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By Monica E. Oss

Here’s a quick question—what do artificial intelligence, virtual health, digital consumer engagement, and value-based contracting all have in common? The answer—all of them require interoperability for realizing a return-on-investment (ROI). Unfortunately, the state of interoperability in the system serving consumers with complex needs is not great. The gap between where most provider organizations are and where they need to go is still large.

So, what exactly is interoperability? The Healthcare Information and Management Systems Society (HIMSS) has defined it—”for two systems to be interoperable, they must be able to exchange data and subsequently present that data such that it can be understood by a user” (see What is Interoperability?). Last year a study that looked at interoperable in health care systems judged hospitals on “data integration, reception, distribution and finding” and found that just 29.7% of hospitals met all four metrics, marking only a slight increase from the 24.5% of hospitals the previous year (see Progress In Interoperability: Measuring US Hospitals’ Engagement In Sharing Patient Data).

These issues were the focus of a recent session at The 2018 OPEN MINDS Executive Leadership Retreat, “I’ve Got Patient Data. Now What? Transforming Outcomes Today.” The session featured Matthew E. Hanis, Founder, Business of Healthcare; Marlowe Greenberg, MPP, Chief Executive Officer, Foothold Technology; Jim Stefansic, Ph.D., MBA, Chief Executive Officer, Raiven Healthcare; Staci J. Connolly, LCSW, Psychotherapist/Owner, Cornerstone Therapy and Wellness, LLC; Peggy DeCarlis, MSSA, LCSW-C, Former Chief Operating Officer, New Directions Behavioral Health.

(from left to right): Staci J. Connolly, Marlowe Greenberg, Peggy DeCarlis, Jim Stefansic, Ph.D., Matthew E. Hanis at The 2018 OPEN MINDS Executive Leadership Retreat

The panel’s take is that part of the interoperability problem falls to the current state of electronic health recordkeeping systems (EHRs). EHRs are still largely siloed—with each organization only having access to their own EHR data. This means EHRs are simultaneously an indispensable tool for individual organizations to record and manage consumer care—and a barrier for multiple organizations to work together to manage groups of consumers. The panel had an interesting take on four key technology issues.

EHR transformation is progressing—Where payers travel, provider organizations follow. This is especially true for Medicare and Medicaid. Last summer, for example, the Centers for Medicare & Medicaid Services (CMS) finalized rules for hospitals under the Medicare and Medicaid Promoting Interoperability Programs (formerly called the Medicare and Medicaid Meaningful Use Programs). The rules are intended to improve hospital use of EHRs and to emphasize measures that require the exchange of health information between provider organizations and consumers (see CMS Finalizes ‘Promoting Interoperability’ Rule For Hospitals). Mr. Greenberg noted, “Our customers are operating in the behavioral health care space. As they coordinate care with other providers, more traditional health care organizations and health information exchanges (HIE), they must decide when it’s useful to share information, which subsets of data, where that data goes, and what type of data is useful to support workflows. An EHR that can nimbly exchange data with other systems is key.”

Artificial intelligence is expanding—The applied use of these “smart decision technologies” have been expanding in the field for the last few years, supporting better collaboration, diagnoses, decisionmaking, research, treatment, and remote consumer monitoring (see Ready Or Not, Cognitive Computing Will Change Your Organization). The reward for pushing greater data-enabled and interoperable AI falls to improving cost and outcomes through better predictions. A recent report from Leavitt Partners notes that AI can both improve population health and decrease costs (see Data Challenges and Opportunities). Dr. Stefansic explained, “AI and machine learning lets you do a lot with a little bit of data. Done right, you can get the information to start making predictions.”

Digital consumer engagement is critical—”System-to-system” and “organization-to-organization” information exchange is extremely important for interoperability, but for health care to “close the loop,” there needs to be a way to pull consumers into the data orbit. To do this, provider organizations will need to not just share the data with consumers, but also know which information is valuable to consumers and the best way to engage with them (see Integration, Interoperability & Consumer Engagement).

Virtual care is strategic—The virtual health market has been predicted to reach $3.5 billion in revenue by 2022 (see Embracing Virtual Health Results In Improved Care) and provider organizations that are making initial investments in this tech will be faced with an additional strategic question. How do we improve on virtual care performance? Expanding what virtual care is capable of means expanding interoperability.

For executives of health and human service organizations serving complex consumers to capitalize on all these trends, this means building a technology strategy that is focused not only on capitalizing on management of their own data, but also building a technology infrastructure and strategic connections that support two-way data sharing among consumers, partners, and payers alike.

For more on meeting that tall order, join OPEN MINDS Senior Associate Joseph P. Naughton-Travers, Ed.M. for his Executive Seminar, Making The Right Tech Investments For Your Organization: An Executive Seminar On Technology Budgeting & Planning, on February 13 in Clearwater, Florida.

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