Vendors speak out on health IT interoperability

In February, the Office of the National Coordinator for Health Information Technology (ONC) released a proposed roadmap for healthcare interoperability, including the data exchange between long-term care and acute care. The proposal, Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap Version 1.0, is part of the ONC’s 10-year plan to improve the country’s health information infrastructure and encourage the greater adoption of health IT to deliver healthcare more efficiently and cost-effectively. The proposal provides groups of goals to reach over the next 10 years, some of which have a timeframe of just three years.

The proposed interoperability roadmap follows closely on the heels of the ONC’s December proposal to expand the Electronic Health Record (EHR) Incentives Program to include provider settings beyond acute care, since health IT adoption "remains low among providers practicing in long-term services and supports, post-acute care and behavioral health settings," the December report noted.

Long-Term Living spoke with leaders in the long-term care health IT systems arena about their reactions to the ONC roadmap and what the challenges are for LTC providers and technology vendors, especially during the next three years.


The ONC’s proposed roadmap is the first deep dive into what meaningful interoperability actually means to those who exchange health data. "Impactful and successful senior care is dependent on integrating data with effective and consistent communication to those in the immediate network of a provider’s care continuum," says Dave Wessinger, chief technology officer at PointClickCare. "Interoperability capabilities enable senior care providers to become better integrated, better connected and more streamlined with their partners in care, whether they be hospitals, accountable care organizations,  physicians or pharmacies, in an effort to drive better care and to better manage health for both people and businesses alike."

Merely being able to exchange data isn’t the same as interoperability, adds Billy Waldrop, vice president of operations at VorroHealth (formerly BlueStep/BridgeGate Health). "True interoperability, as the Health Information Management and Systems Society defines it, is ‘the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged,'" Waldrop says. "Many assume that exchanging PDFs, lab results or other documents between providers is interoperability when that is merely file sharing. Not only does the data have to be available to clinicians (i.e., stored in the system somewhere), clinicians have to be able to use the data that has been exchanged."


Human nature’s tendency to do only what is necessary to "check the box" of interoperability has at times undermined the spirit of the meaningful use initiatives in acute care. Exchanging the right data in a timely way means getting acute care to understand a skilled nursing facility’s workflow needs, notes John Damgaard, NHA, president and CEO of MatrixCare. "We can’t have someone showing up at a nursing home with a paper document pinned to them and then three days later we get the electronic discharge summary. Technically, it counts toward meaningful use and acute care’s requirements for electronic discharge, but it’s certainly not very useful."


Part of the ONC’s proposal calls for expansions—and perhaps a reconsideration—of how the EHR certification process works. The greater goals of the interoperability program will necessitate changes to ONC’s health information technology certification program that can account for true system functionality reporting and measure how technologies designed for providers beyond hospital walls—including telehealth initiatives and mobile technologies—are consistent with standards across the care continuum.

"If the ONC strategy is to ‘encourage consistent standards implementation, reduce variability,’ a more modular approach to certifying very specific data standards will be required," says Doc DeVore, director of clinical informatics and industry relations for AOD Software. "The industry needs a clear and unified strategy with true standards for health information exchange in order for these providers to realize their goals."
MatrixCare’s Damgaard agrees, saying, "Long-term care got it right in that it jumped straight into software-as-a-service. But you still need strong standards and a pristine vendor certification process."


Acute care and long-term care have differing workflows and different pay incentives, yet they share cooperative goals in using health IT to reduce readmissions, smooth care transitions and reduce medication errors. Not only do acute care and long-term care need health IT, each needs the other party to use the technology well and to trust each other's data, explains John Derr, president of JD & Associates Enterprises, who has been involved in healthcare IT standards-making process for more than 30 years. "It’s still really hard to get the [LTC] associations to understand that technology isn’t a separate silo."
Although long-term care’s recognition and adoption of health IT came decades later than its advent in acute care, many say that progress within LTC settings is making those perceptions undeserved. "Long-term care has suffered from a perception of being technology-poor, like we use rocks and sticks or something," Damgaard says. But unlike acute care, "Long-term care’s providers didn’t have [meaningful use incentive] money dumped on their heads, yet they’ve done some really unbelievable things anyway and have done them with a purer intent."
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