Will Healthcare Ever Reach Seamless Interoperability?

By Justin Wu, MD and Matthew Sakumoto, MD

In the rapidly evolving landscape of healthcare, virtual care has emerged as a transformative force, offering patients the flexibility and convenience of receiving care from anywhere. However, the success of virtual care across the US healthcare system will hinge on the seamless integration between virtual care solutions and electronic health records (EHRs) to optimize care delivery and patient experience—and ‘seamless’ may be the last word most would use to describe interoperability at the moment.

Integration Challenges in 2023

As we navigate 2023, it remains a disappointing truth that the integration between virtual care solutions and traditional or “certified” EHRs is far from ideal. Multiple vendors catering to telehealth, remote patient monitoring (RPM) / Internet of Things (IoT), and traditional health systems have led to fragmentation of care. However, provider organizations need to connect with different networks including health information exchanges, immunization registries, lab vendors, referral networks, eligibility and claims, and more to offer the best care for their patients.

While the Office of the National Coordinator for Health Information Technology (ONC) has led the effort to standardize interoperability through key policies such as TEFCA and the implementing regulations under the 21st Century Cures Act, these rules only apply to healthcare providers using certified health IT.

The reality is that most digital health solutions are built on non-certified, home-grown technologies, hindering the seamless exchange of patient information, and current business models don’t incentivize companies to invest in data sharing.

What's the Integration Landscape and Do We Have Any Hope for the Future?

There are different approaches that a health system can take in integrating virtual care solutions with their current EHR. One approach is to utilize the EHR as a single platform where the virtual care solution has an existing integration with the EHR vendor. This can make it easier to integrate with that one EHR vendor, assuming the EHR vendor and virtual care solution already have invested in an integration, but does not help connect to physicians who use different systems, and in fact, significantly limits the choice of vendors and solutions available.

Another approach is to use a third-party integration platform. These platforms can connect different EHRs and virtual care solutions, which can give providers more flexibility in choosing the EHR and virtual care solution that best meets their needs. However, while these companies sell “interoperability,” the solutions provided often involve building bespoke connections to each data source, charging additional fees to ultimately connect data sets from different entities, and require significant investment in ongoing updates and maintenance.

For example, virtual care solutions and cloud-based EHRs with more open application programming interface (API) infrastructures are becoming more common, and they can make it easier to integrate different systems. In fact, an open specification API that any provider can use with any other provider or their EHR has been required by law since 2016. Additionally, the development of open standards for data exchange, including the steady adoption of the “fast healthcare interoperability resource” or “FHIR” standard, is helping to make it easier for different systems to communicate with each other.

Omada Health is currently capitalizing on these maturing open standards to make data available to improve bidirectional data exchange with members’ physicians.

Integration Principles to Make the Best Impact on Clinical Workflow

There are a number of principles that can be followed to ensure that the integration of virtual care solutions and EHRs has the best impact on clinical workflow. These principles include:

• Start with the patient. The integration of virtual care solutions and EHRs should be designed with the patient in mind. This means ensuring that patients can easily access their medical information (as they are required by law to be able to do) and that providers can easily share information across settings without “information blocking” (Information blocking is prohibited by law).
• Use open-source standards. The use of open-source standards can help to ensure that different systems can communicate with each other. This can make it easier to integrate by virtual care solutions and EHRs and can help to reduce the cost of integration and avoid future tech debt.
• Focus on the workflow. The integration of virtual care solutions and EHRs should not be an afterthought. It should be designed to fit into the existing clinical workflow and to make it easier for providers to deliver care. Make sure to involve the entire care team in any design and testing work.
• Be flexible. The healthcare industry is constantly changing, and the integration of virtual care solutions and EHRs should be flexible enough to adapt to these changes. This means using open standards and being willing to change the integration as needed.

Conclusion

As we assess the current state of integration between virtual care solutions and EHRs, it becomes evident that we have a long way to go in bridging the interoperability chasm. We’re starting to see some glimmers of hope as industry stakeholders are increasingly recognizing the importance of standardization efforts and by interoperability protocols.

It is through continued collaboration, research, and investment in interoperability that we can unlock the full potential of virtual care and deliver improved healthcare experiences for patients and providers alike.

Bios & Disclosures:

Justin Wu, MD is VP of Clinical Innovation & Quality at Omada Health. Prior to his current role, he was the Clinical Informatics Officer at the Ravenswood Family Health Center, Regional Medical Director at Blue Shield of California, and Medical Director at Altais Health, a startup building tools and technology to support independent physician practices.

Matthew Sakumoto, MD is a virtualist primary care physician in San Francisco. He is also fellowship-trained in clinical informatics at UCSF, with a focus on virtual care and clinician efficiency tools for the EHR. With prior industry experience at multiple telehealth startups and as a clinician-advisor to many early-stage companies, he is passionate about exploring and expanding the digital health landscape.

This Proof Points edition was originally published on LinkedIn on 10/5/23.