Healthcare has often been considered a technology-driven industry. However, there are still plenty of challenges that need to be addressed in order to make the healthcare system more interoperable.
The US government has invested over $36mn in healthcare expenditure with technological advancements, digitalization of records, plenty of data but the lack of interoperability.
The panacea to all data exchange is the interoperability that helps easy exchange and communication of EHR, apps, clouds, and health legacy systems. The pandemic saw a drastic rise in the EHR exchanges and data records where healthcare software companies focused on various data visualization tools for data sharing and data quality in expectation of better returns.
Interoperability is a term often heard in the healthcare industry. However, there are many misconceptions about what it means and why it’s important.
Rules & Regulations for proposed Interoperability rule:
Payers have now invested heavily into interoperability considering all the potential regulations and abiding by them. Payers that stay atop and opt for a more flexible approach are likely to see better returns from interoperability.
However, some regulations other than interoperability are going to emerge in the next years about which the healthcare payers should pay some attention:
- New rules for enterprise master patient index (EMPI): Once a clear EMPI methodology is prescribed, healthcare software applications and doctors will be able to avoid false positives and false negatives when matching their member data with others’. That will help them comply more quickly with the law.
- Privacy and Security regulations: Payers will need to develop solutions for privacy regulations that are flexible and extensible. They should be able to adapt based on the rules of each country they work with.
- Work with compliance: Most healthcare systems now work in compliance with various set standards. Also, additional refinements will follow HL7 Fast Healthcare Interoperability Resource (FHIR) standard APIs for the smooth exchange of healthcare data. Thus, payers may pay attention to the updates and standards with the set API.
How Interoperability helps your business?
Payers will have to invest in healthcare interoperability if they want to remain competitive. The shorter time frame for the fulfillment of requirements can help payers gain returns from bigger investments as well as potential revenue streams.
Interoperability provides access to the current state of information for healthcare providers in order to reduce unnecessary duplications.
This can be done by empowering automated medical decision-making through tools like patient calendars, electronic health records (EHRs), and procedures within an organization’s PBM data warehouse.
With all data flowing easily, you can get better information that’s useful to payers. You will get a new value proposition based on that kind of information. The payer must be well informed and understand the value of healthcare data so that they can continue to form their relationships with providers based on trust.
Healthcare is complex, but interoperability makes it faster and more simple for everyone involved. For instance, obtaining the data sharing consent for the new members can increase efficiency improved workflow.
A health plan could gather member data from previous insurance companies and send them to another company, either through a transmission or by using an API provided for third-party access under the new rule. The technology also allows healthcare providers to control the information they share, stop sharing personal data that may be harmful or of no value.
Patients will be able to get personalized treatment more quickly, but they can also have a better quality of treatment with this system that helps them access the information they need earlier.
In the near future, Interoperability can also reshape utilization management (UM). It will be vital to have a data warehouse that is built from the bottom up by all stakeholders, including hospitals and pharmacies against clinical outcomes.
Beneath it can also contain “normalized” usage metrics which are synced with EHRs in order to provide meaningful deeper insights for payments and quality measures.
With this interoperable system providers could focus on efficiency rather than duplicative workflows or inefficient administrative processes where they as a whole, everyone benefit from the new structure which demands of itself to operate more efficiently.
If in the future, the providers come to a standard to follow the interoperability rule, payers can make use of the Utilization management and reduce the resultant friction between the healthcare providers and members. This can be done by utilizing the data directly from EMRs using a standard API.
Lastly, a healthcare software development company can use interoperability in their medical software applications to give control to the organizations and providers over member experience.
What’s Next in Interoperability in Healthcare?
By the year 2025, Interoperability will be mainstream in healthcare. The continuous development towards digital health – especially mobile applications and interoperable systems – is a guarantee that 2025 will only serve as a mere stepping stone for what’s to come.
Standardizing APIs is hard to do without collaboration between everyone in your company who uses them to make sure they are working correctly together as one system.
Interoperability has obvious benefits to consumers, the healthcare system, and providers as organizations. It would allow for data exchange of patient records so that sensitive customer information such as medical history could not be misappropriated by rival practices or compromised due to employee errors.
For obvious reasons, Interoperability is widely adopted in healthcare software developments the data becomes more valuable and healthcare becomes interconnected to the systems.
Furthermore, interoperability compliance needs an effort from a whole organization or a complete system. The value of digital patient records will increase so much due to the benefits given by interoperability.
As more healthcare information becomes available worldwide, transparency and accessibility become necessary at all times for this valuable data. The future of healthcare is rapidly transitioning towards interoperability through new technologies.
It allows for the data to be shared amongst all places where there are health information providers, be it various hospital facilities or clinics in different continents using digital medicine equipment that continuously create unique pieces of clinical content.
For healthcare software development, ITs and businesses must comply with all the rules and possibilities of exploitation. Thus, there are a few key areas to consider to incorporate interoperability in healthcare IT:
- Learn how new rules apply to organizations: There are several new rules coming out of the Department of Health and Human Services (HHS) that will impact how healthcare organizations interact with one another. These rules will take effect from January 1, 2022, and they’ll have a significant impact on how healthcare is delivered to patients. The new rules are aimed at making it easier for healthcare providers to exchange information electronically.
- Explore more areas that comply with interoperability: There are other specific laws that apply to industry or business operations. However, there is usually a statutory requirement for various kinds of IT systems and health information technology (HIT) architecture to comply with interoperability managed care organizations. It is important to understand how businesses can use technology solutions wisely.
- Increase security and added privacy: Security and privacy is important issue in healthcare to make sure that patients’ data isn’t excessively accessed. It also helps organizations understand how they can add private communication channels such as HIPAA (Health Insurance Portability & Accountability Act) compliance. Modern-day medical infrastructure lacks those security issues which make it less adequate for the safe execution of interoperability rules.
For example, the standard APIs that are made of external gateways and third-party systems may be vulnerable to intrusion attacks.
Final Thoughts
Data interoperability is the ability to connect data from disparate sources into a single system. Interoperability can improve care and save money by allowing payers to integrate their disparate payment systems, medical records, electronic health records, and other data sources.
By pulling data out of silos, payers can use tools such as evolutionary AI to pre-emptively identify patients who need care and deliver that care faster, cheaper, and with better quality.
The major players in the health care industry are actively working on building a more interoperable system that allows for this type of real-time analysis and prediction. This is just one example of how data analytics could be used to solve some of the biggest problems facing our healthcare system today.
In a nutshell, the future of interoperability in healthcare IT is brighter than ever and we can expect better returns from interoperability in coming years.
