Billions of dollars have been spent on electronic health record systems over the past decade. However, interoperability between EHR systems remains elusive – particularly for post-acute care settings such as skilled nursing and home health. 

Post-acute care providers were left out of EHR subsidies for Meaningful Use, and PAC technology lags behind other care settings. However, even among hospitals and physician groups that benefited from EHR meaningful use subsidies, interoperability is still spotty.  

Part of the interoperability challenge is certainly technology related. Data exchange standards like HL7 and CCDA are not as consistent as one would like. There can be substantial variability in how these standards are deployed, and constant maintenance is required to align data from various sources and formats.  That said, the technology challenges are solvable. It is typically the legal hurdles that keep interoperability from getting out of the starting gate.  

The players have very legitimate concerns about data security and the risk of data breach. Compliance with HIPAA regulations is complicated and there is always the potential for financial and reputational damage if handled poorly. Provider organizations also need to protect their proprietary competitive interests. Under a fee-for-service reimbursement system, financial incentives are not always aligned. Network participants may be financial partners with some patient populations, but fierce market rivals on others. There is also a stubborn perception among some organizations that perhaps there is more to lose than to gain when it comes to sharing of patient data.

There is also the question of who should pay for interoperability. Health Information Exchanges have struggled to find a sustainable business model, and gaps in coverage undermine effectiveness. Post-acute care providers operate low margin businesses which typically receive referrals from multiple hospitals within their community. Any single operator – either hospital or post-acute – often lacks the clout and critical mass to justify the expense of investing in interoperability. How can hospitals and post-acute care providers exchange data on patients they share and at the same time protect access to other data?

With the emergence of new value-based payment models, the calculus changes. Bundled payments will be the catalyst that drives interoperability across care settings. Networks will narrow, with referral volumes concentrated with high quality, cost-effective providers that agree to share data as part of a cohesive interoperable network. To effectively manage patient care transitions and report on key clinical and outcome measures, hospitals and PAC providers will need to have both the technology to support data interoperability and a legal framework for data sharing that protects both patient privacy and financial interests of network participants. PAC interoperability costs will be offset by higher referral rates to providers that meet quality and cost goals. Post-acute providers that do not or cannot provide data interoperability stand to lose out on referral volumes that are essential to their financial survival.

The technology that enables data sharing must allow network participants the ability to exchange data on patients they have in common, while also protecting and segregating data for patients where network providers compete.  Network membership – particularly in the early days – will necessarily be fluid, as objective cost and quality data identify the best performers. Definitive outcome data will secure and maintain a PAC providers place in networks that reward high quality, cost-effective care.  

Technology will also need to work across disparate EHR platforms and link multiple data sources into a coherent longitudinal care record. All this must to be accomplished in near real-time, to allow network providers to proactively identify patients of rising risk and head off problems early.  

To get started:

  1. Identify the Patient Populations of Focus
    Bundles, such as hip-and-knee and cardiac cases require care coordination across a network of provider partners.
  1. Leverage Data to Identify Strong Partners
    CMS data can help organizations understand and select the strongest providers in their region. Organizations may begin with the CMS Five-Star data sets, followed by more sophisticated claims data analytics to produce an in-depth understanding of underlying clinical and financial metrics.

  1. Deploy Technology to Enable Continuous Improvement
    Hospital and PAC EHRs may be able to exchange clinical data for individual patients in transition between care settings. Ideally providers also have visibility across the full episode of care, at both the patient level and broader population level, to systematically identify opportunities for improvement.

  1. Strengthen the Network
    Under fee-for-service reimbursement, great clinical outcomes were not always rewarded financially.  With bundled payments partners have the data and incentives to continuously improve.

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