Information about an individual’s health and healthcare is needed to support coordinated, safe, high-quality, cost-effective, patient-centered care. Much of this information resides in the multiple settings where patients receive care and services, including physician offices, clinics, hospitals and health systems, laboratories, pharmacies, radiology centers, health plans, and even with patients themselves. Interoperability of health information technology (IT) systems helps bring this information to the point of care to support clinical decision-making. It also supports individuals as they navigate their health and healthcare.
The vast majority of clinicians and hospitals have adopted electronic health records (EHRs). The next step is to accelerate interoperability of EHRs and other health IT systems to bring information to clinicians and patients seamlessly.
Progress is being made. The percentage of U.S. non-federal acute care hospitals that electronically find patient health information, and send, receive, and integrate patient summary of care records from sources outside their health systems, has nearly doubled in the last four years, from 23 percent in 2014 to 41 percent in 2017. Ninety percent of hospitals and 48 percent of office-based physicians are electronically sending or receiving (or exchanging) patient health information with health care providers outside their organizations. Individuals are increasingly able to access their health information electronically. But more work is needed.
The federal government has taken many actions to accelerate interoperability, including implementation of the bipartisan 21st Century Cures Act, which was signed into law in December 2016. On February, 11, 2019, the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC) proposed new rules to support the access, exchange, and use of electronic health information. The private sector has also taken several actions.
The chief executives of organizations represented by the Healthcare Leadership Council (HLC) and the Bipartisan Policy Center came together in 2018 to identify ways to further advance the interoperability of systems and electronic information sharing to support better health outcomes and higher-quality, safer, more cost-effective, and patient-centered care for individuals and populations in the United States. HLC and BPC drew upon the experiences and expertise of more than 100 individuals representing every sector of health care, including clinicians, hospitals and health systems, long-term and post-acute care (LTPAC) providers, health plans, life sciences organizations, EHR and other technology developers, data analytics companies, and patients.
Supporting better health outcomes for individuals and populations requires an interoperable healthcare system in which the patient is at the center of care and the right data are available to the right person at the right time. Access to high-quality, accurate, and actionable data is seamless and integrated within clinical workflows, providing value and convenience, as well as reducing healthcare costs. There is trust in the system; privacy is protected, and information is kept secure.
Action to improve interoperability should initially focus on two priority areas: (1) bringing information to the point of care to support care delivery and (2) meeting the information needs of individuals to support their health and healthcare.
Advancing interoperability will require leadership and action in four key areas, outlined below.
1.1. Align Incentives Among Payers and Providers
Payers should collaborate with providers to gain agreement on and drive adoption of baseline expectations for interoperability and information sharing through payment incentives that focus on outcomes versus volume, contracts, and other mechanisms.
1.2. Align Incentives of Providers and Their Technology Partners
Providers, including clinicians, hospitals, health systems, specialty societies, and group purchasers, should collaborate with EHR and other clinical software developers to gain agreement on and drive adoption of baseline expectations for interoperability for products through incorporation into contract language. Existing requirements, such as those included in the ONC Health IT Certification Program, should be leveraged. Clinical software and other technology developers and vendors should collaborate with their customers to integrate expectations for interoperability within their products.
1.3. Engage Individuals
Providers, payers, and technology developers should engage individuals to identify and prioritize information access expectations.
2.1. Adopt Common Baseline Standards to Improve Patient Matching
To improve patient matching, providers, software developers, payers, and other health care organizations should collaborate on the identification and collection of a common set of data elements using federally adopted standards.
Providers, software developers, payers, and organizations representing individuals, should collaborate on efforts to explore, pilot, and evaluate the feasibility of widespread adoption of patient-centered approaches to identification.
2.2. Prioritize Interoperability and Standards Conformance in ONC Health IT Certification
ONC should prioritize interoperability and require real-world testing to assess conformance with interoperability standards in future editions of the ONC Health IT Certification Program.
2.3. Pursue Rapid Adoption of HL7 FHIR®-Based APIs to Accelerate Information Sharing
Providers, EHR and other software developers, payers, and other health care organizations should expand upon existing interoperability efforts by pursuing rapid adoption and implementation of HL7 Fast Healthcare Interoperability Resources (FHIR®)-based or other open standards-based application programming interfaces (APIs), to accelerate interoperability, data access, and information sharing.
3.1. Implement a Common Notice of Information Access for Patients
Healthcare organizations should collaborate with organizations representing individuals as well as with the federal government,
to reach agreement on a standard “Notice of Information Access Practices” and voluntarily make such notice available to patients to reduce confusion and make it easier for individuals to access their health information.
3.2. Align Privacy Laws with HIPAA
States should consider harmonizing privacy laws to align with the Health Insurance Portability and Accountability Act (HIPAA).
The Department of Health and Human Services (HHS) should align consent policies for substance use disorder treatment under 42 CFR Part 2?Confidentiality of Substance Use Disorder Patient Records?with HIPAA.
4.1. Collaborate on Measurement and Improvement
Public- and private-sector leaders should collaborate on the identification and annual reporting of key measures that assess national progress on interoperability and information sharing to support bringing information to the point of care and providing individuals access to their own health information. They should convene efforts to define and launch the execution of private sector actions that will accelerate progress on measures.