Implementing Interoperability
Health care record interoperability is one of the least recognized health and privacy issues at this time. While this issue had not received significant support before Hurricane Katrina, that disaster made government realize the value of easily accessible medical records for patients in crisis and that patient care will improve if health care professionals are given more access to portions of medical records. Another reason frequently cited in support of interoperability is the cost savings that states and insurers will receive from increased efficiencies. Ironically, the current focus on interoperability will likely bring HIPAA's goals to completion.
In theory, interoperability should be simple, but it will likely be somewhat difficult to implement. Interoperability would permit health care providers to review and place a patient's medical information into an electronic chart for the patient. This is a concept that will rely upon -- but be much broader than electronic health records (known as EHRs) -- because all providers will need to communicate and keep one accurate record for the patient and the required technology presumably will be based upon an EHR system. Patients will have to be permitted to restrict certain portions of their medical records, but there will be scenarios (emergent health issues) where physicians and other health care professionals will be permitted to access information without patient consent, which could be impossible to obtain.
California has recognized the importance of interoperability and has a goal to achieve 100 percent compliance between payers and providers in less than 10 years. The state has allocated money to assist the implementation of interoperability, with the goal being to have the Secretaries of the Health and Human Services Agency and the Business, Transportation and Housing Agency, the Director of the Department of Managed Care and the State Chief Information Officer work with public and private sector stakeholders to develop a sustainable business model for an e-health network connecting rural health clinics to medical centers throughout the state using telemedicine and other technology.
An eHealth Action Forum was created to develop a comprehensive state policy agenda for health information technology by:
- defining the goals and values of health information technology for the purposes of state policy and planning; creating an inventory of the various initiatives underway in the state related to health information technology and assess opportunities for building on those efforts, and replicate those projects that prove the feasibility and business case for health information technology and health information exchange;
- identifying the appropriate role of state government in the development of health information technology and health information exchange versus those activities more appropriately coordinated through other entities;
- facilitating statewide adoption of standards and interoperability requirements for e-health to enable the secure exchange of health information across the state and nation;
- identifying areas where state laws and regulations hinder, rather than facilitate, adoption of health information technology, and recommend strategies to remove such barriers;
- identifying and developing strategies for the continued protection of confidentiality and privacy of health information in an electronic environment;
- identifying opportunities and strategies for a public/private partnership approach to create financially viable and sustainable business models for health information technology projects in the state;
- developing options for advancing the implementation of health information technology through the state's role as a major purchaser, provider and regulator of health care services; and
- developing with stakeholders performance metrics to measure the success of the implementation of health information technology throughout California.
In large part, these goals are being achieved through the Privacy and Security Advisory Board (PSAB) of the California Office of HIPAA Implementation. While there is a clear mandate from the state to facilitate and encourage interoperability, the implementation steps of this concept are not clear-cut. There are many models that might work; one option that seems to accomplish many of the goals is based upon the consumer reporting model. A select group of entities could manage your health records in one location, giving providers and others the right to input data, as well as view data, depending on the circumstances. One of the advantages of such a system is that it reduces the chances of having multiple, different records in different providers' hands, all with potentially inconsistent data. It also would seem to reduce the time needed to obtain data in truly emergent situations. While there is agreement on the end goal of interoperability, no model has yet been agreed upon, so there is much work for groups like California's PSAB to do in the years to come.