“We are deadly serious about interoperability.”
-Andy Slavitt, Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) at the J. P. Morgan Healthcare Conference in San Francisco in January 2016.
For those of us in the healthcare vendor community, that defining statement sets the tone for the future interaction between organizations. Slavitt was also clear that achieving interoperability means “leveling the technology playing field” and requiring vendors to interchange data. He discussed open Application Programming Interfaces (APIs) as a specific model for integrating and moving data seamlessly between technologies. These are now guiding principles as we collectively try to benefit more from interactions outside our specific verticals.
CMS charts a new course
Meaningful Use has provided the impetus for widespread use of technology but has fallen short when it comes to achieving outcomes. The new, forward-looking focus of CMS is how we leverage the technology that’s been implemented to realize benefits we all want but have been frustrated in obtaining.
CMS has taken the first giant step on this path by announcing in April that Meaningful Use will come to an end for physicians treating Medicare patients. In its place, CMS is instituting an Advancing Care Information program (ACI) – a component of the Medicare Access and CHIP Reauthorization Act (MACRA) that Congress passed last year. ACI promises to be simpler, less burdensome, and more flexible. Once finalized, ACI will replace Meaningful Use on January 1, 2017. One of the key goals of the new program is emphasizing interoperability, information exchange, and security measures. It also requires patients to be able to access their health information through the use of APIs.
In his address at the J. P. Morgan conference, Slavitt detailed four key goals of the new CMS vision: outcomes, customization, leveling the tech playing field, and interoperability.
Switching from use to outcomes
The new CMS vision shifts the focus from just mandating use of technology to demanding better outcomes as a result of technology use. That means providing flexibility to implement technology that will allow providers to best meet their needs and achieve those outcomes. This new direction now places the onus on both large and small vendors to determine how to work better to help providers meet their goals.
Vendors, as a group, have an obligation to quickly develop and deliver real world technology solutions that achieve the desired interoperability outcomes proposed by CMS.
Enabling customized IT for provider needs
Slavitt’s second key point is that providers need to be able to customize technology to support their own practice needs and goals. Tech companies must build around the needs of the individual practice, not the needs of the government. Going forward, technology must be more highly user-centered to support physicians and not distracting them from their clinical practice.
For us at T-System, our context is the emergency department (ED). For an ED physician caring for a patient, decision making is real time and ED providers are now “on the clock” to make faster and better decisions unlike in any other care setting. The critical nature of “all available information” in the ED makes it a perfect venue for demonstrating technology-focused provider flexibility. This user-centered emphasis could be the ability to apply multiple technology tools that would enhance that clinical interaction, regardless of what the enterprise EHR happens to be. So customization comes more in the context of toolsets and enabling capabilities that allow providers to do exactly what he or she needs to at the moment of care.
At T-System that means we spend more time working on clinical content and supportive workflows, independent of the enterprise environment. A good example is the use of mobility or domain solutions that make the provider more meaningfully informed at the moment of care by providing quick access to data that they don’t have today.
Leveling the technology playing field
To help meet these customized needs, CMS is committed to an even technology playing field. The use of APIs and adherence to Fast Healthcare Interoperability Resource (FHIR) and other emerging standards is driving the vendor community as a whole in a positive direction. Some of the larger vendors in our space should be commended for leadership in this area. Cerner, Epic, Athena, and others have already identified working environments and sandboxes that are API focused and allow a level of development and growth interaction that signals a positive response to the new CMS direction. These are great starting points, but need much more focus and development to achieve interoperability outcomes.
Meaningful Use reached its level of success in part because there were dollars attached to the behavior. In a similar way, the shift to outcomes will be driven by incentives for providers. This in turn will create a demand-pull for technology solutions to help providers achieve those required outcomes.
Part of the potential genius here is that government leaders are now focusing on outcomes, too. This means providers will demand technology companies to embrace interoperability to deliver better clinical care to achieve those outcomes.
Committing to interoperability
We can no longer tolerate business models that prevent or inhibit data flow. When discussing interoperability in this context, the lens that most people look through involves the ability to move data back and forth primarily oriented around post engagement reporting, analytics, and data mining. As vendors, we need to look at interoperability as a way to facilitate real time data movement from multiple sources so clinicians can quickly obtain the data necessary to optimize care delivery. Interoperability will then mean real time data access regardless of the platform or environment in which it resides. We need to support data models that expand and accelerate the velocity of data interaction.
In the fast moving environment of the ED, for example, anything that can be brought to bear to help the clinicians in high stress moments provides huge benefits. We look at our stock in trade as an enormous amount of intellectual capital associated with the delivery of clinical care in the ED. So when it comes to interoperability, our challenge is figuring out how to work in large, complex enterprise IT environments with multiple legacy vendors to deliver our ED intellectual capital to a clinician at the moment of care. The really good news is that with the API/FHIR defined standards and full commitment from our technology vendor community, this is very achievable in the near term!
When it comes to clinical value and interoperability, our company has developed the most comprehensive set of clinical templates available in the ED space. This aggregated 20 years of clinical domain expertise needs to be allowed to move more freely across the technology environment so that ED providers will all benefit, regardless of the legacy platform they’re standing on.
Driving real HIT change
The CMS has set the new direction, but the real question is how do we, as the HIT community, drive real change? There are a number of vendor behaviors and high visibility initiatives that are beginning to engage the discussion with meaningful intent. Translating that into efforts that help clinicians improve outcomes is the next step. It’s important that these forums exist, but it’s more important that they result in action. As Jonathan Bush of Athena has said, we need to “do stuff” instead of just talk about it.
From a broader perspective, achieving change is going to be the result of collaboration between the larger enterprise vendors and the smaller best-of-breed style innovators. The smaller vendors will apply what they can do to truly make interoperability a clinical reality while the enterprise vendors must provide the overall context and participate in a meaningful way - particularly as they respond to their client needs and demands.
In addition, healthcare integrators and consultants have an obligation to help guide clients who engage us for optimization and discuss the implications and importance of interoperability.
This collaborative effort is potentially a great example of a rising tide lifting all boats. Everyone – vendors, providers, and patients – benefit from an accelerated adoption of interoperability.
The impact you can make on moving the ball forward depends on the role you play. Providers should demand optimal technology as part of your care environment. You need to require vendors to interoperate in a way that optimizes clinical outcomes. Interestingly, better documented clinical outcomes will also positively impact financial and operating results. This demand requirement from providers will be the key to driving successful outcomes.
Integrators and consultants should be in a position to advise clients to require different layers of interoperability as they think about solutions at the next level of healthcare.
Finally, we as vendors must be open and collaborative and continue to think about the end game - outcomes that need to be achieved on behalf of both providers and patients. In the end, we need to recognize that if we do good, we will also do well.
For more information on the impact that IT/clinical optimization can have, download our infographic, The Ripple Effect of Clinical Optimization.
T-System is a healthcare IT company that advances care delivery and financial outcomes for episodic care. Specializing in emergency department documentation since 1996, T-System has since expanded its focus to include the development of innovative solutions for the rapidly growing episode-based care market, including hospital-based emergency departments (EDs), freestanding emergency centers, and urgent care centers. Through clinically driven services and documentation solutions as well as charge capture and coding solutions, T-System solves clinical, financial and operational challenges for our clients. Nearly 40 percent of the nation’s hospital-based EDs, freestanding emergency centers, and urgent care centers use T-System to improve the clinical encounter, patient visit documentation, and related downstream outcomes. For additional information about T-System, please visit www.tsystem.com.