Interoperability is seen as the first step to using data for health improvement.

I expect that 2019 will be the “Year of Interoperability”.  The Centers for Medicare & Medicaid Services (CMS), through its hospital and physician incentive programs, is asking providers to have their electronic health records (EHRs) capable of exchanging clinical data with other providers and with patients. 

This is the next step in the slow march towards the use of data for health improvement.  We started with the implementation of EHRs, then further moves towards standardization, and now we have the data exchange requirements. 

This is still not the final goal, which needs to be the effective use of data for the improvement of population health (both the individuals in the population and the population as a whole).  What we need to get there — the next steps — is the development of methods to effectively use the data, the acceptance of those methods, and the promulgation of those methods throughout the industry.  CMS is taking some steps to do that, in their “Meaningful Measures” initiative, but we still don’t have agreed-upon metrics for quality and health.  I imagine the biostatisticians, health economists, and informaticists will be working on those.

However, the increasing amount of data exchange brings with it a number of issues.  First, we need to protect all of that data that is “running around the Internet.”  The privacy and security of data exchange and the use of the data must be considered.  The continuing number of data breaches indicate that we are not there yet; and more data will bring more breaches if we don’t solve the problem.  Getting the consent of both patients and providers will be a critical step in making the data the available.

Also of interest to many of our Talk Ten Tuesday listeners, we will need to focus on the accuracy of the information that is entered into the initial EHRs.  Once that data is part of the record and gets exchanged with other providers and patients, it will be difficult to correct it.  Poor data can lead to making the wrong decision once the data is analyzed.  We have to emphasize the need for data accuracy with all of our users.

While working on the technical exchange of data, the question of semantic interoperability—do the terms mean the same to all users —continues to be raised.  There needs to be consistency in lab values from one lab to another, doctor’s notes and interpretations need to be understandable and meaningful when they are read by others, and terms need to be agreed upon within the industry.  Work still needs to be done in this area.

I think the recent movements by the tech giants (Amazon, Apple) to get further into healthcare has the potential for major transformations.  While both are interested in gathering up the data from various sources and integrating it; it will be how the data can be used for improving healthcare that will have the biggest impact. 

Who knows what projects are being worked on in small offices, in garages, and in other secret locations which may be the next great achievement in healthcare!

Program Note:

Listen to Stanley Nachimson report his regulatory update today on Talk Ten Tuesdays.

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Stanley Nachimson, MS

Stanley Nachimson, MS is principal of Nachimson Advisors, a health IT consulting firm dedicated to finding innovative uses for health information technology and encouraging its adoption. The firm serves a number of clients, including WEDI, EHNAC, the Cooperative Exchange, the Association of American Medical Colleges, and No World Borders. Stanley is focusing on assisting health care providers and plans with their ICD-10 implementation and is the director of the NCHICA-WEDI Timeline Initiative. He serves on the Board of Advisors for QualEDIx Corporation. Stanley served for over 30 years in the US Department of Health and Human Services in a variety of statistical, management, and health technology positions. His last ten years prior to his 2007 retirement were spent in developing HIPAA policy, regulations, and implementation planning and monitoring, beginning CMS’s work on Personal Health Records and serving as the CMS liaison with several industry organizations, including WEDI and HITSP. He brings a wealth of experience and information regarding the use of standards and technology in the health care industry.

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