Why health data interoperability matters for long-term care

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Sanjay Nathwani
Sanjay Nathwani

Health data interoperability was the big topic of discussion at this year's Health Information Management Systems Society's annual meeting – and for good reason. Healthcare providers, especially those in long-term care, need access to data from the various care providers their patients see to make more informed decisions.

The state of data exchange in healthcare is different than in other industries. Healthcare providers and electronic health record vendors have a clear directive to protect patient data, and people are very careful about how they share patient data, so interoperability efforts proceed more deliberately.

There has been a cost factor involved, too: Long-term post-acute care providers and skilled-nursing facilities are not yet eligible for the Meaningful Use incentives, although dialogue persists on possible paths to include them down the road. Regardless of financial incentives, it is clear that senior care health data systems need to be interoperable with other providers' EHRs. Patients and providers need to see the complete picture of care.

At the very least, continuity of care documents or better handoffs from a hospital to a long-term care facility is a big benefit of EHRs. Today, CCDs (in paper or static, unsearchable PDF formats) are a step ahead from none at all, which was the case a few years ago. We look forward to a day when we begin as an industry to send and receive these CCDs in a machine readable format. It falls on EHR vendors to open the doors and enable interoperability such that they are able to trade patient records.

Why it's taken time

Speakers at HIMSS 2016 also said that EHR vendors need to lead improvements in health data interoperability that ultimately will increase care quality. We agree. EHRs should be not only the definitive record of a patient's care, but also should function as an interoperability platform as more and more patient records become available in digital, machine-readable formats. They will need to be nimble, adaptable to standards that exist now – such as HL7 – but also adaptable to emerging standards such as Fast Health Interoperability connectors driven by application program interface connections.

Previous versions of HL7 made great first strides toward standardizing health data exchange. Now that HL7 is moving toward FHIR and leveraging APIs, it makes for clearer standards and helps get all systems on the same page more quickly than ever. PointClickCare will be investing in FHIR, researching its application in our systems and actively monitoring developments among our peers to incorporate their best practices as we share resources.

Since many long-term care providers are using cloud-based EHRs, they have one advantage that puts them ahead of many acute-care providers who host their own systems (some of them multiple EHR systems): Cloud vendors manage the version maintenance on their end, freeing the customer to devote more resources to patient care and less on IT support of EHR upgrades.

Long-term care could reap long-term benefits

Meaningful use has motivated those in acute care to build interoperability through HL7 and FHIR development sandboxes. We are looking directly at those approaches to build our own interoperability platform, to make it easier for senior care providers to plug into local hospitals, physician offices and other providers along the care continuum. Moreover, we're also exploring ways to elegantly enable third-party applications to connect to devices and smart sensors to enable clinicians to quickly spot changes in a patient's status, identify fall risks, and other key markers that affect their recovery and enhance care quality. Caregivers empowered with such data and capability will be able to more quickly respond to these changes, and enhance patient outcomes.

When a senior care resident goes to a hospital or another provider for care, CCDs tell the story. Creating and exchanging these documents help enable bundled payments. But there's more than financial incentives to open up our systems to acute care: By creating APIs to share data, we are fostering cooperation among partner health data systems as well as third-party vendors, which leads to innovation that no one company could create on its own.

All healthcare IT vendors working together can build better interoperability for senior care providers than we could by ourselves individually, which will return richer benefits to patients. This is the promise of emerging standards such as FHIR. Seniors typically have multiple diagnoses, and often multiple chronic conditions. It could be argued that long-term care residents – with very complex, detailed medical records – can benefit the most from health data interoperability. That is the real reason to invest in this initiative, as always: The patients and residents.

Sanjay Nathwani is Director of Product Management, Interoperability, at PointClickCare.

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