Is it realistic to envision a healthcare landscape in which all players are fully interoperable, enabling consistent communication between various providers and coverage sources? Short answer: Yes. And no. Idealistically, we have, right now, the data and the capabilities to achieve this vision, informatics experts say.
If every healthcare entity in a given region committed to adopting a set of standards for data sharing, including broadening what types of patient information is shared, and to implementing and developing a consistent interoperable technology, it could enable widespread data unity and information exchange.
Realistically, however, that doesn’t happen. In the United States, for example, where the government sponsored HITECH act invested millions in helping hospitals and healthcare providers acquire and implement electronic health record (EHR) technology to collect and store patient data, very little of that investment has gone toward encouraging interoperability or developing unified data sharing[1].
However, every step forward pays dividends in creating a stronger digital health infrastructure to help connect different departments, organizations, regions, and even countries, and turn data into meaningful information that can improve patient safety.
Patient safety and the data input gap
Medication errors can have a devastating impact on patients, leading not only to patient harm, but to high care costs and drains on staff resources:
- In England, more than 237 million medication errors are reported every year costing the NHS upwards of £98 million and resulting in more than 1,700 lives lost, according to a 2020 report[2]
- Ten percent of U.S. hospital patients are subject to a medication error, while U.S. community pharmacies have an estimated dispensing error in 1.5% of all prescriptions[3]
- Globally, the WHO estimates 6 to 7% of hospital admissions in some countries to be medication-related[4]
“Drug errors, it’s pretty clear, cost society a lot,” says Steven Hart, MD, a clinical informatics expert. “That includes the individual patients who might be harmed and maybe have a longer hospitalization or become permanently impaired or die. That’s a big deal to that patient, but it’s also a big deal to the insurance company that has to pay for the ramifications and to the hospital, potentially. That’s where it becomes a systemic issue. If you can reduce adverse drug events, the net benefit to society would be quite large financially.”
With the advent of electronic health systems and the increasing digital maturity in many developed healthcare ecosystems, professionals turn to clinical decision support (CDS) to help prevent medication errors. In a hospital setting, healthcare professionals have access to a wealth of inputs from which to draw context for clinical drug safety screenings: lab data, current patient weight, problem lists, demographics, and more. But then, that patient and their prescription leave the hospital and head out into the wide world of retail pharmacies, clinics and outpatient care.
The whole role of the pharmacist is to monitor drug therapy and make sure it’s right for the patient and then bring anything to the physician’s attention if it’s not. But retail pharmacists and other providers only have access to a small fraction of the demographic and diagnostic data that prescribers consult.
When it comes to data, location matters
Your data sharing is often affected by your location. In Germany, for example, medical information sometimes cannot be shared even across different departments of the same hospital due to data protection regulations[5].
The data gap that exists between providers is not a universal phenomenon. It is a common challenge in healthcare eco-systems in which organizations have the ability to purchase their own healthcare information system and patients have the choice of private insurers, either through their employers or out-of-pocket purchase. This economic choice creates data silos. Each system or business owns its own data, and patients and professionals must rely on government regulations or standards bodies to develop and enforce interoperability.
Some countries such as the U.S., the U.A.E and the Kingdom of Saudi Arabia have achieved a higher level of digital maturity. However, data silos exist in some countries where healthcare infrastructure is lacking. Informatics experts describe similarly siloed situations in less developed regions where healthcare professionals have compensated for lack of resources by supplementing paper charting with home-grown EHRs of their own design.
The barriers to information sharing are lower in countries with national health systems, which strive to create equal access to care for all citizens. But even when a national identification system for patients helps enable information sharing between a country’s provider organizations, there are still barriers to interoperability, including gaps in technology infrastructure and data quality in different regions and hospital locations.
Improving how and what we share
Experts agree, the key to improved data sharing and interoperability lies in two areas of investment:
- Standardized, sophisticated technology infrastructure
- Quality data delivered in sharable format
The worldwide push to adopt EHR technology over the last two decades represented a first step in the global digitization of healthcare. Although disparate systems cannot always share information smoothly and different regions operate at vastly different levels of technological maturity, we now have a global consensus toward electronic records and information sharing.
Newer technologies like SMART on FHIR help further streamline app development and enhance decision support with CDS Hooks. Except in cases where a platform or type of data is mandated nation-wide by a ministry of health, there will always be a mix of choices. Interoperability and data sharing will depend on standards, quality, and our willingness to adhere to them. To be as prepared as possible, experts suggest investing in a data system that is “future-proof”, or able to map to variety of standard concepts and identifiers so as to adapt to unexpected industry demands.
The future of data can start right now
Data unity may still, in many ways, be an ideal, but our reality is a more interoperable, interactive healthcare information technology landscape than we had even a decade ago.
“I personally see this problem as an opportunity,” says Hart. Instead of looking at health information exchanges and only seeing the gaps where information isn’t being shared, he advises that the health- care industry and innovators instead ask themselves, “can we provide a product or a mechanism where we can pull that information into the system, and all of a sudden, you can provide better results”.
References
- https://www.statnews.com/2020/11/18/interoperability-untapped-tool-fight-against-covid-19/
- https://qualitysafety.bmj.com/content/30/2/96
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6173242/
- http://www.who.int/mediacentre/news/releases/2017/medication-related-errors/en/
- https://www.nature.com/articles/s41746-019-0158-1
To be as prepared as possible, experts suggest investing in a data system that is future- proof, or able to map to variety of standard concepts and identifiers so as to adapt to unexpected industry demands.
Wolters Kluwer
Wolters Kluwer provides trusted clinical technology and evidence-based solutions that engage clinicians, patients, researchers, students, and the next generation of healthcare providers. Organizations and professionals in 190+ countries rely on Lexicomp®, Medi-Span®, UpToDate® and Emmi® patient programs to reduce care variations, harmonize decisions, and measurably improve clinical effectiveness.
