While Covid-19 has illuminated healthcare’s struggles with interoperability, it has also provided an invaluable learning opportunity and, in some ways, established the data and technology landscape healthcare needs to thrive in the future. ONC laid the foundation for greater interoperability by requiring seamless access and exchange. However, payers and providers must also be able to look to advanced analytics in order to gain actionable insights that will move the needle on collective efforts to improve risk assessments, care coordination, value-based reimbursement, and more.
A fully interoperable, analytics-driven ecosystem of all patient information—such as age, preexisting conditions, care disparities, genetics, social determinants of health, past procedures, and medication history—would be invaluable for public health, medical, and scientific experts working to identify high-risk patients and targeted therapies. Doctors would have access to comprehensive patient data to make informed, personalized care decisions quickly and accurately, which is equally important for clinicians on the frontlines as well as others filling in the gaps and addressing non-emergent needs. Payers would have access to the same datasets to make more streamlined and accurate decisions about pre-approvals, reimbursements, and claims, while staying more closely connected with their provider counterparts as they respond rapidly to meet the needs of the evolving situation.
Aside from care delivery, interoperable data and analytics technology could benefit broader population and public health initiatives launched in response to the pandemic. While elderly and other individuals with preexisting conditions have been hit especially hard by the virus, patients with health disparities linked to social factors are also high-risk, though the demographic and social determinant data pointing to this is not typically available in most EHR or claims data. Applying AI-driven analytics to comprehensive patient records, including social determinants data, could better identify all at-risk populations and drive the development of proactive approaches, guidelines to aid vulnerable populations, and personalized clinical interventions.
Access to diverse patient data, combined with the ability to extract actionable information, could also help the U.S. better track infection spread even amid an ongoing lack of COVID-19 tests. In fact, analyzing claims data to find anomalies in the correlation between flu testing and flu diagnoses has been shown to accurately predict regional surges in Covid-19 cases. Leveraging interoperable data in this way could help public health organizations forecast areas at risk for an outbreak and make informed decisions regarding the implementation of social distancing measures. More universally accessible health data could also help city and state governments determine the viability of reopening and assess how their communities are responding to reopening measures once implemented.
Envisioning an interoperable future
Though healthcare has an arduous journey ahead between the response to the Covid-19 pandemic and the shift to greater interoperability, both challenges are setting the scene for stakeholders to work together and drive improvements in quality and cost. By laying out clear guidelines, the federal interoperability requirements offer universal data and IT standards to foster a more collaborative environment among payers and providers built on greater trust, shared information, and better alignment across clinical, economic, and administrative centers. Greater interoperability and industry collaboration will help address waste, which comprises 25 percent of annual healthcare spending. It will also drive down administrative complexities, which account for most wasteful spending at $256.6 billion annually.
Taking the components of the rule one step further, the industry would benefit from the introduction of a single patient identifier, something nearly all other developed countries already have in place. A single patient identifier would allow patients to have access to their healthcare data and “carry” it with them from health plan to health plan and provider to provider. In the context of a pandemic, a single patient identifier would give providers and payers a clear, concise, and accurate view of a patient’s health and medical history, allowing them to quickly and accurately assess patient risk and make informed treatment decisions together. This would also allow public health officials to track the spread of the disease with much greater accuracy.
When applied in this way, interoperability can provide a 360-degree view of the patient while delivering value-based care and better outcomes. It can also help preserve the financial health of healthcare organizations while mitigating unpredictable challenges. This pandemic has demonstrated just how far healthcare must go on the road to interoperability, but it has also fueled the movement that has been building across the industry for more than a decade. Now is the time for health leaders to ensure they are poised to adapt to the federal interoperability rule and help drive this long overdue evolution.
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