Qual-IT - March 2005 | Archived

Much of the current interest in health information technology (HIT) relates to its potential for improving clinical care.  Essential to fulfilling that potential, as discussed in the January issue of this newsletter, is interoperability—the ability to capture patient information across provider settings and to facilitate the authorized exchange of information among patients, providers, and payers.  Interoperability, in turn, is based on two fundamental building blocks—the development and use of data standards governing definitions, content, and the like, and the widespread use of electronic communications to facilitate data collection and access.

This is not a new concept, however. These building blocks are also central to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, requiring the development and adoption of standards for data used in electronic health care transactions, including claims processing and payment.  The HIPAA experience, although primarily concerned, as it is, with administrative data, holds vital lessons for the future implementation of interoperable clinical information systems as well.

·         HIPAA implementation, based on a partnership between government and a full spectrum of private-sector stakeholders, allows for considerable flexibility to accommodate their varied needs, systems, and resources. Established through federal law and regulations, HIPAA requirements apply to all health care organizations that send and receive transactions electronically.  The law requires that the data standards for these transactions be developed, maintained, and updated by private organizations that depend on the voluntary participation of a broad cross-section of health care stakeholders.  These standards permit customization of requirements for transactional content.  As a result, many organizations have developed their own implementation guides that provide more explicit instructions about how to use and interpret the data contained in electronic transactions.  This pluralistic approach will likely be replicated as part of an evolving process of developing requirements and conventions governing clinical data exchange.  

·         HIPAA has yet to achieve the major administrative efficiencies promised, in large part because providers can elect not to use electronic data exchange.  While payers are required to respond in kind to any provider that chooses to conduct transactions electronically, HIPAA simply establishes requirements in the event that such exchanges are used.  So far, implementation has been much slower than expected, with progress focusing largely on converting existing electronic transactions, such as claims, to the new HIPAA format.  Further, complete final regulations have not yet been issued.  Realizing the full benefit of HIPAA will depend on having a comprehensive set of standards covering all of the major transactions, and on the extent of alignment among the parties to those transactions. This will be a threshold issue in realizing the value of clinical data exchange as well; in that arena, too, widespread buy-in and use of electronic tools will be necessary in order to maximize benefits.

·         Health care organizations can adopt any number of strategies to conform to HIPAA requirements.  Although complying with HIPAA data standards requires everyone involved in electronic health care transactions to adopt changes in operations and systems,  the law and regulations are completely neutral as to the implementation strategies and techniques used to meet the requirements.  Generally speaking, health care organizations can reprogram or upgrade their existing systems, procure new systems, or hire an intermediary, such as a claims clearinghouse, to send and receive electronic transactions in HIPAA-compliant form.  For a number of organizations, the clearinghouse approach has been attractive because it limits up-front financial outlays, minimizes disruptions of business operations, provides ready access to large numbers of payers and providers, and simplifies future changes in existing standards or adoption of new ones.  Health care organizations will face similar choices and options as clinical data exchange becomes more common and a comparable set of standards is developed.  A combination of open-architecture systems design and public domain standards will make it easier to achieve clinical data interoperability.

HIPAA transactions and clinical data exchange activities are very distinct activities, yet there are important similarities that should be considered as both of these strategies mature.  The consistent use of clearly defined standards is essential—there is little added value in electronic exchange of data that are not comparable.  But standards alone will not ensure interoperability or achieve the cost efficiencies and other benefits hoped for by the promulgation of such standards.  Future technology solutions and services need to be transparent and based on open-architecture design that will support direct connectivity by patients and providers.  Practical considerations dictate that implementation will be incremental, but significant value will only be achieved with widespread alignment of all the stakeholders, based on common goals and objectives for health care process improvements, both administrative and clinical.

Center for Information Technology Leadership, www.citl.org

Massachusetts Health Data Consortium, www.mahealthdata.org/ma-share 
 

New England Health Care Electronic Data Interchange Network, www.nehen.org

Walker J, E Pan, D Johnston, J Adler-Milstein, DW Bates, and B Middleton.  The value of health care information exchange and interoperability.  2005. Health Affairs Online January 19.  http://content.healthaffairs.org/cgi/reprint/hlthaff.w5.10v1

·         Highlights from the New York State Health Information Technology (HIT) Summit

·         Update on State Policies Relating to HIT