Interoperability Is the Key to Lower Healthcare Costs and Better Patient Outcomes. But How Do We Get There?

Bob Fuller
JULY 30, 2018

For an industry flush with data—healthcare data will fill about 231 million Libraries of Congress by 2020—healthcare lags behind its counterparts in retail, high tech and media. Ask what the slowest adopting industries are, and healthcare will invariably show up alongside insurance, financial services and the government. Lack of interoperability has been a huge roadblock to innovation—how easy is it today to leverage clinical data, health payer data and health information exchange data for better patient insights? Not very.

>> Read: EHRs Lower Mortality Rates, But Effects Take Time

But recent interoperability standards, like Fast Healthcare Interoperability Resources (FHIR), carry the promise of a more enlightened future. When health providers and payers can integrate clinical data with claims data, there are multiple implications: Not only will we be able to reduce costs and inefficiencies and increase payment processing speed, more important, we can better diagnose and treat patients, identify health trends and affect population health over time.
 

The Future of Medicine with Interoperability

Interoperability and adoption of FHIR standards open the door for innovation. As data are shared between legacy healthcare centers, from providers to patients on a variety of devices, third-party developers will be able to create medical apps that integrate into existing systems.

These apps could connect patients to their clinical data, from lab results to diagnoses, in real time, simultaneously sharing that information across the patient’s healthcare ecosystem. Real-time information sharing creates better patient experiences and outcomes, but it also cuts down on operational inefficiencies and costs. Physicians spend half their time working on electronic health records (EHRs), not to mention the countless hours spent comparing billing or scheduling from one system to lab services in another, reconciling data because the systems lack interoperability.

But interoperability holds the key to more than apps and greater efficiencies. As healthcare catches up to other industries and their customer-centric offerings, telemedicine and digital care delivery will be at the center of changes that push improved patient experience and care even further.
 

No Innovation Without Adoption

Healthcare providers know interoperability is key to driving value-based care, and payers know it can reduce inefficiencies and improve member outcomes, but getting there is a challenge. Gartner research says payers likely won’t have enterprise-wide clinical data solutions for at least three years, and many health providers cite concerns that federal policies are not sufficient to drive adoption by 2020.

But is there an alternative? The change is coming, with Silicon Valley tech giants already staking their claim on healthcare, seeing the inevitability of interoperability and other opportunities for innovation as an opening for disruption. Amazon’s recent purchase of PillPack, Apple’s investment in EHRs and Google’s medical case studies are clear indicators they hope to—and believe they can—create profitable healthcare divisions.
 

Investing in Today for ROI Tomorrow

While widespread interoperability may be more future than present, we see clients moving in the right direction and taking actions with confidence that their investments will pay off.
 
Here are a few areas where our clients are gaining traction and your organization can benefit:
 
  1. Clinical data integration between health plans and providers, improving patient and member outcomes through more timely and enhanced interventions
  2. Standardization using proven metadata driven frameworks, resulting in improved data quality
  3. Adoption of industry data standards and open architecture, paving the way for future information sharing
  4. Cross-departmental data sharing and process optimization, resulting in improved coordination of care, enhanced member experience and reduced costs to service.
 
For example, we are working with a health plan to improve information sharing for clinical purposes across the many areas, including:
·         Disease management
·         Case management
·         Utilization management
·         Risk management
·         Healthcare Effectiveness Data and Information Set
·         Quality
 
Increased visibility across these groups provides for a better overall health management approach and improved clinical care coordination. By sharing patient data more effectively and optimizing communication through channels based on member preference, we are enhancing member experience and improving health outcomes. 
 
More broadly, accountable care organizations, patient-centered medical homes and pharmacy benefit managers who deliver information to improve members’ health are also benefiting from improved data sharing and workflow optimization.
 
Improving data integration helps prioritize which members need to be engaged and, when multiple messages need to be delivered from multiple areas, opens opportunities to combine messages to be delivered by one area in a more effective manner. Maintaining accurate contact information and member preferences is challenging, but sharing this information and tailoring communication results in higher success in member engagement.  
 
Finally, channel optimization driven by member preferences can further streamline member engagement and improve results, including better integration with call centers and digital channels. 
 
It’s not too early to start to prepare for interoperability and the opportunities for better patient care, greater efficiency and innovation that will come with it.
 
Bob Fuller is managing partner and head of the healthcare practice at Clarity Insights, the largest onshore U.S. consultancy focused exclusively on data and analytics. www.clarityinsights.com

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