Readers Write: Interoperability’s Last Mile – Universal Patient Consent and Access is Holding Us Back

Interoperability’s Last Mile – Universal Patient Consent and Access is Holding Us Back
By Lew Parker

Lew Parker, MSIS, MBA is chief technology officer of Arrive Health of Denver, CO.

As always, the latest round of health technology conferences has inspired us with new ideas for the application and value of interoperability in healthcare. The combination of existing and new technology offers tremendous potential to impact patient outcomes and provider experiences. There’s one last mile we’ve yet to cross, however – our business policies haven’t caught up to our technology, and we’ve fallen short on the key step for how true data sharing will work.

Healthcare interoperability is meant to create transparency, giving providers and patients the information that they need to make decisions about all types of things, including diagnoses, treatments, costs, and more. We’ve made great strides in developing technology to standardize how we share data, such as HL7 and FHIR, at a granular level. There are also shining examples of interoperability at work to tackle specific challenges, such as using real-time prescription benefit (RTPB) data to support patient affordability and adherence.

What’s needed to cover interoperability’s last mile is a federated, decentralized way to authenticate, access, and, most importantly, verify consent to that data.

This isn’t an impossible task or pie-in-the-sky recommendation. Think about when you register a website domain. You purchase the domain from a single registrar, point it to your server, and every DNS instantly knows where to route traffic. The registration isn’t centralized, but it is handled in a way that makes the ownership and access, managed by one registrar, available to all for verification and use.

For another example, look at how SSL certificates facilitate secure communications across the internet through a federated registry system, where trust is decentralized yet universally acknowledged. Over 100 trusted certificate authorities are providing this service. By applying a similar federated model to healthcare, we can enable seamless access to data while respecting the autonomy of individual entities within the network. Imagine what our world, and patient experience and outcomes, would look like if we achieved this same level of trust and access.

In a federated model, the focus shifts from establishing a single centralized governing body to an alliance of healthcare entities that agree on shared policies and standards for data use and access. Much work has been done to create these types of alliances, and we should leverage existing organizations if possible. This would:

• Create a single place for healthcare entities and partners to ping for information once patient consent is given.
• Streamline access to data, removing firewalls that we experience today because of contract or independent business policies.
• Foster innovation by providing an easy way to grant data access to trusted partners.
• Pave the way for patients to access, understand, and plan their healthcare in a single place.

In this future scenario, RTPB data has new potential. RTPB surfaces millions of real-time patient events a day, events like me getting a new prescription or having a prior authorization approved, that others could use to improve care delivery, lower costs, connect me to community resources, and a million things I have not thought of myself.

Without a unified way to provide access to this data, however, these opportunities to make my experience better cannot happen. Instead, to gain access to real-time information, each innovator and partner must establish 1-to-1 relationships and partnerships, each with their own policies, contracts, and requirements. Our systems become complicated and cumbersome as we must codify this variability into our interoperability applications. This ultimately slows down, and in many cases prevents, access to the very data that is needed to drive progress and health outcomes.

I am extremely proud of our industry for our interoperability achievements, and I remain positive about what’s to come. I also believe covering the last mile and achieving true interoperability in healthcare is going to require us to think more broadly and collaboratively about not only how we share data, but how we use it. It remains to be seen if TEFCA can provide the federated model that is required for success.