer called the Affordable Care Act (ACA), also known as Obamacare, entered the stage and proved to be a turning point. The Centers for Medicare & Medicaid Services (CMS) joined the effort too, committed to making healthcare financially sustainable.

How? Well, the answer lies in interoperability.

At its essence, healthcare interoperability represents the ability of various healthcare systems, providers, and patients to seamlessly share vital medical information.

This exchange of data, often extending beyond Electronic Health Records (EHRs), holds the promise of – reducing errors and enhancing patient outcomes.

In this blog, I will walk you through the progressive landscape of healthcare integration and interoperability, exploring:

  • the latest regulations
  • governance measures
  • the future of this dynamic field

Starting with the mandates first!

Key Regulations and Measures

Although integration and interoperability have existed within healthcare since the 80s, it was only in 2011, that the Promoting Interoperability (PI) initiative was launched by CMS under the Medicare and Medicaid EHR Incentive Program, with the goal of promoting the meaningful use of certified EHR technology (CHERT). However, despite nearly a decade of effort, patients still face challenges accessing their health data.

Over the years, a series of regulations and guidance have aimed to dismantle data silos, and CMS has consistently worked toward advancing interoperability.

Here are some pivotal regulations that have significantly shaped this field:

Pivotal Regulations

  1. The 21st Century Cures Act (2016/2020): This act, passed in 2016 and updated in 2020, promotes next-gen interoperability in healthcare. It requires healthcare organizations to give patients access to their electronic health records (EHRs) through APIs while also banning “information blocking.”
  2. Information-Blocking Rule: As a part of the 21st Century Cures Act, this rule puts an end to practices that obstruct the sharing of electronic health information. It imposes penalties, including fines of up to $1 million per information-blocking violation, to deter such practices.
  3. CMS Interoperability and Patient Access Rule: The Centers for Medicare & Medicaid Services (CMS) rule mandates that health plans make patient data accessible and share electronic notifications related to admissions, discharges, and transfers with relevant healthcare providers.

To make the most of interoperability, understanding the role of governance is essential. Keep reading!

Role of Governance in Interoperability

Effective governance is the cornerstone for the successful implementation of interoperability in healthcare. It encompasses essential elements like data-sharing agreements, privacy safeguards, and data quality standards. Here’s why governance matters:

1. Data-Sharing Agreements:

  • These formal agreements establish the rules and responsibilities for data sharing between entities.
  • They ensure that data flows smoothly and predictably between Health Information Exchanges (HIEs) and healthcare organizations.

2. Privacy Safeguards:

  • Governance includes robust privacy measures to protect patient confidentiality.
  • These safeguards prevent unauthorized access to sensitive health information.

3. Data Quality Standards:

  • Governance sets standards for the accuracy and completeness of health data.
  • Ensures that the data being shared is reliable and trustworthy.

Further, get to know, how interoperability has become the preferred choice for healthcare solutions.

Growing Need for Healthcare Integration

Let’s delve into specific sectors where healthcare integration is reshaping the way we deliver care and drive innovative health solutions.

1. Healthcare Integration for Clinical Research Organizations:

Clinical trial organizations are increasingly relying on data from a multitude of sources to enhance drug discovery. They harness data from various channels, including patient forms, electronic health records (EHRs), mobile and wearable devices, clinical registries, health claims, genetics, and more.

This data wealth enables these organizations to generate insights from Real-World Data (RWD) and apply them to their studies.

Regulatory bodies like the US FDA 1 and the European Medicine Agency (EMA) 2 are acknowledging the value of observational data in supporting clinical efficacy.

Streamlining data for submission-ready datasets, through FHIR to CDSIC mapping, CDASHIG, SDTMIG, LAB, LOINC, and UCUM mapping, further enhances the evidence base for clinical trials.

2. Growing Need for Integrated HIE:

Patient-centered care is fundamental in healthcare, and interoperability is the key to giving patients a complete view of their health information. Seamless access to clinical data empowers healthcare providers to make informed decisions. Thus, enhancing the overall patient experience.

Connecting with Qualified Health Information Networks (QHINs) like CommonWell is pivotal for healthcare organizations to:

  • generate patient journey view
  • ensure seamless data exchange
  • foster patient-centric approach
  • accelerate care delivery exponentially

3. VBC, Healthcare Innovation Centers:

Value-Based Care (VBC), Population Health, and various innovation-centered health IT organizations collect data from diverse sources. They integrate data from electronic health records, administrative details, risk assessment, laboratories, pharmacies, Social Determinants of Health (SDoH), genomic data, and more.

This comprehensive patient health journey mapping is essential for VBC organizations to:

  • optimize cost utilization
  • stratify and mitigate risk
  • Defining contractual obligations
  • execute effective campaigns improving care

4. Interoperability for Healthcare Plans:

CMS’s Payer-to-Payer data exchange mandate, utilizing USCDI v1 dataset standards, facilitates seamless member transitions between payers. This ensures continuity of care while aligning payers with a member’s clinical history.

Explore the significant impact of Interoperability on Healthcare Ecosystems.

Well, healthcare interoperability may seem straightforward, but at times, you might encounter some challenges. Get ready to discover what these barriers are and how to overcome them in the next section.

Overcoming Interoperability Challenges

Despite the presence of regulations, certain challenges persist in the journey towards seamless interoperability. Issues such as – data security and the diversity of EHR systems pose hurdles.

Here’s how you can tackle such roadblocks:

  • Data Security: Today, cybersecurity threats are ever-present, and healthcare organizations must implement robust measures to safeguard sensitive information. For this, comprehensive security strategies encompass encryption, multi-factor authentication, and routine security audits.
  • Standardized Data Formats: The diversity of EHR systems and data formats can create interoperability barriers. To address this challenge, the healthcare industry is moving toward standardized data formats and most adaptive to Fast Healthcare Interoperability Resources (FHIR) standard. This ensures that data can be seamlessly exchanged across different systems be it any.
  • Solving the Patient Puzzle: Finding one patient’s information in a sea of data from – electronic health records, insurance records, labs, pharmacies, claims, health information exchanges, and care management can be tough.
    To tackle this issue, implementing an enterprise master patient identifier that captures a unified golden record and links all data to a single source, complete with traceability identifiers for tracking, can effectively address data retrieval and transformation hurdles.

Now that you know how to surpass the barriers, I bring you the future of healthcare at its best.

The Future

Interoperability has come a long way since its inception. For a visual journey through its evolution and importance, refer to the following image:

Key Events Timeline

Key Events Timeline

As technology advances, interoperability will gain greater importance, extending horizons and continuing to provide a multitude of health benefits. Here’s what you can expect:

  1. Refining Standards: The industry will enhance standards like FHIR, CDISC, and LOINC to adapt to evolving healthcare needs.
  2. Cybersecurity Priority: With increased digitalization, protecting data will gain prominence with stricter privacy regulations.
  3. Equitable Access: Efforts to ensure universal healthcare data access, and bridging socioeconomic gaps will become crucial.

Therefore, through such effective regulatory progress, healthcare’s future promises 3 major things to mankind:

  • improved patient outcomes
  • enhanced experiences
  • a healthier society

If you want a brighter future with top-notch healthcare services, join hands with Nitor Infotech, who are at the forefront of this transformation.

We specialize in centralizing data into Clinical Data Repository (CDR) structures.

Using customizable connectors, we – unify patient data with eMPI tagging and ensure HIPAA-compliant security on trusted cloud platforms. This empowers better management of long-term, multiple-chronic conditions.

Sounds interesting? Get in touch with us.

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