Qual-IT - January 2005 | Archived

Interoperability of health information systems promises important benefits to consumers, purchasers, clinicians, and health care organizations.

• For consumers, access to specific records (e.g., childhood immunizations) or to a more complete health history, including prescriptions and lab test results, even if these services were received in different health care settings;
• For purchasers, efficient management of transactions with multiple payers and providers;
• For clinicians, more effective application of evidence-based care standards to patients' individual histories and needs;
• For health care organizations, more functional monitoring of performance and target interventions to improve quality and safety within and across clinical units.

Major national organizations have determined that interoperability is a key to improving health care quality, safety, and efficiency.

• The Department of Health and Human Services (HHS) has issued its Framework for Strategic Action to drive adoption and interoperability of electronic health records;
• The Agency for Healthcare Research and Quality (AHRQ) and Health Resources and Services Administration (HRSA) are funding state and local demonstrations that focus on integration of health information across systems and communities;
• Several major legislative proposals have been advanced with bipartisan support in both houses of Congress.

Public-private collaborations are also important to promoting solutions to the operational and technical barriers that impede interoperability today, including standards development for data elements, transaction formats, and key operational processes:

• The National Committee for Vital and Health Statistics has issued recommendations for ambulatory electronic prescribing standards;
• The Massachusetts Medical Society and several other groups have spearheaded development of specifications for the “continuity of care record,” which would contain basic demographic and health history information;
• The Institute of Medicine has issued a report on specifications for electronic health records, and draft standards are currently under review;
• The Council for Affordable Quality Healthcare is promoting administrative simplification that improves interaction among payers, physicians, and consumers, including the development of business rules governing the exchange of information about eligibility and benefits.

Three reports issued this year specifically focus on interoperability strategies and options. Another focuses on health plans' customer-focused website strategies and highlights a different set of interoperability issues and opportunities.

Framework for Strategic Action (July 2004) presents HHS' vision of a consumer-centered and information-rich health care system, focused on four goals:

• Informing clinical practice by promoting electronic health records;
• Interconnecting clinicians through regional and national collaborations;
• Personalizing care through personal health records and information to support consumer choice;
• Improving population health through improved public health surveillance, quality monitoring, and use of evidence-based clinical knowledge.

The report also presents numerous supporting strategies to advance the Department's vision and goals.  Read more or download the report at www.hhs.gov/onchit/framework.

Connecting for Health: Achieving Electronic Connectivity in Healthcare (July 2004) provides a roadmap for key decision points and specific actions needed to promote the broad goal of interoperability. Three broad categories of recommendations address the technical framework for connectivity, financial barriers, and public engagement. The interoperability model is based on regional networks that could be linked across the country to create a “network of networks.”

Connecting Americans to their Healthcare (July 2004) focuses on personal health records (PHR) as a vehicle to promote electronic communication between clinicians and patients. There is no single PHR model, so common structured data sets and messaging standards are needed to support a variety of models. With a general lack of public knowledge about or engagement in this discussion, the need for a concerted public engagement strategy is clear. Both Connecting reports can be accessed through the website www.connectingforhealth.org.

How Health Plans Are Using the Internet to Reach Customers: A Survey of Payer Websites (November 2004) is Capgemini's analysis of health plans' programs for promoting simplification and innovative practices through enhanced use of their websites and web portals for specific customer segments. Some of the administrative functions that are more commonly conducted through websites include eligibility and benefits information verification, claims processing, precertification requests, and credentialing. Plans are now focused on better integration of information between web-based and legacy systems. This report can be accessed at www.us.capgemini.com (the report is free, but registration is required).

The Fund's Quality Strategies Initiative has three central components:

• Determining the best strategy for establishing Regional Health Information Organizations (RHIOs) in New York to organize IT activities at the local level. Major policy, operational, and technical issues need to be addressed, agreements among parties forged, and technical pathways for data exchange established. The federal government will provide general direction about the form and functions for RHIOs, but a multi-stakeholder effort will be needed to implement them in communities across the country.
• Evaluating and testing models for interoperability. This is a new field and only a few small-scale pilots have begun to tackle these issues. Each of the models is promising, but they are all very different in their structures and approaches. We need to determine the best value-enhancement goals for this area, and the most feasible organizational and technical models to accomplish those goals.
• Disseminating information about these issues to both professional and consumer audiences. With IT issues affecting everyone in the health care system, keeping people informed about key national and local developments is a crucial part of the Initiative's activities. Simultaneously, the Initiative will investigage the best strategies for engaging the general public and determining how they might benefit from improved access to and integration of health information.