By A. Andrews Dean, CPHIMS, CHDA, CPHI, CPPM, CPC
The healthcare industry is buzzing with terms like “machine learning,” “APIs,” “blockchain,” and more—each one supposedly promising to solve the ever-growing challenge of maintaining and facilitating the exchange and sharing of healthcare information. At the heart of our healthcare system, the data—when inaccurate—drives inefficiency, errors, and avoidable administrative strain as well as costs. More importantly, inaccurate data can interfere with the care that patients receive.
The promise that these and related healthcare technologies hold relates to solving one of the industry’s greatest challenges: healthcare data exchange. Leveraged correctly, health information technology can help automate efforts, increase transparency, and reduce miscommunication between health plans, providers, and healthcare organizations. This is where the emerging and maturing field of health informatics comes into play as a distinct area of health information management (HIM) discipline.
Health informatics can be described simply as optimizing technology to effectively capture and manage health information. Using electronic health record platforms, integrated medical devices, and health information exchange (HIE), health informatics professionals are responsible for managing, interpreting, and communicating the data that come through healthcare facilities, all with one primary purpose: improving the quality of patient care. Reducing the cost of that care is also within the purview of their work.
When optimally implemented, informatics can improve the coordination of patient information, allowing clinicians to assess and analyze every element of patient information—improving both outcomes and patient satisfaction. HIM professionals who are trained in informatics, knowing how to best incorporate data into care workflows, are now able to provide both a higher quality and higher volume of point-of-care information and historical patient data than ever before—due in great part to advances in health information exchange and interoperability.
Health Information Exchange and Interoperability
There are two basic components to true interoperability:
- The ability of two or more systems to exchange information
- The ability of those systems to effectively use the information that has been exchanged (informatics)
HIE is vitally important in today’s healthcare industry, and it has been the recent focus of modernizing the Centers for Medicare and Medicaid Services’ “meaningful use” EHR Incentive Program and Merit-Based Incentive Program (MIPS) Advancing Care Information (ACI) quality reporting category— now called “Promoting Interoperability.” HIE is necessary for interoperability, but is not sufficient on its own for achieving meaningful health information interoperability—informatics is needed to cover this additional ground.
While healthcare organizations and providers using Direct messaging or a community cloud of shared patient data on the same EHR platform may be able to exchange information, HIM professionals still need to be able to deploy the information from the originating system in the receiving system in a way that makes it meaningful to providers and patient care—alerting the provider automatically of a new potential drug allergy, for example. So, to get to health information interoperability, we need more than just data exchange. We must also use the exchanged data effectively for the data to have meaning and actionable purpose in patient care.
2018: The Year of Interoperability
The Health Information Management Systems Society 2018 Annual Conference (HIMSS18) was held in early March 2018. One of the most pivotal announcements was the overhaul of meaningful use and the MIPS ACI category with a renewed focus on interoperability. Although big data, machine learning, application programming interfaces (APIs), and artificial intelligence may currently be well-hyped, the industry is starting to realize some practical and valuable uses of informatics and adoption of informatics principles in healthcare—especially in healthcare information exchange. The healthcare industry is moving beyond the more familiar simple one-to-one push/pull approach to health data exchange, looking instead toward a more robust exchange network that enables healthcare organizations and providers to share and utilize data more effectively than ever before.
In July of 2018, the industry received even more guidance as CMS continued overhauling meaningful use and the MIPS ACI category. When the Medicare Physician Fee Schedule (MPFS) Proposed 2019 Rule was released, it included the Quality Payment Program (QPP) information for 2019, which also focuses more on interoperability—further defining and refining what it means to be interoperable.
Reduced Medical Errors and Higher Quality
What does interoperability have to do with medical errors and quality measures? Patient safety and care quality are primary concerns of every healthcare provider. Health informaticists can provide important data to clinicians that can prevent medical errors, such as information about a possible drug interaction or allergy from updated records that might not otherwise be apparent.
Multiple studies have noted that when clinicians use EHRs:
- Fewer problems were encountered when preparing patients for discharge
- Fewer medication errors occurred
- Better quality of care was rendered
Clinicians also reported that information was more likely to be shared when EHRs are used, a great benefit to patients and providers responsible for their care.
An HIE and Interoperability Case Study at HIMSS18
A presentation at HIMSS18 titled “QPP/MIPS Success With Longitudinal Quality Measurement” examined quality measures calculated using data from primary care practices’ own EHRs and compared this with quality measures computed from the data in the Kansas Health Information Network (KHIN) HIE.
Data gathered in the 2016-2017 study used one of the quality measure capture and reporting method options in the MACRA Quality Payment Program—Qualified Clinical Data Registries—and sued data from unconnected EHRs to calculate quality measures across providers.
When KHIN computed quality measures across all providers treating a patient, this resulted in higher-quality scores for providers and a more complete, patient-centric view of the care provided. The MIPS quality model calculates individual provider measures computed only from the data in a specific provider’s EHR.
Why is this important? Patients receive care from many different providers, and the KHIN study indicates a more accurate assessment of the complete quality of care provided to a patient can be achieved by using HIE data. The study also demonstrated the value HIEs can provide when patient data across all healthcare providers is aggregated and organized into a longitudinal patient view using interoperability protocols for data exchange and informatics principles for best implementing that data. The study also demonstrated that longitudinal patient data from multiple providers, when shared and effectively utilized, can improve the accuracy and completeness of quality reporting.
Innovation in Interoperability and Informatics
The demand for more provider-to-provider data exchange is still very real, but increasingly we are seeing more advanced uses of data obtained through HIE, guided by informatics and enabled by interoperability. When a patient needs to share data with their primary care physician, when an EHR automatically checks a state immunization registry, or when a provider checks a prescription drug monitoring database—and that data needs to be accessed and captured by the provider’s native EHR—these are instances where we are seeing innovation, interoperability, and informatics mix successfully.
The increased maturity of HIE and continued adoption of APIs will further allow HIM professionals to develop solutions, pull data from a nearly endless array of sources, and give clinicians access to a new frontier of patient information.
What are APIs?
APIs are sets of requirements that govern how applications communicate and interact with one another. An open API is an interface that provides developers with programmatic access to a proprietary software application. The Fast Healthcare Interoperability Resources (FHIR) Specifications, created by Health Level Seven International (HL7), defines data formats and elements (known as resources) for exchanging electronic health records. Open APIs interconnect any healthcare system, doctor, patient, or medical device by normalizing all incoming requests and data as appropriate FHIR resources. API-based approaches to interoperability have the advantage that APIs can be assembled to rapidly create different kinds of aggregate functions.
From the Consolidated Health Informatics initiative to the 2018 Interoperability Standards Advisory and now the new CMS Promoting Interoperability program, along with the development of APIs, the fields of informatics and interoperability have come a long way. No longer just buzzwords or temporary trends, informatics and interoperability efforts will continue to become an even bigger portion of our everyday experience in clinical systems and patient care.
Modern healthcare is driven by information—documentation stored in EHRs that is collected and organized into discrete structures for exchange. Patient care documentation needed by clinicians can now be examined longitudinally, over time, enabling healthcare providers to make better decisions about how to provide care and to decide when changes or adjustments need to be made—thus increasing both patient safety and quality measure performance. This is a win/win for patients, providers, and informatics.
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Andrews Dean (firstname.lastname@example.org) is a healthcare informaticist and value-based care strategist.
**Editor’s note: this article was updated to add references and amend text wording on 9/5/2018.