Interoperability and Standards Will Be Areas of Focus Through Year End
By Michael Burger
Michael Burger is practice lead, EHRs and EDI, for Point-of-Care Partners of Coral Springs, FL.
While there are many uncertainties in healthcare, interoperability and standards will undoubtedly be areas of focus through the end of 2017. To that end, the government and industry will continue to refine existing standards and address interoperability challenges. This involves activities by the Office of the National Coordinator (ONC) and ongoing efforts by standards development organizations (SDOs) and electronic health record (EHR) vendors.
Despite potential severe budget cuts, ONC says it is committed to interoperability and standards as main areas of emphasis. For example, ONC is putting the finishing touches on its Proposed Interoperability Standards Measurement Framework, the final document for which will be issued this fall. It also is accepting comments through November 20 for the Interoperability Standards Advisory, which is a stakeholder-informed catalog of the standards and implementation specifications that can be used to meet interoperability needs in healthcare. The newly created Health Information Technology Advisory Committee will also be influential with regard to standards and interoperability. Its recommendations to ONC doubtless will be translated into rulemaking and policy.
The next few months also should see continued progress by SDOs in refining standards for interoperability with a focus on practical use cases by EHR vendors.
One example is FHIR (Fast Health Interoperability Resources), which is one of the newest standards from Health Level 7 (HL7). Vendors are beginning to embrace the most recent iteration of the standard for various clinical use cases and FHIR is being used to extract relevant clinical data from EHRs.
Also, the National Council for Prescription Drug Programs (NCPDP) is refining the SCRIPT standard to facilitate the transition to electronic prescribing of specialty medications. Today, specialty prescribing is largely a manual process that isn’t easily adapted to existing electronic prescribing workflows. An NCPDP task group is looking at ways in which new data elements could be added to the SCRIPT standard to handle enrollment for specialty medications, which accompanies the prior authorization that is required for nearly all such medications. The goal is to enable enrollment and electronic prior authorization (ePA) for specialty medications. Changes to the standard will enhance the ePA functionality, which EHR vendors have already built for non-specialty medications.
There are still obstacles that must be overcome to move health IT interoperability down the field. Three come to mind:
- Lack of a national patient identifier. One of the biggest interoperability challenges is the lack of a national patient identifier. While industry solutions are being developed, they are one-offs that are not totally standards based. True interoperability cannot be achieved unless this problem is solved.
- Changes in business models. There is much talk around data-blocking by EHRs, but this is not so much a technology challenge as a business one. The competitive nature of healthcare delivery is primarily what prohibits the exchange of clinical information, as competitors don’t want to make it easy for patients to seek care outside of their networks. When there is demand among customers to connect systems, software vendors respond by building and selling connectivity solutions. The most successful of these solutions rely on standards that have been created and vetted through SDOs.
- Variations in standards implementation. Other interoperability challenges are created by variations in how standards are used in application program interfaces (APIs) with EHRs. Sometimes these APIs rely on technology that is not standardized, thus adding to the complexity and inconsistency in how data are exchanged among EHR platforms. The goal of using standards to achieve interoperability can only be met when standards are interpreted, implemented, and used consistently.
These are but some of the opportunities and challenges we see in the waning months of 2017 when it comes to standards and interoperability. These issues are not going away anytime soon and will continue to occupy stakeholders’ attention in 2018.