Interoperability is one of the most complex and challenging imperatives for healthcare. But it's a matter healthcare chief information officers and other health IT leaders must tackle.

A good way of understanding interoperability and how to solve it is by looking at where healthcare-provider organizations will be making interoperability investments in the future. That's what Healthcare IT News is doing in this second article in its latest feature series, "Health IT Investment: The Next Five Years."

For this series, we speak with health IT leaders, primarily chief information officers (CIOs), to learn from them the path forward through the priorities they set with their investments in six categories: AI and machine learning; interoperability; telehealth, connected health and remote patient monitoring; cybersecurity; electronic health records and population health; and emerging technology and other systems. Click here to read the first feature, on AI and machine learning.

This second feature focuses on interoperability. The health IT leaders sharing their plans for the next five years in this second installment in the series include:

• Cara Babachicos, senior vice president and CIO at South Shore Health, a health system based in Weymouth, Massachusetts.
• Matt Hocks, COO at Sioux Falls, South Dakota-based Sanford Health, a $6 billion health system serving a predominantly rural population over a four-state footprint with both payer and provider arms.
• Dr. J. Michael Kramer, chief medical informatics officer at OhioHealth, a health system based in Dublin, Ohio.
• Mike Mistretta, vice president and CIO at Virginia Hospital Center in Arlington.
• B.J. Moore, CIO of Providence, a health system that operates 52 hospitals across seven states – Alaska, Montana, Oregon, Washington, California, New Mexico and Texas.
• Michael Restuccia, senior vice president and CIO at Penn Medicine in Philadelphia, Pennsylvania.
• Dr. Umberto Tachinardi, CIO at Regenstrief Institute in Indianapolis, Indiana.

These experts offer board members, fellow C-suite officers, IT managers and workers in the trenches invaluable guidance in this latest feature article in the series.

A big, huge, whopping 'yes'

Mistretta of Virginia Hospital Center says it's a big "yes" when it comes to investing in interoperability over the next five years – but not in the manner one might expect.

"Most of our spend is not going to be [on] exchanging results with other providers; I think we have come about as far as we are going to get with a national patient identifier being put into place, and that doesn't appear to be a priority for our government," he stated. "Where I see the spend taking place is putting more power into the hands of our patients.

"The bi-directional transfer of patient information where they can upload and download on demand and access their information will continue to be enhanced in the next five years."

"Where I see the spend taking place is putting more power into the hands of our patients."

Mike Mistretta, Virginia Hospital Center

COVID-19 provided a huge proving ground for device interoperability since patients were looking for low-contact solutions to minimize exposure, Mistretta said.

"We started this initiative earlier this year with the rollout of our branded app," he noted. "We also have a product called OB Connect we are giving to low-risk expectant mothers where we provide a scale and ultrasound at home to self-monitor their progress.

"Prior to their scheduled checkup appointment, they record information that is reviewed by a midwife at their practice, and if there are no issues, they skip that appointment," he continued. "I see more of these technologies emerging moving forward with other diagnoses that will be huge patient satisfiers. The care-at-home market is where investments are going to be made."

Another area that has seen a tremendous amount of progress but is only beginning to mature in this space is direct addressing, he said.

"Using this capability to transmit data between different points of care can bring tremendous value, especially at the physician practice level," he observed. "The issue is most independent and small practices simply don't understand the technology in order to use it.

"We have had physicians provide Gmail addresses in their credentialing applications when we request their address for patient exchange purposes, which shows we haven't done an effective job in the industry rolling this out," he continued. "Look for this simple exchange method to grow and take off in the next five years."

Standards and APIs

Moore of Providence has been eyeing standards and APIs as a place of investment to help with the problem of interoperability.

"Obviously, things like FHIR [Fast Healthcare Interoperability Resouces] and other standards help with interoperability," he stated. "But we don't just see standards moving data around as a way of solving interoperability. We focus on the simplified side of things.

"So use PACS as an example," he continued. "We have kind of islands of PACS [picture archiving and communication systems] throughout our enterprise; where images are locked up is proprietary, or you need to use a proprietary reader. We're in the process of moving all of those images to Microsoft Azure and then using vendor-neutral readers to read that."

"We don't just see standards moving data around as a way of solving interoperability. We focus on the simplified side of things."

B.J. Moore, Providence

So one can solve interoperability through application programming interfaces (APIs) and standards, but this is an example where there is no reason to get 300 systems to talk with each other when one can just change the core underlying technology, he added.

The importance of interoperability is growing

Interoperability is a crucial part of healthcare and continues to become more so as data volume grows and healthcare becomes more global and interconnected, said Tachinardi of Regenstrief Institute. Additionally, the pandemic has highlighted the importance of being able to exchange data understandably, accurately, securely and quickly, he added.

"Since 1994, Regenstrief Institute has been home to LOINC, a system of universal terms created at Regenstrief to uniformly identify laboratory test results and health observations," he noted. "This standard allows information to be seamlessly exchanged and understood across systems.

