Achieving interoperability with advanced technology, cultural change

Healthcare industry leaders chimed in on both the potential and the challenges associated with interoperability during “Leveraging Multi-Agency Interoperable Data Impacting Quality of Patient Care Outcomes,” an education session sponsored by Leidos.

Since leaders are all looking to tap into interoperable data to meet a diverse array of objectives – from adjudicating benefits and claims to improving patient care to supporting population health – they face similar challenges as they seek to achieve interoperability. Joe Lopez, Assistant Deputy Administrator of Analytics, Review and Oversight for the Social Security Administration; Lance Scott, Acting Technical Director and Solutions Integration Director of the Federal Electronic Health Record Modernization (FEHRM) Office; and Bobby Saxon, Health Group Vice President at Leidos, participated in the panel discussion moderated by Don Kosiak, MD, Chief Medical Officer at Leidos. 

Learning by doing

A look at how the panel members’ individual organizations are dealing with data shed light on both the importance of interoperability and the challenges associated with the journey.

Scott explained that interoperability sits at the center of the FEHRM, as the organization’s mission is to promote a single, common federal electronic health record to other agencies. “FEHRM’s basic role is strategy … and more importantly, coming up with ideas that haven’t been thought about while also identifying efficiencies,” he said.

Lopez pointed out that interoperable data from multiple sources is exactly what the Social Security Administration needs to make disability benefits decisions more efficiently.

“What keeps me up at night is the pending disability claims that we have at the initial claims level. We have a very large number of claims pending at that level and we continuously look for ways to process those cases more efficiently,” he said. “In terms of timely and accurate disability decisions, electronic health record collection allows for expedited disability determinations. Social Security uses Health IT to automate parts of the disability process. By interoperating with electronic health record vendors, we see case processing times reduced. This allows applicants to receive their disability decision sooner.”

Deploying various technologies to empower healthcare organizations to receive information quickly is only part of the interoperability equation. More advanced tools such as artificial intelligence are also needed to help make sense of the data.

"An administrative law judge or a disability examiner often has to review large volumes of evidence per case to determine whether a person is disabled or not … Health IT has helped us receive some evidence electronically,” Lopez said. “But once we have the electronic evidence, we can leverage decision-support software (AI and machine learning) to quickly identify critical evidence that the adjudicator may want to review first to determine if a person is disabled or not.”

While technology can improve administrative efficiency, it can also be used to enhance clinical care from the beginning of the patient encounter, according to Scott. 

“When I think of improved patient care, I think of the patient encounter. What do patients experience when they go in front of that doctor?” he said. “We’ve all had experiences where you walk into a doctor’s office after you’ve already been to five other ones and they say, ‘So tell me what’s happening?’ And you have to go through the whole thing over and over again. It’s incredibly frustrating and long and drawn out.”

Getting data in front of physicians, however, is just the first step. “I am pretty much in awe of the amount of data that we put in front of clinicians, but … how in the world can a clinician sift through all this data and find that needle in a haystack in the few minutes that they have with that patient?” Scott asked.

Quickly making sense of various pieces of data is exactly what’s needed to improve the clinical care experience, according to Kosiak. “During my last experience in the emergency department, I was trying to get information from an agency… all I wanted was the old ECG that the patient had just done. I called that agency, and they faxed me the records. I finally got the thing, but 142 pages of fax came over. And so, that interoperability is there. I did get the information I needed. But was it efficient? No.”

To address such inefficiencies, the FEHRM recently launched the Longitudinal Natural Language Processing (NLP) Pilot. Through this initiative, clinicians will be able to “take the reason for the visit and do an NLP search on the data. So, when the patient comes into the office, the clinician will already have all the documents that relate to that issue stacked up for them to look at. It just makes the patient experience that much better,” Scott explained.

Beyond the tools

To move forward and truly benefit from interoperability, however, organizations are finding that they need to do more than simply implement the requisite technologies.

To begin with, healthcare organizations must establish trust with partners. “Often, it’s not just about the data, it’s about the trust and belief in the person you’re doing business with. The federal government has had lots of challenges over the years – backlogs in retirement paperwork and so on. Part of that is because they don’t trust any other providers’ data,” Saxon said. “So, we not only need to work on the technology piece of this, we need to work on the governance, on the trust and the belief that we can work as an enterprise.”

Perhaps most importantly, leaders should zero in on supporting the cultural change necessary to achieve true interoperability. The panel participants agreed that addressing organizational culture is just as – if not more – important than getting the right technologies in place when striving for interoperability.

“You’ve got to think about how you change culture. How do you get senior leadership who are willing to put their reputation on the line to back an initiative to say, ‘I, too, believe in this’?

Culture change often takes place one or two or three minds at a time. And then you start to build momentum,” Saxon said. “So, you need senior leaders to believe in it, to be passionate about it, to get panels together before even talking about the technology.”

Saxon pointed out that, in his former role as Deputy CIO at the Centers for Medicare & Medicaid Services (CMS), he and his team were able to quickly address technology problems – but then had to focus on culture problems to truly achieve interoperability.

“The problems at healthcare.gov that kept it on the front page of the Washington Post were not technology problems. Those technology problems were fixable. The very next year after I got there, we went to 99.8% uptime,” he said.

“We didn’t do that because I knew how to spell healthcare.gov. We did that because the people who were on that team were highly qualified people, both from inside the government as well as the vendor partners that we were working with,” he explained. “For the last few years that I was at CMS, when talking about interoperability challenges, my answer typically was, we don’t have a technology problem – we have a culture problem that is impacting our technology.”

Once leaders realize that they must address both the technological and the cultural challenges inherent in the pursuit of interoperability, healthcare organizations’ efforts will result in improved care, efficiency and care coordination.

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