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Measuring Up on the Interoperability Front

New Metrics Designed to Spotlight Industry Progress

By Brian Levy MD, Vice President of Global Clinical Operations for Wolters Kluwer, Health Language

Interoperability remains a high-level opportunity and challenge for the healthcare industry. A focal point of national initiatives for nearly a decade, this ongoing quest to improve health information exchange promises to transform care delivery from both a cost and quality standpoint.

The good news is that there has been significant progress with interoperability in recent years. Nonetheless, industry stakeholders acknowledge that a valid method for measuring the maturity and return on investment of its efforts has been lacking. It’s not enough to simply rubber stamp the transfer of information from one system to another as “interoperability achieved.” The industry needs to validate that the vast resources invested are, in fact, moving the needle on performance.

As such, the Office of the National Coordinator (ONC) recently identified two metrics to support specific indicators of “widespread interoperability” in the industry. The metrics were developed in response to directives laid out by The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and read as follows:

  • Measure #1: Proportion of healthcare providers who are electronically engaging in the following core domains of interoperable exchange of health information: sending; receiving; finding (querying); and integrating information received from outside sources.
  • Measure #2: Proportion of healthcare providers who report using the information they electronically receive from outside providers and sources for clinical decision-making.

It is important to note that these metrics are separate and distinct from other specifications proposed by the Department of Health and Human Services’ Quality Payment Program and will require no additional reporting. The data for assessing interoperability maturity comes from existing national surveys of hospitals and office-based physicians, including the American Hospital Association’s (AHA) Information Technology Supplement Survey and the Center for Disease Control and Prevention’s (CDC) National Center for Health Statistics’ annual National Electronic Health Record Survey of office-based physicians.

On the surface, the new measures appear straightforward, equitable and aligned to industry goals, yet achieving a framework to support this level of maturity is anything but simple. While the introduction of standards has enabled easier exchange of information, that critical step forward is just the tip of the iceberg. These measures are specifically designed to gauge the industry’s progress with the next level of interoperability, characterized by information exchange that is easily integrated into receiving systems, understandable and actionable for improving care delivery.

A Deeper Look

Healthcare stakeholders must understand how the industry defines interoperability maturity and success to adequately measure progress. Some insights can be garnered from the more than 100 comments provided to ONC following a Request for Information initiated prior to developing the new measures. Specifically, ONC reported that much of the feedback related to four topics:

  • Burden: Do not create significant additional reporting burdens for clinicians and other healthcare providers.
  • Scope: Broaden the scope of measurement to include individuals and providers that are not eligible for the Medicare and Medicaid EHR Incentive Programs.
  • Outcomes: Identify measures that go beyond exchange of health information. Although measuring the flow of information is important, it is also critical to examine the usage and usefulness of the information that is exchanged as well as the impact of exchange on health outcomes.
  • Complexity: Recognize the complexity of measuring interoperability. Multiple data sources and more discussions are needed to measure interoperability fully.

Specifically, the comments related to outcomes align with other nationally-accepted definitions of interoperability. For instance, the ONC’s interoperability roadmap (Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap) calls for measurement and evaluation around three domains: 1) the adoption of technology and policy enablers that increase the capability to exchange in an interoperable manner; 2) information flow and usage of interoperable information; and 3) impacts of exchange and interoperability on improved health and healthcare and the cost of that care. 

The Healthcare Information Management Systems Society (HIMSS) also defines three levels of maturity related to interoperability. The first, “foundational,” speaks to the basic exchange of data minus the ability of receiving systems to interpret data. The second level, “structural” interoperability, defines the syntax of data exchange or a format that enables uniform movement of healthcare data from one system to another. As the highest level, “semantic” interoperability enables systems to not only exchange information in a standardized, structured format but also understand and use it in a meaningful way.

Industry initiatives that have introduced specific technologies and standardized clinical vocabularies (e.g. SNOMED CT®, LOINC®, RxNORM) are advancing the goals of foundational interoperability that enables basic exchange of data. The new measures introduced under MACRA point to the highest level of maturity, semantic interoperability, where data exchanged is trustworthy and reliable, easily integrated across multiple sources and positively impacts outcomes.

Laying a Foundation for Semantic Interoperability

While the industry has made progress with both foundational and structural interoperability, the complexities of aligning the volumes of disparate data with industry standards are notable for all industry stakeholders—providers, payers and vendors. Yet data must be normalized around a single source of truth to achieve the goals of semantic interoperabilityand produce the meaningful information exchangeneeded to elevate care delivery.

For instance, analyzing a population health cohort for heart failure requires that all representations of the condition (such as ICD-10-CM, SNOMED, free text, etc.) be normalized across a multitude of IT systems within an integrated delivery network. These representations must then be mapped to an appropriate industry standard for clean, accurate capture of data.

Health networks increasingly recognize this challenge. It’s why a patient-centered medical home (PCMH) initiative (Vermont Blueprint for Health) and an accountable care organization (ACO) in Vermont are looking to their state-wide health information exchange (HIE) organization for assistance in aggregating disparate clinical data.  

Vermont Information Technology Leaders (VITL), operator of the Vermont Health Information Exchange (VHIE) is working collaboratively with public and private organizations around the need to prioritize data capture and quality management by addressing data at: 1) its source, 2) in the middle of the network and 3) at the end-point analytics solution. As data moves through the system, the organization leverages a number of health IT solutions to measure quality and consistency, implement standards based structural interoperability, facilitate semantic interoperability terminologies for accurate data capture and ensure integrity of its master patient index (MPI).

VITL is in fact investigating the degree of data quality maturity that includes examining whether Continuity of Care Documents (CCDs) are well-formed and the degree to which standard terminologies are implemented and actually used in these documents.  VITL has undertaken a study to evaluate the relationship of data quality maturity, technical maturity and community clinical activity to expenditures, utilization, and preventive care in Vermont’s health service areas.

The reality is that most health networks manage dozens of clinical, claims and administrative systems—all with their own inherent clinical language and proprietary codes. Semantic interoperability requires that all varying terminologies be normalized to an agreeable standard accepted by systems communicating with each other. For many resource-strapped organizations, the business case for leveraging the expertise of an industry partner and an advanced enterprise terminology management platform is an easy one to make in light of these complexities.

Advancement of health information exchange will remain a focal point of industry initiatives for the foreseeable future. The recently-introduced interoperability metrics demonstrate this reality. Providers, payers and vendors must strategically address the next level of interoperability as the industry moves closer to full maturity.

*This article was syndicated with permission from Wolters Kluwer, Health Language.