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NQF: EHR Interoperability is Central to Quality Improvement

By Jennifer Bresnick

- Increasing the availability of big data by strengthening the nation’s EHR interoperability capabilities is an essential first step towards improving quality and patient outcomes, says the National Quality Forum in a new white paper.  In order to turn raw data into actionable insights for healthcare providers, a robust health IT infrastructure must promote the free flow of information across providers and other artificial barriers.

EHR interoperability and big data analytics

Interoperability can contribute to the systematic improvement required to combat rising costs and provider productivity losses due to inadequate EHR systems, says the white paper, which recaps a series of stakeholder meetings designed to identify strategies for making the most of the nation’s health IT tools.

“Because of inefficient processes and workflows, clinicians often have to take heroic action to ensure patients are safe and delivered high-quality care,” the paper says. “Moreover, the time and energy that clinical teams spend circumnavigating these inefficiencies is time that they could use on initiatives that improve care quality.”

“In short, the goal of systems improvement is to reduce waste, such as time spent working around inefficient workflows. This could generate opportunities to focus on higher value areas, such as personalizing care for an individual patient’s specific needs or undertaking other improvement initiatives.”

Personalized medicine and population health management both require a high degree of data liquidity in order to provide a meaningful platform for informed clinical decision-making.  Without a robust way to access the wealth of patient data locked in EHR systems, neither of these initiatives, which make up the two sides of the quality care improvement coin – will achieve their potential.

When asked about the biggest challenges to making systematic improvements to the healthcare industry, stakeholders identified developing the required level of EHR interoperability as one of their top concerns. 

“Linking disparate data sources, given data at the community level, individual patient level, and at different levels of the healthcare system” is a goal that has long eluded healthcare organizations, who struggle to use big data effectively for internal improvement and clinical decision support while fostering health information exchange with external partners.

“A patient’s data are often fragmented across multiple electronic health records, depending on their insurance and the providers they visit, and limited interoperability among those record systems prevents many providers from having a full picture of a patient’s healthcare,” NQF says. “Common data models are one approach that can identify the key data elements for quality, cost, and value and ensure that such data are exchanged across different EHR systems.”

While there have been multiple attempts by rule makers, collaborative industry groups, vendors, and public-private partnerships to address the interoperability woes that may be limiting the march towards the Triple Aim, healthcare organizations still largely wrestle with basic data exchange conundrums.

Substantial, large-scale effort will be required to help providers vault past these barriers to interoperability, NQF says.  The healthcare system must work together to identify best practices for data exchange, adopt data standards that encourage interoperability, and embrace cultural and financial reforms that promote the free flow of information across competitive lines, such as participation in value-based reimbursement models.

“Participants noted that improving efficiency can still be viewed as a threat to revenue in an environment of mixed payment models, and cautioned that without aligned incentives, there may be unintended consequences,” states the white paper. “For example, providers will understandably be balancing readmission payment penalties and potential revenue from admission volumes. This underscores the value of nonfinancial incentives, such as peer and public reporting, in improvement initiatives.”

As the healthcare system continues its transformation from an unstandardized, fee-for-service industry to a data-driven, value-centric care continuum, EHR interoperability must be a priority for systematic improvement.  Without access to data that can measure quality and performance while aiding the delivery of informed, accurate, and effective services, healthcare organizations will continue to struggle to meet the demands of providing high quality patient care.