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Stage 2 Meaningful Use: Surfing the Waves of Interoperability, Part III

by Jitin Asnaani, Director of Technology Standards and Policy

Stage 2 Meaningful Use is supposed to enable the flow of health care data by breaking down barriers, mandating greater care coordination and patient engagement. In my third and final post (See Parts I and II) of this series, I share my final thoughts on how Meaningful Use has kick-started a number of pathways for truly opening up healthcare data silos.

Competitors working together to make interoperability a reality
The combination of open forums created to facilitate development of Meaningful use standards —such as the Standards and Interoperability (S&I) Framework and the Federal Advisory Committees —have inspired a new wave of interoperability efforts that extend beyond the government: communities of competitors collaborating to create interoperable standards (try saying that ten times fast). These communities act as test beds for new standards and policies, somewhat like connect-a-thons and hack-a-thons, but with real-world constraints and at greater scale. Though there are dozens across the nation, a few cooperative efforts stand out due to their membership and/or impact:

  • EHR/HIE Interoperability Workgroup, the Western States Consortium, and DirectTrust: These organizations, made up of state health information exchanges (HIEs) and health information technology (HIT) vendors, focus on developing implementation guidance for interoperability based on existing standards, particularly those in Stage 2 Meaningful Use. They are also taking some bold steps to address gaps in current regulation—particularly via provider directories and “managing trust” in health care networks—that complement Stage 2 regulation.
  • CommonWell Health Alliance:
    This consortium is dedicated to the vision that a patient’s data should be available to patients and providers regardless of where care occurs. The Alliance believes that caregiver access to this data must be built into EHR technologies at a reasonable cost – thus disrupting today’s more prevalent “silo” business model, where access to patient’s data is expensive to the end user and (often) a sizeable source of revenue to the HIT vendor. To this end, the Alliance plans to promote and certify a national infrastructure, with services and standards for linking and matching patients across settings of care, and enabling simpler cost-effective patient access.

Raising the ceiling with population health management
Even as Meaningful Use and community-driven efforts are creating the technologies to enable interoperability – what I call the supply side of interoperability – there are still more waves of innovation driving the demand side for the data. And this is where the developments are really exciting.

This wave of interoperability is driven by the rising crest of population health management, a rapidly growing field that was given a shot in the arm through the Accountable Care Act and the concurrent rise of Accountable Care Organizations (ACOs). Population health management is “raising the ceiling” of interoperability because it puts a financial incentive on groups of health care providers (such as health systems, and Independent Practice Associations) to achieve higher quality and lower costs for entire populations of patients. This payment model creates an economic incentive for health entities to meaningfully share financial and clinical health care information among those patients’ caregivers. If caregivers don’t share this information across the network, they will not be able to earn the financial incentive (or avoid financial loss) because they will have no visibility or influence into their network of providers and patients.

This in turn is driving the accelerated development of Extract, Transform and Load (ETL) platforms, which obtain data from heterogeneous technology environments that pervade health care communities today. athenaClarity, a cloud-based service that leverages athenahealth’s health information backbone to vendor-agnostically interoperate with payers, billing systems and a variety of clinical systems. In doing so, athenaClarity extracts silo’d data and converts it into actionable insight for health system leaders and physicians. For example, recently Lahey Clinic selected athenaClarity to increase network-wide data visibility across disparate information systems and in turn support ACO goals.

Calling for more disruption, please
The final wave is dedicated to the future Elon Musk’s and Marc Benioffs of the healthcare world. If you’re that brave technologist or entrepreneur who is patiently waiting for that blessed day to connect your innovative idea to the real world… surf’s up! The next wave of interoperability is on its way! App developers, trading partners, medical devices, and the growing landscape of non-traditional caregivers are finding ways to leverage all of the standards described in these blog posts to improve the quality, costs, user experience, and outcomes for patients everywhere. They are experimenting with new technologies, new ways of learning from data, and new business models. It seems that everywhere you look, experiments and ecosystems are popping up that are mashing up the emerging health internet.

At athenahealth, our More Disruption Please (MDP) ecosystem program is squarely aimed at attracting entrepreneurs, health care IT companies, investors and thought leaders – anyone who shares our vision of changing the status quo in health care through openness and connectivity of disruptive solutions. Those who join us as partners can achieve immediate scale via our network of more than 43,000 providers, offering the benefits of their innovative services to a broad population of caregivers and patients.

That’s it… for now
Whew! There’s a lot of activity, and much to look forward to. In the next few months, Stage 2 Meaningful Use will become a reality and the waves it is churning will accelerate toward us. Whether you’re a physician, a patient, or a technologist—or just someone yearning for a change from the days of isolated EHRs and walled-off practices—it’s time to take a deep breath and dive in.

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