True interoperability moves closer to reality

Think back 20 years, when it was predicted that patients soon wouldn’t have to enter the same information about treatments, conditions, surgeries, medications, and other information physician after physician and visit after visit. Now think about the last time you went to a physician — even for a routine visit. How much paperwork (yes, actual paperwork) did you have to fill out, and how much of this information was actually new to the provider?

The January release of the Trusted Exchange Framework and Common Agreement (TEFCA) completes a crucial requirement of the 21st Century Cures Act that promotes interoperability. While much work remains, it’s apparent the industry is moving toward interoperability that will benefit patients and providers.

One pivotal question still to be answered is how to deal with the continued presence of fax machines among providers and payers. A recent industry survey shows that 61% of administrators use the fax machine most often because it’s a known quantity and easy to use.¹

Digital faxing can provide the ease that providers and administrators crave and the structured data that interoperability demands.

Barriers to a complete health record

No one would argue that the patient shouldn’t be the center of the healthcare experience, but that remains an elusive goal. Patients face barriers to accessing a complete healthcare record, and no single provider appears to have the entirety of that data. Physicians, hospitals, ambulatory and post-acute care facilities and others generally share just transactional data related to a specific test, procedure or treatment.

Recent federal regulations are addressing many of the interoperability issues, including technical interoperability standards, requirements for electronic admission, discharge and transfer (ADT) among many provider types that accept federal payment and the need for digital contact information
for hospitals.

True communication remains a goal unless the receiver can effectively receive data, read it, act on it, prioritize it and use it to deliver the best patient care. The barriers are two-fold: timely information and actionable data.

Rehab centers, skilled nursing facilities and home health agencies still often receive paper faxes when a patient is transferred to their service. But patients need immediate care upon arrival at a post-acute care facility or at home, including medication reconciliation, wound care, physical therapy, etc. Lack of timely, easy-to-consume and actionable data delays patient care and runs counter to the Quadruple aim of better individual and population health and higher patient and clinician satisfaction.

Regulations cut through information silos

For decades, patient information existed in siloes. Electronic health records (EHR) system vendors were among the worst offenders, hoarding a wealth of patient data that was incompatible with other IT systems upstream and downstream from the hospital care setting. Vendors often were able to “lock in” hospitals and health systems from changing EHR systems because they feared significant data loss during migration. The only compatibility available between IT systems was between software from the same EHR vendor.

Other IT vendors were guilty, too, of not sharing data with other systems. At first, it was different coding languages used to program individual IT systems. Then it became the time, expense, and potential security concerns over using application programming interfaces (APIs) to connect individual system to individual system.

The TEFCA framework cuts through many of those obstacles, establishing three common goals: 

• Establish a universal policy and technical floor for nationwide interoperability
• Simplify connectivity for organizations to securely exchange information to improve patient care, enhance the welfare of populations, and generate health care value
• Enable individuals to gather their health care information

Although the framework is non-binding, the strong movement toward interoperability is expected to propel providers across the spectrum to participate. The Common Agreement encompasses support for healthcare operations, including treatment, payment and patient access, as well as uses for public health and determination of government benefits.

Data sharing among healthcare systems will utilize industry standard HL7 Fast Healthcare Interoperability Resource connections.

Digital faxing still has a role to play

True interoperability requires the transition of unstructured data to structured data. Paper faxes and other physical documents are unstructured data that can be incorporated into a patient record only as images. While providers can access and view this data, it is not searchable and cannot be incorporated with other types of individual electronic patient data or aggregate data used in population health and other care initiatives.

Digital faxing with natural language processing (NLP) and artificial intelligence (AI) protocols can create the required structured data. Once a document is digital, the task is no longer about “document” exchange – it is then “data” exchange. With technology that leverages NLP and AI, workflows can improve so that providers can receive documents with automatically identified information such as patient demographics and clinical information to provide a longitudinal look at that patient record.

For example, a provider can convert unstructured cloud fax documents into consolidated clinical document architecture (C-CDA) documents using NLP/AI that can be consumed more intelligently by an EHR or practice management, while still maintaining an original file that can be faxed externally. More electronic data can bring better decision-making at the individual patient level, among patients with similar conditions or comorbidities and at the population health level. NLP and AI can help close technology gaps and unlock the potential of important documents to improve the delivery of healthcare, quality reporting, research and safety.

Once true interoperability is achieved, the patient/provider paradigm can shift from filling out or perusing forms to empowering relevant conversations that help patients better understand, monitor and control their chronic conditions or emergent diagnose. 

Conclusion

Healthcare continues to make strides toward interoperability of patient data that can lead to seamless transitions of care, better medical decisions and improved outcomes. The industry isn’t there yet, but federal regulations are propelling the industry forward.

Digital faxing, combined with NLP and AI protocols, can leverage the communications medium that most providers still prefer with the ability to create structured data that can be ingested into a complete patient record. 

¹ Consensus: 2021 Industry Trends Survey for Healthcare (2021)