Supporting Interoperability During A Pandemic
This is the third blog post in a three-part series on advancing interoperability. See the first post, Interoperability – Yesterday, Today, and Tomorrow, and second post, Defragmenting Healthcare with FHIR.
The effective and timely sharing of medical records is more vital now than ever before, as COVID-19 continues to spread across the globe. Key lessons from prior public health emergencies (such as hurricane Katrina) demonstrate the need for widespread interoperability of electronic health records (EHRs). With the destruction of multiple health care facilities and over 200,000 people with chronic medical conditions displaced from their homes, the absence of a uniform, interoperable EHR contributed to delaying the delivery of care to those who needed it most. Looking at what we’re experiencing now with the COVID-19 pandemic, U.S. health care organizations need a widely adopted system that supports the rapid exchange of patient’s test results and prior medical history.
Around the same time the World Health Organization declared COVID-19 a pandemic (on March 11), the Office of the National Coordinator for Health Information Technology (ONC) and the Centers for Medicare & Medicaid Services (CMS) issued final rules on interoperability, information blocking, and patient access. These rules come at a time we need them most, and the content is worth breaking down further to better understand the impact of the legislation and how it will help us fight COVID-19.
First, the rules require the adoption of standards, specifically Fast Health Interoperability Resources (FHIR) Version 4. As Daniel Vreeman discusses in the second part of this interoperability series, FHIR is a data specification standard created by HL7 and has the potential to streamline the exchange of health data by providing a vendor-neutral API standard. Further, the ONC rule proposes the adoption of the U.S. Core Data for Interoperability—a core set of data elements required to support nationwide interoperability. Encouraging the standardization of data could facilitate the dissemination of an improved understanding of COVID-19 and the most-effective interventions to address it.
Both rules also draw a hard line against information blocking. At this point in the pandemic, sharing information is essential. On March 29, 2020, Vice President Pence sent a letter to American hospitals requesting they report COVID-19 testing data to the U.S. Department of Health and Human Services. This is done alongside hospitals reporting on bed capacity and supply data to the Centers for Disease Control and Prevention. Although the information-blocking provisions won’t take effect immediately, the ONC and CMS rules describe future steps to prevent information blocking and how health IT developers, clinicians, and hospitals will be held accountable when they engage in information blocking.
Encouraging the standardization of data could facilitate the dissemination of an improved understanding of COVID-19 and the most-effective interventions to address it.
Both [interoperability] rules also draw a hard line against information blocking. At this point in the pandemic, sharing information is essential.
Turning the focus to how these rules impact patients, the ONC rule has several components that improve patients’ access to their health data. First, the rule proposes adoption of an export functionality, allowing patients to export their health information directly from a certified health IT system. The ONC rule also establishes a secure standards-based application programming interface to give patients more control of their health information through third-party applications (such as the apps on a smartphone). Improving patients’ access to and control over their health information allows that information to better follow the patient, which is sorely needed when pre‑existing health care staff, resources, and IT infrastructures are already stretched thin. With more and more patients getting sick, health care professionals might not have time to send faxes or follow up to ensure a sick patient’s information was received.
The COVID-19 pandemic is placing a significant strain on our health care system, accentuating our current IT capabilities and shortcomings. Although not the final step, these rules are a step in the right direction to address some of the most-critical needs and barriers facing interoperability today.