Center for Improvement in Healthcare Quality Newsletter
July 2022

CIHQ-ARS Article

Healthcare Interoperability in 2022: Looking Forward and Back to Shape What’s Ahead

An article provided by Audacious Inquiry
If the first month of 2022 is preview for how the rest of the year will shape up, we are in for an exciting ride on the healthcare interoperability track. On January 7th, efforts to standardize health data took a major leap forward with the release of Project US@, a year-long initiative intended to promote consistent patient matching between care teams and health IT systems by systematically capturing patients’ physical mailing addresses in a flexible but conformable manner.
Less than two weeks later, on January 18th, anticipation turned into reality with the announcement that TEFCA (“Trusted Exchange Framework and Common Agreement”) was going live, following years in the making. With the announcement, the Office of the National Coordinator for Health Information Technology (ONC) formally released the initial Common Agreement, QHIN Technical Framework, and corresponding FHIR roadmap.
As we prepare to build on this momentum with what’s ahead for the field of health IT and healthcare interoperability, we want to take the opportunity with this blog to highlight a recent, forward-looking interview with Audacious Inquiry president, Scott Afzal, combined with a retrospective look-back at recent themes and topics that support what Scott foresees for the year ahead.

Looking Ahead to Healthcare Interoperability in 2022 and Recent Retrospective

  1. Expect health plans to engage more assertively on clinical data acquisition. Scott Afzal: “Plans will focus data acquisition strategies on breadth of connectivity, depth of data types, and quality of the data necessary to satisfy their use cases. Plans will begin to prune away connectivity that doesn’t meet data quality thresholds.”
    Retrospective: We are experiencing a shift towards a national health IT infrastructure with deeper health information data exchange that is helping connect siloed health care data. Data standardization and EHR interoperability—layered with real-time indications of a patient’s admit, discharge, and transfer status and timely clinical documentation retrieval—are all key ingredients in the recipe for a successful, patient-centered approach. Progression toward quality data standards will move the needle in the direction of lower costs, increased efficiencies, and improved patient coordination and satisfaction.
    Related reading: Learn about the value EHRs provide and how they differ from EMR in our blog: What is the Difference Between EMR and EHR?
  2. Health Information Organizations will collaborate and place emphasis on public health. Scott Afzal: “As HITECH-era funding ends, health information organizations will seek scale through collaboration (and mergers) on shared technology and services and will focus energy on areas they serve uniquely well, including Medicaid and public health agencies at the state and federal levels.”
    Retrospective: With federal funding from HITECH in the rearview mirror, health information organizations (HIOs) are seeking alternative paths to revenue and long-term sustainability. The continued shift to a value-based care model calls for organizations to band together and drive deeper engagement through shared resources and enhanced reporting and data analytics.
    Related reading: Learn about a sustainable path forward for HIOs after HITECH in this whitepaper: Health Information Organization Sustainability
  3. National networks continue to gain traction and see deeper use. Scott Afzal: “eHealth Exchange, Carequality, and Commonwell will continue to ramp up both scale of participation and scale of use. Challenges associated with leveraging the networks at scale will be addressed by both third-party services and the networks themselves. The networks will accelerate work toward supporting FHIR-based exchange, but the preponderance of data exchange will continue to be document-based.”
    Retrospective: National health information networks connect hospitals, health systems, and other sources of patient medical data, enabling secure exchange of clinical records. These organizations have become increasingly interoperable over the last decade, connecting more than 75% of hospitals, 77% of regional health information exchanges, and 85% of dialysis centers in the U.S. Connectivity within and between ever-growing national networks has benefited clinical decision-making in routine health care settings such as hospitals and ambulatory practices, as well as in unconventional but common situations to prevent care disruption during natural disasters and public health emergencies.
    Related reading: Learn how national health information networks can prevent care disruptions during natural disasters and emergencies in our PULSE e-Book
