Digital Whitepapers

Effective sharing of patient information depends on getting different and often disparate systems to exchange data and, at the highest level, process those data.

This requires sturdy bridges between systems, interpretive and compatible algorithms, and integrated strategies for how different systems will be used and will work together.

THE BASICS OF INTEROPERABILITY

CHALLENGES

SOLUTIONS

Why Interoperability Is Important

Between 2010 and 2013, U.S. hospitals spent $47 billion annually on information technology (HIT), according to the American Hospital Association. In 2014, nearly all (97 percent) of the hospitals tracked by the U.S. government possessed a certified electronic health records systems, according to the Office of the National Coordinator for HIT. But, because patients use multiple providers in multiple locations and these locations may be in hospitals, physician offices, post-acute care facilities, pharmacies, retail clinics, labs and imaging facilities, it is difficult to put all the relevant medical information in the hands of those who need it. Years of IT specialism has spawned disparate systems driven by particular strategies for handling specific types of data. Imaging specialists benefitted first through picture archiving and communications systems. Other specialists and general practitioners followed with electronic medical records systems.

Today, as data are being spread across the enterprise and among specialties, the strategies that guided the acquisition, storage and transmission of specific types of data are being homogenized to allow access to caregivers in multiple departments and across enterprises regardless of the type of department or whether those data were collected in in- or outpatient facilities.

And so they should. Patient health, after all, is the only reason these data are collected. Care coordination facilitates good healthcare and helps keep a lid on costs by optimizing drug expenditures, testing, and billing, according to research published in 2003 by Excerpta Medica.

It makes sense, therefore, that clinical data be acquired and shared interoperably and seamlessly in forms usable by doctors, nurses, nurse practitioners, other staff and patients. This is particularly needed in cardiology, in which patients may be examined and treated at multiple facilities and as both in- and outpatients. This has led some providers to seek out a “single-stack solution” -- a single IT system that handles all facets of diagnosis and treatment.

To serve the patient, data must be accurate. That accuracy must be maintained during the exchange. And the transmission must be quick.

Critically important data must not be held up by methods needed to ensure its security, for example, its encryption and decryption – or because the caregiver doesn’t know the password.

Efficiency is important also for the provider to remain financially viable. Patients must be managed effectively despite continuing reductions in reimbursements as medical practice shifts from fee-based to value-based care.

Effective and efficient data exchange is crucial for the patient to benefit and the provider to survive.

CHALLENGE: Consolidating Healthcare IT Systems

Hospital consolidation is gaining momentum. At the end of 2016, Becker's Hospital Review predicted that this movement toward fewer but larger health systems would continue. Among the drivers are an increased focus on population health, disputes between payers and providers, and lower reimbursement.

This trend has been going on long enough that mega for-profit and not-for-profit provider systems, integrated delivery networks or IDNs (aka integrated health networks or IHNs), have taken root. They have brought with them a plethora of disparate IT systems, each chosen and implemented by once independent hospitals and care facilities. In some instances, this has bred a cacophony of data -- a specialist’s report turns somehow from “English to gibberish,” states the AHA; values appear in the wrong section of a lab report; data are dropped from critical fields in a care summary; inpatient data do not accompany patients transferred to outpatient facilities.

Going to a unified system that establishes a single platform throughout the IDN/IHN might remedy many of the problems but it usually is not economical to do so. Installed IT systems are often viewed as investments. But, as medicine moves from a fee-based to a value-based model, they must be managed to provide efficient and effective patient care.

In a single hospital, the challenge of connecting the various silos, each representing a different specialty, can be formidable. The subspecialties of cardiology may be viewed in much the same way, walled off from each other; patients entering and exiting different silos, data barriers reinforced by disparate IT systems--one for nuclear cardiology, another for echocardiography, another for cardiac cath.

Interoperability is the key to interfacing multiple information technologies throughout cardiology, just as it is the key to unifying IT systems throughout hospitals and the enterprise. And interoperability depends on standards.

CHALLENGE: Securing Systems And Patient Data

Healthcare depends on patient trust -- trust in the physician, in the system, in the privacy they provide. Security breaches of the IT systems that hold patient data can undermine that trust. Will patients who do not trust the integrity of health IT spill over to providers, leading some to go to other providers? Will those who remain hesitate or refuse to disclose details that physicians and nurses need to manage their healthcare?

Early this year, hackers successfully cyberattacked Emory Healthcare, exposing data about at least 79,000 patients. Theirs were among more than 325,000 patient records hacked in just the first two months of this year, according to the U.S. Department of Health and Human Services Office for Civil Rights.

Stopping cyberattacks is critically important not only for the continuation of provider-patient relationships but to prevent loss of revenue and federal penalties. Since the Health Insurance Portability and Accountability Act of 1996 was enacted, the federal government (as of February 28, 2017) has investigated and resolved 24,879 cases that allegedly violated HIPAA rules. Of these, 47 cases have been settled for a total of $67,210,982.

Cyberattackers were responsible for 31% of the major HIPAA data breaches reported in 2016, according to TrapX Security. Last year 93 major cyberattacks were successfully launched against healthcare organizations, according to TrapX. Among the most substantial were Banner Health (3.6 million records), 21st Century Oncology (2.2 million), and Valley Anesthesiology Consultants (880,000).

A leading type involves ransomware -- malware that typically encrypts data, which the attacker promises to decrypt if a ransom is paid. The Emory assault was a variation. Cybercriminals removed the appointments database and demanded ransom to restore it. (Emory did not publicly disclose in news articles about the breach whether it paid the ransom.)

Other types of attacks may pilfer patient data for sale on the black market. Patient records include loads of valuable information including social security numbers and insurance information.

Keeping these data secure means understanding your IT systems -- how they function and what their patterns of operation look like. When patterns change, trouble may be afoot.

Sponsored By: