The road to interoperability is long, but not impossible. In healthcare, this decades-long effort to improve data sharing has already seen successes, like standardized information-sharing practices and the shift away from paper-based documentation. But while progress is being made, there’s no magic button for interoperability.
The current administration has set aggressive goals in place to mandate interoperability within a short timeframe, like the CMS Interoperability and Prior Authorization Final Rule for Medicare Advantage, Medicaid, CHIP and exchange plans to implement new or enhanced FHIR APIs by 2027. As a result, thousands of our country’s health organizations are racing against the clock to complete necessary technological updates. Some will win, some will lose, but all risk losing sight of healthcare’s most precious element: the patient.
In the push toward a more seamless, digitally enabled future, it’s important we understand exactly how this rush to interoperability may actually harm patients, instead of helping, and what we can do to make sure they keep pace.
Making progress
Faster information-sharing, more complete patient records and reduced administrative burden. These, and other benefits, are the promise of interoperability. In the long-term, healthcare can get there, and we’re already making progress.
Published in 2020, the ONC 21st Century Cures Act Final Rule drove widespread adoption of FHIR APIs and began to curb information-blocking practices that were key barriers to patient information sharing. Outside of CMS rules, many healthcare organizations are still working to modernize legacy systems and workflows, but outdated workflows still slow progress toward interoperability.
There is no way we can get to true, beneficial interoperability without system-wide changes over time. But in the short term, the move to interoperability can have unforeseen consequences for all types of healthcare organizations and, more importantly, their patients.
Where mandates might leave patients behind
The varying speeds of adopting new interoperability standards may deepen the digital divide and result in unintentional harm to patients. A few key areas to watch out for:
1. Prior authorization. While payers move to a FHIR model by the January 2027 deadline, many healthcare organizations cannot shift as quickly, specifically rural health, post-acute care, behavioral health facilities or health organizations serving safety net populations. Since most of these entities did not receive financial support to transition to EHRs after the HITECH Act in 2009, many lag behind other provider groups. Without the technology in place to support FHIR APIs, they will be forced into duplications and workarounds that may not meet payer criteria for prior authorizations.
Where this can leave patients behind: The risk to patients is two-fold. First, these duplications and workarounds add more administrative burden, taking staff focus away from the patient. Second, it heightens the risk of prior authorization rejections, which can delay necessary care, lead to adverse events or total treatment drop-off if the patient disengages in their care due to lack of insurance coverage.
2. Behavioral health. Most patient records include codes that fit neatly into pre-determined boxes in a standardized form. However, behavioral health records include important notes, narrative and nuance that may not fit neatly into a discrete data field. Further, behavioral health data is often more sensitive and is attached to different privacy rules and expectations than other health data.
Where this can leave patients behind: If behavioral health organizations lack the resources to move patient records to more structured clinical formats, it could result in patient data getting left behind. Crucial notes or context might be lost, leading to inaccurate or inadequate care down the line. Further, if these organizations are pressured to update patient records too quickly, errors might occur around privacy and portability for conditions like SUD. If such information found its way into areas of the patient record without necessary patient consent, it could shatter patient and provider trust.
3. The digital divide. Our industry already struggles with a digital divide between more well-resourced organizations and smaller, rural or safety net clinics. Unfortunately, a speedy shift to new interoperability standards may only exacerbate the issue. Larger, technologically savvy organizations will enjoy a “fast lane,” getting information faster, receiving more approved prior authorizations and facilitating stronger care collaboration. Meanwhile, as smaller organizations try to keep up, technological investments will cut into already thin margins.
Where this can leave patients behind. More resources dedicated to technology means less for patient support. Add this to what could be a compounding issue of lower PA approvals and delayed care, and these organizations might face reputational harm, be unable to serve patients, or face clawbacks they can’t afford, risking closure to the facility altogether.
Meeting organizations where they are
The best way to ensure our industry reaches its destination on the road to interoperability is to ensure all healthcare organizations have the support they need to get there — without leaving their patients behind.
This doesn’t strictly mean financial support either. Instead of forcing organizations into an interoperability race, we can meet them where they are, while still advancing our collective goals.
Progress will depend on practical solutions that help organizations connect systems, reduce friction and improve data sharing across care settings. By identifying opportunities to support interoperability efforts while smoothing the way for all healthcare entities, we can ensure that no healthcare organizations, or their patients, are left behind on the road to modernization.
Photo: ipopba, Getty Images
Stacy Pur, MBA, BSN, RN, is Senior VP of Product for eFax by Consensus Cloud Solutions. A global leader in secure data exchange, eFax is evolving the future of digital fax to serve healthcare and other highly regulated sectors requiring mission-critical reliability. Stacy’s strategic edge is forged in the ICU and hospital leadership in epidemiology and safety, where she mastered the art of rapid assessment and decisive action. Stacy views high-fidelity data, transparent intelligence, and low-click workflows as the essential vitals of a successful product. By delivering solutions vetted by clinical intuition, she ensures eFax products and AI-driven interoperability and healthcare tools, are as intuitive as they are secure. Stacy architects globally dispersed organizations to execute ambitious roadmaps, focusing on accelerated go-to-market execution and “intuitive delighters” that maximize operational efficiencies for providers, payers, and patients worldwide.
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