Interoperability is the heart of care coordination

We all know that care coordination is fundamental to improving the quality and accessibility of care. We also realize that on paper, care coordination looks fairly easy- just the integrated efforts of primary care physicians, specialists, nurses, health coaches and all the caregivers. As the amount of healthcare data increases and as patients find themselves surrounded by bustling health-related activities, the need for safe, secure data exchange increases. To look at the bigger picture, providers need to have access to all the pieces. This is where interoperability comes in.

As of 2015, 75% of hospitals have at least a basic EHR, a major increase from 9% less than a decade ago. Yet, only 40% hospitals make use of the electronic information they receive. In fact, only about a quarter of them can actually send, receive and access electronic information. The most serious challenge in care coordination today- the inability of healthcare organizations to speak the same language and efficiently transfer accurate, relevant information.

The notion of interoperability is no more centered around exchanging data between two electronic systems. It has evolved and is about accessing data spread across various systems and viewing it as a single, holistic record.

Good data = Great care

Even in health care, EHRs- one of the primary sources of data in healthcare- have become a cornerstone. However, to achieve data-driven care coordination, data from EHRs alone won’t suffice. With more and more patients getting care across a number of settings, patient data becomes fragmented day by day. For example, a patient goes to a lab to get his HbA1c tested, followed by an ultrasound and a flu shot at Walgreens, before coming to visit his PCP. All of these events that took place in different settings, create a disparate patient record. The data isn’t just limited to EHRs, and comes in many types:

• Clinical data
• Claims data
• Patient satisfaction data
• Registries
• ADT feeds
• Consolidated Clinical Documents (CCDA feeds)
• Continuity of Care data (CCD feeds)

The need to find ‘good data’- one which is accurate, reliable and consistent- is fundamental to providing evidence-based care. Yet, owing to protocols, specifications and the inability of systems to adopt document-based exchange, there are several inefficiencies in data exchange.

The role of API-based data exchange

API, or Application Programming Interface, has recently started gaining traction in healthcare.

• It provides a way of efficient and secure data exchange and doesn’t rely on static, document-based exchange.
• In healthcare, open APIs can help providers have easy, efficient access to significant clinical data that would support their clinical decision making and make more informed choices.
• By using open APIs, providers can collect data, enable analysis and even patients can easily and securely access their own healthcare information and make updates.
• Developers can avoid the closed infrastructure of data exchange and create apps that would allow access to patient-level data, helping them monitor their health and comply with post-discharge care instructions.
• Additionally, healthcare APIs can allow hospitals to share resources from federal agencies and other healthcare organizations in a meaningful way, learn about staff requirements and work on reducing overhead costs and lessen the possibility of errors.
• With the right tools, providers can interact with each other and access critical information at the point of care.

Challenges with API development

Healthcare today is dotted with a complicated mix of technologies, applications, systems, and processes- which as time passes, become more and more inefficient until they are no more interoperable with newer technologies. It is important that such legacy systems be integrated to make APIs work.

• The lack of access to effective tools for designing, testing, and monitoring APIs and the shortage of developers is a major challenge.
• API development requires constant feedback and reviewing but without a vibrant developer community and robust systems, crafting APIs is difficult.

FHIR in healthcare

As open APIs transform the healthcare and become the points of communication between healthcare systems, the presence of dated, loose standards is poorly suited to transmit the tremendous amount of healthcare data present today. In fact, a majority of healthcare data exchange takes place in different formats, making interoperability between systems challenging and spiking the adoption of FHIR.

Several trends are driving the adoption of FHIR in healthcare, most significant of them is a need for real-time access to clinical data via APIs. FHIR, or Fast Healthcare Interoperability Resources, is a simplified but powerful reinvention of CCDA, HL7 v3, and HL7 v2. FHIR has two critical advantages among many:

• First, FHIR works on the same web technology as the likes of well-known social media, e-commerce websites and search engines. This is a plus when it comes to sharing data scattered across multiple systems, in real-time.
• Secondly, once healthcare data is represented in FHIR, it doesn’t have to undergo any modifications for any information-exchange protocol- REST, HL7, or CCDA.

The road ahead

FHIR is new, but maturing rapidly. As healthcare moves towards value-based care and bringing the continuum of care to a full circle, FHIR will most certainly help organizations bind clinical and financial data. 100% interoperability would reduce the insane amount of manual effort that would have to be undertaken, and FHIR with its pragmatic, robust data standards can help providers easily skim through whatever information they want to dig out about any patient. FHIR is already disrupting healthcare with an agile and flexible architecture and is all set to become the huge success that it can be- pushing the boundaries of data exchange forward.

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