"Institute research scientists also are investing significant resources to develop and disseminate innovative solutions to improve patient matching."

Dr. Umberto Tachinardi, Regenstrief Institute

"The system is used in nearly every country in the world, demonstrating the value of exchanging information," he continued. "LOINC joined an international council of standards organizations that work together to facilitate global interoperability moving forward."

Regenstrief Institute will continue to dedicate time and resources to OpenHIE, a community that provides strategic guidance and other supporting resources to low- and middle-income countries for developing interoperability plans in resource-constrained areas. The institute expects this work to grow, improving healthcare in settings where deploying sustainable health information exchange is challenging.

"Institute research scientists also are investing significant resources to develop and disseminate innovative solutions to improve patient matching," Tachinardi said. "The ability to accurately integrate patients' healthcare records from different providers and electronic medical record systems will improve patient care and safety."

The EHR is the foundation

Within healthcare, interoperability has many definitions, and at times, has become akin to a four-letter word within the industry, said Restuccia of Penn Medicine.

"At Penn Medicine, we view interoperability as the ability to appropriately share data internally and externally among differing systems, networks, facilities and so on," he explained. "For us, the foundation that makes the required level of interoperability possible is our common, integrated electronic health record. With this foundation in place, sharing and transmitting data becomes a more straightforward effort.

"For us, the foundation that makes the required level of interoperability possible is our common, integrated electronic health record."

Michael Restuccia, Penn Medicine

"Our interoperability capabilities are driven by a solid data foundation based upon system integration," he continued. "The belief that one common integrated system across all care settings serves to not only enable patient care and clinician satisfaction, but also facilitates the ability to seamlessly share data across multiple settings."

Many areas of investment

OhioHealth has invested heavily in interoperability over the years.

"A good bit of interoperability is required by the 21st Century Cures Act and federal interoperability programs; these are the table stakes," Kramer said. "Despite the regulation and incentives, organizations have not reliably connected or fully implemented.

"For example, many have yet to ingest or publish secure direct messaging addresses to the National Provider and Payer Enumeration, to be required by CMS in January," he continued. "We see direct benefits of interoperability such as reducing administrative burden like faxing, improving population health and, of course, improved care."

In addition to interoperability to benefit clinical care, payer interoperability will help providers understand costs, utilization and populations, he added.

"How can aggregated and integrated EHR data improve community health needs? This is unexplored territory worthy of investment."

Dr. J. Michael Kramer, OhioHealth

"These all have been major areas of investment in our interoperability plan," Kramer said. "A final area of interoperability may be at the community level with data and community organizations. How can aggregated and integrated EHR data improve community health needs?

"This is unexplored territory worthy of investment," he noted. "We are hoping that implementing Epic COSMOS across the state of Ohio, including at OhioHealth, might drive a greater view of the needs of our community."

Interoperability improves the experience for all

South Shore Health plans to continue to make investments in interoperability because making systems as seamless and complete as possible improves the health experience for all, Babachicos said.

"Interoperability is sharing the right information at the right time, and it is the true promise of digital transformation," she stated. "If an organization outsources care or consults with another party for some of the care, it's not okay to have that care documented outside of the primary electronic health record because it wasn't considered as part of the deal or because it's inconvenient.

"In the call center world, we also plan to see more of an emphasis on interoperability as we enhance the user experience through lower call wait times and more options for self-service."

Cara Babachicos, South Shore Health

"From the provider perspective, they want to see the care documented in one place, and from the patient perspective, they want a comprehensive record of their care."

Additionally, South Shore Health wants to make the use of its systems convenient for its caregivers, whether that's through features such as single-sign-on, contextual linking, or any other tactic that will help to reduce the number of passwords and the login time while at the same time secure interoperability and lower cybersecurity risk, she said.

"In the call center world, we also plan to see more of an emphasis on interoperability as we enhance the user experience through lower call wait times and more options for self-service," Babachicos said. 

"Through the use of CRM systems, pop screens and smarter call technology, we plan to increase customer satisfaction by routing calls and services more efficiently or by directing calls to more options to obtain answers to questions."

Significant funding

Sanford Health will continue to invest significant resources in interoperability over the next five years.

"We will continue to look at investments that offer our providers better access to real-time data during a clinic or hospital visit to support collaborative clinical decision making."

Matt Hocks, Sanford Health

"We currently are partnering with industry-leading vendors to integrate technology that provides timely access to healthcare information, reduces the administrative burden on our providers, and allows our care teams to focus on what's most important – patient care," said Hocks of Sanford Health. "We will continue to look at investments that offer our providers better access to real-time data during a clinic or hospital visit to support collaborative clinical decision making."

Twitter: @SiwickiHealthIT
Email the writer: bsiwicki@himss.org
Healthcare IT News is a HIMSS Media publication.