Jul 27, 2020
The Familiar Paradigm
The common denominator in most patients’ journeys is chaos. A patient may have to complete a comprehensive health questionnaire five+ times when seeking a solution to a health issue – resulting in identical information siloed throughout their journey.
For example, a 66-year-old male patient has felt weak in the mornings. During an appointment with a new primary care physician, he’s referred to a specialist. Days later he leaves the second appointment with new medication. At the pharmacy he learns the drug isn’t covered by insurance. While the pharmacist coordinates with his doctor for a cheaper generic, he leaves unhappy and empty-handed.
The patient had to advocate for his healthcare coverage by asking “Is this new doctor in-network? Are these additional tests covered?” or, “Can I be prescribed a cheaper generic?” These data silos make it impossible for a 360-understanding of his health and, ultimately, negatively affect his patient experience.
With a simpler health journey, the health plan-patient relationship greatly improves, guided by the seamless flow of information from one data system to another. In this case, a variety of long-standing challenges hinder the exchange of information between healthcare players:
- Unstructured, malformed or missing data
- Use of outdated standalone legacy systems
- Interface discrepancies between systems
- Disparate adoption of standards
- Complex and misunderstood privacy and security policies
- Lack of unique patient identifier
Our biggest limitation as an industry is not capabilities of technology, but rather solving a complicated puzzle of big data, integrating systems, seamless information exchanges, rising competition and federal regulations. Access to complete point-of-care data will have a far-reaching impact on targeting the quadruple aim – cost, experience, outcomes and physician burnouts.
Interoperability Final Rules – What They Mean, Why They Matter
The interoperability and patient access rules, finalized in early 2020, are intended to guide the secure, efficient and effective sharing of electronic health information with a goal of increasing innovation, safety, patient outcomes and affordability. Refocusing on these regulations will allow payers, providers and third-party developers to address interoperability by actualizing technology that resolves long-standing patient data challenges in a way that is win-win for both patients and the industry. Solving the technical challenges of interoperability through digital transformation initiatives allows for the delivery of quality patient care through a human-centered experience.
Reforming the Human-Centered Experience
In the same way purchase decisions for food, clothing and travel are increasingly driven by convenience and choice, the same rise of consumer power has shifted healthcare. Rather than a prescriptive approach, payers offer high-deductible plans, health savings accounts and health retirement accounts. Patients also decide how to spend their money by “shopping” for a surgery, procedure or prescription drug.
To align with modern consumer expectations, providers are creating human-centered experiences that provide quality care and improve patient outcomes. Partnerships and network coordination will serve as the key competitive edge as the member experience continually advances in the digital age.
When designing human-centered experiences, it’s imperative both patients and providers remain in focus. Missing data, outdated systems, disparate adoption of standards and complex processes create tremendous barriers for physicians whose sole purpose is to treat patients.
The lack of interoperability is yet another factor in the rise of physician burnout. A recent meta-analysis of 47 studies found that physician burnout doubled the risk of adverse patient safety incidents and led to poorer overall quality of care and decreased patient satisfaction. Since patient safety and health is closely correlated with physician burnout, strategic investment in digital transformation can relieve operational burdens from physicians and keep them focused on providing better quality care.
The definition of interoperability must extend beyond system capabilities by designing a human-centered experience for data, relationships and experiences. Designing with a human-centered strategy maximizes the value of digital capabilities, draws valuable insights and promises a positive ROI. Interoperability goes beyond the infrastructure for data to be shared seamlessly, it requires data to be high-quality, relevant and structured in order to be valuable. By designing human-centered experiences, organizations ensure their investment in interoperability will add maximum value.
Interoperability will have a far-reaching impact on the quadruple aim. To maximize the value of comprehensive patient data from disparate sources, a set of critical capabilities need to be established upon which interoperability can function, including:
- Data Enablement: Gives systems the tools they need to be more efficient, effective and transparent while enabling data sharing across the healthcare spectrum.
- Microservices Architecture: Enables an efficient business operation by controlling authorization, identity management, data pipeline management and software application interactions. Microservices are built to enable third-party applications and offer scalability for APIs that support a wide range of functionalities.
- Data, Workflows and Operational Integration: Removes data silos bringing enterprise-wide agility to navigating changes or disruptions.
- Master Data Management: Enables organizations with better quality and a reliable single source of truth for all master and reference data like patient, provider, medical codes etc.
- Talent Enablement: Minimizes the obstacles of interoperability and further digital transformation within systems by identifying business leaders and technical architects to drive change and enable talent through up-skilling/cross-skilling endeavors.
Managing these interoperability-ready capabilities will help integrate and manage data, derive actionable insights and improve patient experience. By instilling these capabilities, organizations can move toward achieving the future state of interoperability.
Data’s Growing Pains
A focus on transformation is key to solving the complex puzzle of interoperability. According to a recent survey, more than half of health systems and health plan leaders said they plan to use the interoperability compliance requirements as a first step toward broader strategies on interoperability. For organizations on the path to digital transformation, it is vital to invest in a partner to achieve true interoperability and integration through an array of services and assets including:
- Operational assessments and strategic consulting including FHIR Server strategy
- Selection, implementation of suitable API management tools
- End-to-end API operating model design
- Interface architecture, custom interface development and support using interface factory model with a catalog of service offerings
- Management and comprehensive platform enabled interoperability solution
- Data migration between disparate systems, databases or applications
The interoperability final rules will erode significant barriers between payers and providers, improving the quality and quantity of data exchanged. While challenges aplenty remain, systems and processes have the capabilities to improve patients’ health, and digital transformation will be a vital step in creating a happier, healthier patient journey.
As the digital transformation enabler, we’ve partnered with payers and providers to break down barriers that are slowing down healthcare. Let us help you think strategically, risk appropriately and maximize technology to deliver care better.