The combination of regulatory pressure and technological advances will help move the needle forward — and not just for the sake of better interoperability, but also to get the Covid-19 pandemic under control and improve the health and wellbeing of us all.
The Covid-19 pandemic has brought to the surface many harsh realities around healthcare interoperability. For example, the flow of patient data to public health surveillance systems is antiquated and even today, often requires paper and faxes. Additionally, healthcare vendors lack incentives to interoperate with other vendors’ systems, which can lead to duplicative tests, unnecessary care, and higher expenses.
The health IT community has been working to solve these realities with incremental progress. To move the U.S. healthcare industry toward interoperability a little faster, regulators from the Department of Health and Human Services put out two new rules: The CMS Interoperability and Patient Access rule, and the ONC Information Blocking Rule.
While interoperability rules pushed the industry to change, the pandemic served as a forceful shove.
With the development of two FDA-approved Covid vaccines, and with several more on the horizon, we can breathe a collective sigh of relief – as small one and assuming of course that vaccine administration picks up — and reflect on how the pandemic accelerated some positive trends already happening with interoperability.
A Look (Not That Far) Back
SARS-CoV-2 and the disease it causes, Covid-19, forever changed healthcare technology. Telehealth use increased by nearly 50% during the first quarter of 2020 compared to 2019 according to the Department of Health and Human Services, and usage remained high through the summer. Videoconferencing, work-from-home options, prescriptions by mail, supply chain, inventory management — these systems and others scaled up and/or reinvented themselves dramatically in 2020.
For years, healthcare providers have tracked supplies and transmitted lab results electronically, employed telehealth, and allowed employees to work from home, but at a limited scale. The pandemic changed all that. As a result, any technology that reduces human contact or helps track Covid-19 data is undergoing explosive growth and change.
Telehealth and Remote Patient Monitoring
While most of the global population sheltered in place, healthcare systems had to rapidly make existing technologies work for a virtual environment. In no time, telehealth and remote patient monitoring became the norm rather than the exception: because of the need to rapidly scale these services, telehealth grew from a $3 billion to a $250 billion industry.
As IT teams worked overtime to deploy new systems or scale-up existing solutions, they also had to integrate them with existing systems, including EHRs. Meanwhile, government agencies did their part to support the shift. CMS expanded reimbursement for telemedicine visits. On December 1, the agency announced it would extend Medicare coverage for more than 60 telehealth services through 2021.
We know now telemedicine is going to be part of patient care for the foreseeable future. Yet in-office visits have started to return. It’s time to determine and use the right platform for every encounter. Sometimes the doctor needs to physically examine a patient, and sometimes a remote visit will suffice. It’s time to offload those encounters to a setting that works for both the patient and the provider.
Increased adoption of the most up-to-date healthcare standard, FHIR 4, will help facilitate exchange of information between telemedicine and other systems, the EHR, and between providers and patients. This is what we’ll need for telemedicine to reach its full potential.
With increased telemedicine visits comes the need to track patient vital signs and other data remotely. We’re seeing, and will continue to see, an increase in use of “smart” blood pressure cuffs, scales, pulse oximeters, glucose monitors, and similar devices.
These devices allow patients to provide health data from home; however, telehealth platforms and EHRs need the capability to manage and use this data. Vendors will want to consider adding more robust data integration capabilities into their products to make this happen.
Lab Result Reporting
We’ve seen a huge increase in lab reports submitted to public health agencies as a result of the need to report daily COVID-19 data. With the push to make COVID-19 testing readily available, we’ve also seen a sharp increase in the number of labs — many of them with new interfaces to facilitate reporting.
Moving from paper and spreadsheets to digital technology and electronic reporting, with interfaces that allow seamless sharing of information, will go a long way toward battling future public health emergencies. However, technology can’t solve chronic underfunding of reporting infrastructure. As the new administration reinvests in federal and state public health, that may change.
Another Type of Interoperability: Vaccine Management
Now that states are receiving shipments of the Pfizer/BioNTech vaccine and Moderna’s as well, seamless transmission of patient data is essential to a successful rollout. Critical information to monitor and analyze includes:
- When facilities receive shipments and the quantity of those shipments. Once delivered, facilities can only store vials of the Pfizer/BioNTech vaccine for five days at refrigerated temperatures.
- Which healthcare workers and patients have received the first and second doses.
- Which vaccinated and unvaccinated individuals have tested positive for Covid-19 and when.
- If these individuals received a Covid-19 test outside of their healthcare facility, data must be shared between the testing site, the lab that analyzes the test (especially in the case of home-based tests), the primary care doctors, and public health officials.
- Information about employees’ and students’ vaccination status and/or test results shared, for contact tracing and public health purposes, with employers and school administrators in addition to public health officials and healthcare providers.
FHIR 4 underpins many of the changes to come. Interoperability rules require payers and providers to expose data about their patients or members as FHIR APIs. Using APIs will help facilitate the exchange of information so we can meet more of the intermediate interoperability goals discussed here.
While many healthcare organizations do need to shore up their IT infrastructures to achieve interoperability, we’re also not done with our current public health crisis. The combination of regulatory pressure and technological advances will help move the needle forward — and not just for the sake of better interoperability, but to get the COVID-19 pandemic under control and improve the health and wellbeing of us all.