  4. FHIR will continue to garner excitement but will be a slow burn in production. Scott Afzal: “FHIR is seeing continued uptake, but as shown in MITRE’s very cool FHIR endpoint dashboard, there is a lot of work ahead on adoption/deployment and updating to more current versions. Importantly, large scale use of FHIR will require progress on central infrastructure concepts through ONC’s FAST Task Force.”
    Retrospective: Using FHIR® has proven advantageous in data sharing for its ability to specify and transmit only the most essential pieces of information. As Scott notes, there is a path for progress ahead, with the three-year roadmap for the TEFCA project serving as a prime example. The technology, meanwhile, is proving its value in response to COVID-19, bringing leading experts and health IT communities together to improve real-time situational awareness of health care system capacity during the pandemic.
    Related reading: Learn about The SANER Project, an open-source initiative that leverages HL7® and FHIR to support resource allocation and streamlined data reporting for public health emergencies.
  5. Accountable Care Organizations (ACOs) and providers in risk-bearing arrangements will demand greater insight into hospital care. Scott Afzal: “Provider organizations that have taken on risk will focus energy on real-time access to clinical data, especially acute care services. Many at-risk providers and ACOs are proving they can control patient flow, forcing hospitals to respond to demands for greater insight into acute care. The ability to engage a patient during or immediately following a hospital encounter will become table stakes to perform within these payment models.”
    Retrospective: Navigating contracting and payment arrangements can be difficult for ACOs, providers, and other risk-bearing entities. In building process and modeling to mitigate risk, these organizations depend on data to drive performance to meet contracted obligations and realize value-based incentives. For acute-care services especially, connectivity plays a critical role in data transparency. Taking data from the initial acute-setting patient encounter and tethering it to follow-up treatment upon discharge or transfer paints a larger picture for all parties involved. These deeper insights close gaps to improve overall transitional care management, drive down costs, expedite payments, and provide more opportunities for reimbursements and incentives where applicable. Most important, data transparency keeps the patient front and center with respect to treatment outcomes, ongoing patient behavior, and health equity.
    Related reading: Learn how healthcare providers and risk-bearing entities can utilize health IT to reduce hospital readmissions to improve outcomes and save on costs in our blog: 5 Strategies for Reducing Hospital Readmissions Learn how rural hospitals can benefit from connecting to health information exchanges to overcome some of the challenges they face: HIE Benefits: Helping Rural Hospitals Enhance Care Coordination
  6. The Information Blocking Rule begins to have an impact but will be ignored by the largest entities. Scott Afzal: “The rule will begin to accelerate data exchange purposes beyond treatment (i.e., healthcare operations and payment) but, absent strong enforcement, many of the largest offenders will continue to go unchecked.”
    Retrospective: In August of last year, National Coordinator for Health Information Technology Micky Tripathi addressed information blocking during his keynote speech at the SHIEC 2021 Conference. Reframing “information blocking” positively as “information sharing,” Tripathi emphasized education in achieving healthcare interoperability and overcoming any practices that prevent or discourage access to, exchange, or use of electronic health information. He asserted that further rulemaking must also be accompanied by materials and outreach that improves general understanding of the issues. The ONC has since continued to push out new educational materials about information blocking. However, a final enforcement rule has not been issued yet, nor have they released any regulations that outline potential disincentives to offending parties.
    Related reading: If you missed it last year, we shared a recap of Micky Tripathi’s speech about information sharing in our blog: Key Takeaways from Micky Tripathi’s SHIEC 2021 Keynote For more on information blocking and other policy updates, read our blog by Senior Director of Policy at Audacious Inquiry, Kory Mertz: 7 Important Policy Updates to Know for Healthcare IT in 2022

As we anticipate momentum in the months ahead, we are well-prepared to embrace progress and work alongside our state and federal partners to drive deeper healthcare interoperability across the continuum—in line with Scott Afzal’s look ahead and backed by our regulatory expertise and continuous coverage of existing and emerging themes.