Why Interoperability Is Worth the Challenge

About four years ago, well before the CommonWell-Carequality connection, I faced what is probably still my most difficult health-related challenge. Up to that point, I had been relatively healthy and hadn’t needed to regularly see my primary care physician (PCP). Wanting quick relief from a common infection, I went to an urgent care facility. I then went back for the same infection.

I had no idea that taking a second and then third round of antibiotics would lead to suffering from something worse. Leaving out the gory details, I soon had such severe symptoms that I rushed to my doctor, only to receive a diagnosis of C. difficile. It took about two months of following a strict, life-altering diet and receiving treatment before I started feeling normal again.

Fast forward a year. I was seeing my OB/GYN, who used a different EHR from what my PCP used. This, of course, meant that my OB/GYN had to mainly rely on me to relay my medical history. I was given an antibiotic to treat yet another infection, and though I told them about my experience with C. difficile, the OB/GYN told me that it was highly unlikely that the antibiotic would cause C. difficile. Having no other options, I took the antibiotic and was soon in familiar C. difficile territory.

If my OB/GYN had had access to my records, he would have known that I had already had that antibiotic and would have been given other important details that I didn’t have the expertise to convey and that I, frankly, just couldn’t remember. Of course, I now know that any antibiotic will cause C. difficile for me, but that’s another issue. Fortunately, this bout with C. difficile didn’t involve a two-month recovery. Still, this experience, among a host of other lesser ones, remains my personal example of why interoperability matters.

The Current State of Interoperability 

As providers feel more pressure to take on interoperability, options to fulfill this need have cropped up everywhere. Regional HIEs, point-to-point interfaces, and Direct messaging are just some of the solutions. The CommonWell-Carequality connection was made available in late 2018, enabling many organizations to take strides toward data sharing.

There is still vast room to improve data sharing, but the changes are currently taking place. In fact, a KLAS report from earlier this year focuses on the next hurdle—how well vendors are making that shared data usable. Being able to see the data in context to make timely decisions is one important goal.

A large piece of data usability also revolves around creating standards. Kevin Mehta of Payformance Solutions points out, “The key to quick wins with interoperability solutions is getting information that flows quickly through the organization to have accurate information to make the best decision at the right time. To do this, you need standardization of data collection and reporting with a clean UI/UX. There is no amount of AI, machine learning, data science, natural language processing, or fuzzy matching logic that can make up for starting with good data.”

Patient Privacy Challenges

Patient privacy is a huge concern with interoperability. In recent news, two federal agencies put forward proposals that would impact the exchange, access, and use of all health care data. The ONC’s proposal focuses on the agency’s potential new health IT certification requirements and information-blocking provisions from the 21st Century Cures Act. The CMS proposal encourages interoperability and promotes a patient’s access to all the data their health plans have about them.

While these proposals sound good on paper, the AMA has voiced concerns that these suggested rules could lead to unintended consequences. Given that some doctors have taken to calling meaningful use “meaningful abuse,” I can understand their hesitancy to view regulations as the solution to our regulation-instigated digital health problems. Another major concern about opening data to patients is that third-party vendors could possibly sell or trade this data too.

The reality of this issue comes home to me when considering popular DNA-testing companies like 23andMe and Ancestry. These companies certainly have a vested interest in keeping their customers’ data private. However, they are still selling genetic data to some third parties, including P&G Beauty and The University of Chicago.

The arrest of the Golden State Killer is a striking example of the unintended use of this genetic data. Joseph James DeAngelo, a former police officer, was finally caught because law enforcement compared DNA found at crime scenes to DNA of DeAngelo’s distant relative on an open-source DNA-sharing website.

While this extraordinary case may be the (positive) exception, it’s a good example of how the healthcare industry needs to consider now how to better protect patients.

The Benefits of Connection

Even knowing some of the risks of interoperability, there is still much to be gained from the healthcare industry being better connected. Interoperability directly benefits everyone involved—from the physicians who save time by having all the information they need to the patients like me who can avoid unnecessary or harmful prescriptions. I’m excited to see what happens with interoperability efforts in the future. If those efforts mean better help for patients like me, I say full speed ahead.