The largest remaining barrier to interoperability is not a technical challenge but the lack of will to make it happen, according to one industry leader.


May 1—Healthcare industry leaders have very different views on how soon patient data will widely flow as needed through interconnected entities—if it happens at all in the foreseeable future.

At a Washington, D.C., meeting this week of healthcare leaders, one of the most optimistic views of the movement toward healthcare data interconnectedness was given by Jonathan Bush, chairman, president, and CEO of athenahealth, who expects broad hospital connectivity within five years.

Bush expected offline data sources covering 75 percent of U.S. hospital beds to be connected with the Internet by 2018, with the remainder connected over the ensuing four years.

“But more importantly, we will see a rise in the sales of cloud-based systems that, whether they are Athena or not Athena, will be able to be connected with [each other] explicitly; there will be no interface as a concept,” Bush said, referring to his company’s connectivity initiative.

Craig Samitt, executive vice president of Anthem, does not expect broad data sharing to occur for about 10 years. But interconnectivity must happen to support the industry-wide movement toward value-based care, he said. Nearly 60 percent of Anthem’s payments are now value-based.

“For our clinician partners to really align and achieve all that’s possible from a population health perspective on a value-based payment, we’d better get interconnected and fast because that’s how we actually deliver results,” Samitt said.

Samitt also emphasized the need for connectivity that includes not just data but also other ways to link various sites of care.

“It’s how do we achieve alignment with the patient at the center so we can see a whole patient? Data is just one part of that,” Samitt said.

Payment reforms are expected to support the data connectivity and other types of connectedness that eventually will transform health care.

Steven Corwin, MD, president and CEO of NewYork-Presbyterian health system, questioned whether any interoperability solution was likely.

“People will use these transactional systems as best they can and then layer on top of them real artificial-intelligence machine learning and the ability to do virtual visits,” Corwin said. “I don’t see the interoperability problem being solved in the short run.”

Corwin expected an increase in patient demands to have access to their own data. But the ability to connect providers through regional healthcare organizations or information exchanges “is not going to happen.”

“I’m very pessimistic about true interoperability,” Corwin said.

Why the Lag

The failure of broad healthcare data interconnectivity was laid at the feet of different entities.

“The promise of interoperability is still is a promise; we’re still not there,” Corwin said. “We had the notion that we could have various EHRs that would be perfectly compatible and interoperable, and that’s clearly not been borne out.”

Corwin said the Obama administration’s implementation of the HITECH Act, a 2010 law that provided $35 billion to incentivize the adoption and use of EHRs, effectively was a declaration that interoperability was not achievable nor a viable goal because the rules contained no requirements on interoperability.

His health system is faced with the challenge of linking multiple EHRs across various settings and then layering a system on top to reduce the amount of needed exchanges and linkages between those systems.

Another major issue for connectivity is the threat it can create for providers.

“This free flow of information is problematic from the standpoint of security,” Corwin said.

The cybersecurity threat has grown so quickly that his organization’s cybersecurity insurance premiums have increased from $2.5 million four years ago to $100 million, based on a potential breach of 4.5 million records.

“Ransomware attacks are just the tip the iceberg in terms of what can happen to healthcare organizations,” Corwin said.

His organization’s IT system was attacked through a breach that originated in a radiation oncology software system from the Netherlands and penetrated “into the depths of our security apparatus.”

“The tendency is going to be not to connect to everything because somebody can get in through a potentially weak portal to your system,” Corwin said.

One security response of his health system was implementation of a policy that barred connecting medical devices to the organization’s IT system unless the manufacturer was willing to put needed safety precautions in place.

Getting to Interoperability

The primary barrier to interoperability in health care is not technical but a lack of will, Samitt said.

He argued that health information—as it relates to population health and delivering better care at  lower costs—should be viewed as a public benefit. Instead, payers have the most complete data set, but it is not timely; clinicians have the most specific data set, but it is not complete; and patients have the most relevant data, but it is not actionable without access to other information.

Bush expressed hope that the Trump administration will move to ease federal restrictions on data sharing and on the benefits of such sharing. Specifically, he expected the administration and Congress to push changes to the Stark Law and Anti-Kickback Statute, which prevent hospitals from being able to buy patient data from physicians.

“It’s illegal for a primary care doctor who has all of this digital information on a patient and who doesn’t work for the hospital to get paid a small percentage of the savings that the hospital would generate by digitally pulling that information upstream,” Bush said. “That’s ridiculous.”

The federal government also could allow more providers to see the information it has on their patients.

A sign of progress was a provision included in the 21stCentury Cures Act, which was enacted in 2016, that barred data blocking. Also in 2016, three large EHR vendors allowed athenahealth to connect to all of their hospitals, which will build extensive connectivity.

“The good news is that there is now a change in will; we’re working with commercial payers and they are giving us claims data that they didn’t used to give,” Bush said.


Rich Daly is a senior writer/editor in HFMA’s Washington, D.C., office. Follow Rich on Twitter: @rdalyhealthcare

Publication Date: Monday, May 01, 2017