Interoperability considerations for health policy

Too often, electronic health records (EHRs) are disconnected. In simple terms, they do not talk to each other to share patient data appropriately or efficiently. However, by making relevant health information easily accessible, interoperable health IT systems should also make lives easier for physicians and other healthcare professionals and improve the level of care they are able to provide their patients.

While the rise of digital health technologies can raise concerns that physicians have to spend more time with documentation and data entry and less time with their patients, interoperable EHRs can reduce the documentation burden (for example, by avoiding repeated entry of data) and simplify cumbersome information retrieval processes. This can enable physicians to focus on their patients and provide optimal care.

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As noted by the authors of a recent article published in NPJ Digital Medicine, interoperable EHRs can also help patients to manage their own health more actively. Currently, much of the information that drives providers’ decisions about treatments is not easily accessible to the patients themselves, making them inactive bystanders in the treatment process.

If patients are given better access to their health data (combining, for example, information about prescriptions, treatments and data from personal health apps), they can take more control of their health. This can have positive health effects, as patients become active managers of their health and well-being.

In March 2020, the US Department of Health and Human Services (HHS) finalized two rules that will give patients safe, secure access to their health data. In the words of HHS, these rules deliver on giving patients true access to their healthcare data to make informed healthcare decisions and better manage their care. Putting patients in charge of their health records is a key piece of giving patients more control in healthcare.

The rules, issued by the HHS Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS), implement interoperability and patient access provisions of the bipartisan 21st Century Cures Act (Cures Act). The ONC final rule:

• Updates certification requirements for health IT developers.
• Establishes new provisions to ensure that providers using certified health IT have the ability to communicate about health IT usability, user experience, interoperability, and security including (with limitations) screenshots and video, which are critical forms of visual communication for such issues.
• Requires electronic health records to provide the clinical data necessary, including core data classes and elements, to promote new business models of care.

The rule advances common data through the US Core Data for Interoperability (USCDI).  The USCDI is a standardized set of health data classes and data elements that are essential for nationwide, interoperable health information exchange. The USCDI includes “clinical notes,” allergies, and medications among other important clinical data, to help improve the flow of electronic health information and ensure that the information can be effectively understood when it is received. It also includes essential demographic data to support patient matching across care settings.

The Centers for Medicare & Medicaid Services (CMS) notes that lack of seamless data exchange in healthcare has historically detracted from patient care, leading to poor health outcomes, and higher costs. The CMS Interoperability and Patient Access final rule establishes policies that break down barriers to enable better patient access to their health information, improve interoperability and unleash innovation, while reducing burden on payers and providers.

CMS envisions a future where data flows freely and securely between payers, providers, and patients, and in which we can achieve truly coordinated care, improved health outcomes, and reduced costs.