By W.Glenn Hilburn, VP-IT, Grady Health System
For the past decade, interoperability has been a keystone to digital transformation within healthcare. Most, if not all, healthcare organizations have matured in their use of electronic health records and network-connected medical devices in providing care for their patients, and these disparate systems collect a multitude of valuable information about a patient’s treatment and response to care. Facilitating the safe and secure exchange of patient information between disparate systems and devices can yield great value in improving quality of care, patient safety, clinician efficiency and patient satisfaction. When patients experience transitions of care such as:
- Admission from home to hospital
- Discharge from hospital to home with follow-up ambulatory care
- Presenting for urgent or emergent care
- Transfer between healthcare organizations (tertiary, Post Acute Rehab, SNF)
These transitions often leave care providers with a fragmented view of care across the continuum and that can yield a risk of missing critical allergies, medication interactions or lead to duplicative diagnostic testing.
Of course, most recently, the COVID-19 pandemic has demonstrated to all the critical need for a robust national interoperability structure for improving the availability of patient data. Translating patient data between health information systems has been an arduous task, but recent federal efforts coupled with the challenges of the public health crisis have served as a catalyst for rapid improvement in strengthening these connections.
One critical item currently missing from the push for interoperability, is a formalized plan to address patient matching challenges.
In 2009 with the enactment of the American Reinvestment and Recovery Act (ARRA), the federal government established incentive payments to healthcare organizations that demonstrated meaningful use of their electronic health records. This legislation served as an effective stimulus for the digitization of healthcare, and as time passed, it became apparent that further work was necessary to facilitate patient access to data and the exchange of data between providers and patients. As a result, in 2016, the 21st Century Cures Act (Cures Act) was passed in an effort to accelerate innovation and support of delivering efficient access to better patient information for both patients and clinicians. Following that, in 2018, the Centers for Medicare and Medicaid Services (CMS) rebranded the “Meaningful Use” program to “Promoting Interoperability”, but it was clearly much more than a rebranding effort as it shifted its incentives and penalties specifically toward patient information exchange.
All of these federal initiatives have come together to drive progress, but in April 2021, the Cures Act compliance deadline changed the game and will continue to do so as we move toward further expansion in October 2022 with the next compliance deadline. While the Cures Act has already spurred some app development, it is projected to open up a network that will enable patients and clinicians alike to engage with healthcare through apps on mobile devices and electronic record systems. The evolution of this technology is creating a healthcare ecosystem that is very different from anything we have experienced in the past and is poised to create a cultural shift in the healthcare experience within the United States, but a barrier remains.
One critical item currently missing from the push for interoperability, is a formalized plan to address patient matching challenges. As noted previously, the U.S. has recognized tremendous improvement in defining standards and vehicles for interoperability, but we continue to face challenges in patient matching as a patient transitions across medical facilities. While organizations utilizing the same EHR vendor do not experience the same complexity in matching barriers, there are many systems nationwide on disparate systems that create significant risk around matching mistakes that compromise patient safety as well as quality and efficiency of care. There are even greater concerns about these risks in the medically underserved populations due to the frequent change of address, telephone and insurer that impact effective matching protocols.
While Congress voted in July 2020 to repeal a ban on the use of federal funds to develop a national patient identifier (NPI) for interoperability, the Senate quickly voted against its approval. Privacy, security and cost remain the primary reasons for opposition to such a measure. In a current landscape fraught with cybersecurity threats in healthcare, many are concerned that if a patient’s identifier were compromised then a patient’s entire health record would be easily accessible. While the concern is valid, the reality is that the risk around the breach of a health data identifier is not as significant as that carried with a social security number. While SSN breaches carry risk of a bad actor accessing banking and other financial information, that is not the case with a NPI; however, there are valid concerns around fraud related to medical identity theft and gaining access to prescription medications.
The cost associated with creating a secure framework for a NPI system will require a significant investment for development. Many argue that it would be so significant that cost could outweigh the value. A point for consideration though is that the cumulative cost (from the perspective of both patient and provider) associated with understanding the care provided to patients with our current fragmentation can be as great and likely more so and would hence offset the expense. Finally, the cost incurred (both financial and in human lives) during the current pandemic is clear evidence that we must take immediate steps to improve the reliable exchange data between the federal government and local health authorities. This effort would sure up nationwide efforts in early identification, tracing, and vaccinations.