The Interoperability of Technological Systems and Patient Data
Introduction
The interoperability of technology and systems is an important theme that rings true across many sectors. Earlier this week, I wrote my technology news commentary piece on the formation of the AI Alliance, a group that is focused on creating open-source and interoperable AI systems. The purpose of this interoperable approach is to both improve the quality and accelerate the development of generative AI. Like the advancements in generative AI development, in healthcare, there are similar efforts to open up data channels. However, in healthcare, these pipes link patients, providers, and payors; and the system is not called open-source AI, it is called Healthcare Data Interoperability (“HDI”).
Every year, the US’ geriatric population grows, and every year, there are fewer working class individuals to support the cost of this aging population. To mitigate the supply-demand imbalance between young working-class individuals, and the elderly population that they are supposed to be supporting (vis-a-vis taxes paid towards Medicare and Medicaid), the US healthcare system needs to figure out a way to lower the healthcare cost per geriatric. One way to accomplish this deduction in cost is to increase the quality of care — which can help to eliminate expensive emergency department visits, the mismanagement (over and under-utilization) of care, and retroactive (vs. preventative) treatment programs.
To accomplish the above, a patient’s many providers and payors needs to be in the same boat and rowing in the same direction. The integration and collaboration of these stakeholders (also known as care-coordination) is crucial, and it requires the sharing of highly sensitive and disparate patient data. The objective of HDI is to facilitate this exchange of, and access to, a patient’s health data across multiple EHR systems and external data sources.
What is Healthcare Data Interoperability?
The average patient generates at least 80 megabytes of clinical data annually. Up until recently, this massive amount of data has been dispersed across dozens of stakeholders (e.g., specialists, caregivers, primary care physicians) and data sources (e.g., imaging, clinical notes, insurance information). US providers use EHR systems to log, exchange, and access this patient data. To the detriment of the patient and US healthcare system, there are hundreds of EHR products producing non-standardized data. Due to the nature of this non-standardized data, and lack of “data piping”, patient data is often stuck in disparate EHR platforms that are not integrated with other EHR platforms. Up until about 10 years ago, this has been the state of affairs for patient-level healthcare data. However, within the past decade, there has been a serious push by the healthcare ecosystem to adopt better healthcare data interoperability solutions.
The adoption of HDI is crucial for many reasons. Primarily, HDI allows providers to have a better view of their patient’s medical journey. By allowing multiple providers to have access to the same comprehensive patient data, stakeholders can streamline care coordination between parties. If providers are more adept at coordinating care, they can improve patient safety by implementing preventative care and check-ups, and ensuring medication adherence. HDI also allows providers to reduce the administrative burden of data-sharing.
The HDI ecosystem can be segmented into two major categories: data access and exchange, and data integration and application. Data access and exchange refers to companies that streamline patient data between health systems stakeholders, and electronic systems. This sub-segment provides solutions such as record sharing and patient record release. Companies in the data access and exchange sub-segment provide the “piping” for data sharing.
The second sub-segment is data integration and application. Companies providing these solutions are concerned with embedding and integrating patient data from multiple sources into cohesive information systems. This integration can include the interconnectivity of EHR data with other clinical, external, and administrative datasets. The next generation of data integration and application will include AI-focused analytics to inform clinical decision making.
Two key tailwinds have underscored the recent adoption of HDI solutions: technological advancements and health care reform. Recent technological advancements have enabled a boom in HDI application programming interfaces (“APIs”). APIs are software protocols that allow digital health applications to interact with one another. All healthcare focused APIs need to be Fast Healthcare Interoperability Resources (“FHIR”) certified. Additionally, advancements in AI are increasing the clinical applications of aggregated patient-level data to better inform treatment and care for patients.
These technological advancements could not have been implemented without serious legislative reform. Beginning in 2016, healthcare reform and government regulation has accelerated the demand and utilization of healthcare data interoperability solutions. In 2016, Congress passed the 21st Century Cures Act, which stated that health systems and insurers were required to use EHR systems to provide patient facing API. In 2020, Congress passed the Patient Protection and Affordable Care Enhancement Act, which mandated that healthcare organizations begin to adopt interoperability solutions which improve clinical results and reduce healthcare costs. These pieces of legislation mandated the adoption of HDI solutions, and spurred investment in technological innovation.
Conclusion
Like other industries (i.e., generative AI), the interconnectedness of technology and systems is extremely important in healthcare and patient data. As aforementioned, the US healthcare system is at a critical juncture characterized by an aging population and a diminishing tax-paying workforce. With healthcare expenditures forecasted to outpace healthcare funding, the US healthcare system must find a way to lower the cost per geriatric and improve quality of care. Improved care coordination, only made possible by HDI, is one of the most actionable ways to achieve this objective. The proper adoption and implementation of HDI solutions over the coming decade will be crucial in making the healthcare system more effective, improving quality, and consequently — lowering cost.
