B.J. Boyle

Interoperability: The Key To Enhanced Care and Becoming A Preferred Provider

Interoperability: The Key To Enhanced Care and Becoming A Preferred Provider

By B.J. Boyle, vice president of product management, PointClickCare.

B.J. Boyle
B.J. Boyle

Interoperability, as it was envisioned, should be built on transparency and connectivity, allowing a patient’s critical health information to be easily accessible, regardless of where treatment is being administered. By creating an infrastructure that supports the sharing of patient data along the care continuum, hospitals, skilled nursing facilities (SNF) and long-term post-acute care (LTPAC) facilities can offer the best care possible. As a result, organizations that participate in interoperability best practices are positioned to become preferred providers.

Unfortunately, interoperability is still a work in progress for many organizations. While more than 95 percent of hospitals and 90 percent of office-based physicians are now utilizing electronic health record (EHR) platforms, many struggle with — or have reservations around — sharing information outside of their facility. As such, silos represent a great barrier to realizing a fully implemented state of interoperability.

The current data gap can drastically impact care. For example, a patient experiences a serious medical incident — such as a fall or stroke — and arrives at the hospital where staff may not have access to existing patient data which could inform the best delivery of care. Or perhaps they’re able to access that data, but not right away. Care is now delayed, which can be additionally concerning depending on the time-sensitivity of the patient’s condition.

Taking this example a step further, let’s explore what happens after care at the hospital has concluded. The patient requires rehabilitation, and a continuation of care document (CCD) is issued to a post-acute care facility. From there, the patient’s information is transferred by less-than-foolproof methods such as fax, for example. A glitch as simple as a jammed paper feed could prevent critical information from reaching the appropriate caregiver.

As value-based care and payment-care models are moving toward the forefront, blind handoffs of patient information are no longer viable, as they drastically increase the financial risks hospitals and payer groups are subject to — not to mention the clear detriment the system has on delivery of care.

Closing the gap

The larger question is how does the industry get from Point A to Point B? The easy answer is to liberate the data through a cloud-based infrastructure that supports an efficient, easy-to-access data exchange between all caregivers. An integrated solution would connect stakeholders across the care continuum, providing accurate insights when needed, eliminating data silos between care partners, and enabling more confident decision-making.

These systems would promote:

  • Optimized transitions: Data needs to travel with the patient — or before movement — discretely across all systems.
  • Patient visibility: Data should reflect the most current ADT information, identifying and sharing where a patient is and from where they’ve been discharged.
  • Central view of LTPAC patients: This facility-agnostic feature should offer automated updates of a patient’s functional progress.
  • Ongoing status and monitoring: Maintaining continued care is facilitated through alerts and notifications to caregivers regarding any change to their status or well-being and meaningful feedback on care pathway progress.
  • Facility performance: Beyond understanding a patient’s status, it’s also helpful to understand how facilities in and out of their PPN have performed.

Overcoming concerns

The concept of interoperability, in some ways, seems contradictory to traditional best practices. Healthcare organizations are charged with protecting patient data at all costs, and the idea of sharing data in a way that opens access to a wider group of stakeholders could give pause. Regulatory infractions for data loss in the healthcare industry can be steep, and the number of well-publicized data breaches in recent years reinforces how valuable health records are to both the organizations who keep them and those who try to steal them.

So, it should go without saying that an EHR “superhighway” must be developed with security in its DNA, taking stringent regulatory requirements into account. The good news is that the newest breed of information exchange platforms is being built with security roles in mind, drastically reducing the possibility of data loss.

The business case for interoperability

While patient care is the most important outcome of interoperability, there is also a business benefit: becoming a preferred provider. In recent years, hospitals have begun narrowing their network of referral partners, choosing partners based on more scrutinized criteria — and data is at the heart of those choices. The sharing of data, for many healthcare providers, has become a non-negotiable prerequisite.

For example, penalties for readmission is a prominent financial risk for many hospitals and accountable care organizations. According to a recent study published in the American Journal of Accountable Care, one in five Medicare patients are readmitted within 30 days of discharge at a cost of approximately $17 billion per year. As a result, it is in a hospital’s best interest to only refer patients to LTPAC and SNFs with a history of providing a level of care that reduces the probability of readmission. Simply put, facilities that are not using the most innovative systems to limit re-admissions are not reaching preferred status.

In today’s preferred healthcare environment, interoperability is the gold standard, and having the necessary tools to send and receive critical data is paramount, not only to improving care, but ensuring a robust, ever-expanding referral network.

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