Care Coordination and Interoperable Health IT Unit 3: Overview of Interoperable Health IT Lecture a – Benefits of Health Care Interoperability Welcome to Care Coordination and Interoperable Health IT Systems, Overview of Interoperable Health IT, Lecture a. This is the first lecture in a three-part series of an overview of interoperable health IT. This material (Comp 22 Unit 3) was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. This work is licensed under the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-sa/4.0/.

Overview of Interoperable Health IT Learning Objectives Objective 1: Define health care interoperability (Lecture a) Objective 2: Summarize the vision and benefits of interoperable health IT (Lecture a) Objective 3: Identify and examine several barriers and challenges to obtaining interoperable health IT (Lecture b) Objective 4: Discuss the U.S. strategy for health interoperability (Lecture c) This unit will cover the following learning objectives: 1) define health care interoperability; 2) summarize the vision and benefits of interoperable health IT; 3) identify and examine several barriers and challenges to obtaining interoperable health IT; and 4) discuss the U.S. strategy for health interoperability. In this lecture, we will be covering the benefits of health interoperability. You will be able to define health care interoperability and summarize the vision and benefits of interoperable health IT.

What is health care interoperability What is health care interoperability? – Office of National Coordinator (ONC) definition “the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user” Means “making the right electronic health information available to the right people at the right time across products and organizations, in a way that can be relied upon and meaningfully used by recipients” What is health care interoperability? Let’s look at the definition by the Office of the National Coordinator or “ONC”. Health care interoperability is “the ability of a system to exchange electronic health information with and use electronic health information from other systems without special effort on the part of the user”. It means “making the right electronic health information available to the right people at the right time across products and organizations, in a way that can be relied upon and meaningfully used by recipients”.

What is health care interoperability What is health care interoperability? Health Information Management Systems Society (HIMSS) definition “In health care, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged”  “Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of health care for individuals and communities” What is health care interoperability? Let’s look at the Health Information Management Systems Society or HIMSS and their definition. “In health care, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged”. And “Interoperability means the ability of health information systems to work together within and across organizational boundaries in order to advance the effective delivery of health care for individuals and communities”. This definition is from the HIMSS Board on April 5, 2013. Health IT Workforce Curriculum Version 4.0

Interoperability within an organization Numerous health IT systems communicate within an organization to share data to improve care and efficiency Example messages: Admission of patient Order of lab test Order of medication Availability of lab result Let’s look at interoperability within an organization. For example, a hospital’s IT systems could communicate with each other to share data to improve care and efficiency. Some example messages that might be sent between systems would include: a patient has been admitted; or a lab test has been ordered; or a medication has been ordered; or a lab result is available. These messages would include data about that admission; or that order; or that medication; or that lab result. This slide includes a diagram. On this diagram, we have a patient administration system, where a patient would be first recorded that they were admitted. That message might flow to the EHR, the hospital pharmacy system, the hospital laboratory system, and the hospital’s data warehouse, as well as perhaps many other systems. On the EHR, a doctor may record a lab order. The lab order would flow to the laboratory system, as well as to the data warehouse. The doctor may also record a medication order. When the doctor orders the medication, it would flow from the EHR to the hospital’s pharmacy system and the data warehouse. When the laboratory finishes processing and gets results of a lab test, it would send that result back to the EHR, and perhaps to the data warehouse. These are some examples of interoperability within an organization. 3.1 Figure (Lorenzi, V., 2016) Health IT Workforce Curriculum Version 4.0

Interoperability between organizations Now, let’s look at interoperability between organizations. This is a diagram that shows numerous organizations and systems. Let’s start at Doctor A’s office, which has an EHR. Doctor A may write the patient a medication prescription. That prescription would be electronically sent to the community pharmacy. At the community pharmacy, they need permission to fill this medication and authorize its payment. They send a request of authorization to the insurance company. The insurance company responds with an approval of that authorization. Doctor A may also decide to refer their patient to another doctor. Doctor A would create an electronic care summary and it would get electronically sent to the EHR of Doctor B. Also imagine that Doctor A had ordered a lab test for the patient. Sometimes those lab tests are not done when a patient is at the office, but it is important for the doctor to receive those results whenever they come in. The doctor may have a subscription with a community lab. Whenever the lab completes the result, it checks its subscriptions. Since Doctor A is on the subscription list, a message containing the result is sent to Doctor A’s EHR. Now let’s go back to the patient who is visiting Doctor B. Doctor B may decide to give the patient an immunization, like a flu shot. Immunizations are really important for the public health department to keep track of. So a message may electronically go to the public health authority. These are some examples of interoperability between organizations. 3.2 Figure (Lorenzi, V., 2016) Health IT Workforce Curriculum Version 4.0

ONC’s national strategy for health care interoperability Build an interoperable health IT ecosystem that supports a learning health system This will be discussed in more detail in lecture c. Thinking at an even higher level, the United States has a national strategy for health care interoperability across the nation. They want to build an interoperable health IT ecosystem that supports this concept called a learning health system. This is from the ONC’s report called “Connecting Health and Care for the Nation: A Shared Nationwide Interoperability Roadmap”, which was published in October 2015. This will be discussed in more detail in lecture c. Health IT Workforce Curriculum Version 4.0

Imagine where your provider had access to the data needed for your care… Let’s talk about a vision of interoperable health IT. Imagine a health care system in which your care provider with your consent actually had access to the data needed for your care, no matter where the data was initially collected…And that the data spanned the continuum of your care…where no provider was delayed and holding up your care because they didn’t have the data yet…And where technology helped providers successfully communicate and actively collaborate on your care from wherever they were. Then you would have interoperable health IT supporting real care coordination. 3.3 Figure (Lorenzi, V., 2016). Health IT Workforce Curriculum Version 4.0

Imagine where you, the patient… Imagine a health care system where you the patient could access your medical record, you could add to it, and you could share it with others whenever you wanted to. And you, the patient, had control over what data was shared and with whom. Where you and your clinician could communicate online and even have an appointment remotely using telemedicine. And your caregiver, with your permission, could access your record and use the information to advocate for your care. Well then, we would have interoperable health IT supporting real patient-centered care. 3.4 Figure (Lorenzi, V., 2016). Health IT Workforce Curriculum Version 4.0

Imagine where patient information from all over Imagine a health care system where patient information from all over was rapidly collected and analyzed in aggregate, and then shared to prevent outbreaks, cure disease, improve public health, manage health of populations, improve overall care quality, and reduce inefficiencies and cost. Imagine a health care system where clinicians and patients can make informed decisions informed by knowledge derived from health information of the whole population. Interoperable health IT is an essential foundation to a learning health system. 3.5 Figure (Lorenzi, V., 2016). Health IT Workforce Curriculum Version 4.0

ONC’s definition of a learning health system “A learning health system is an ecosystem where all stakeholders can securely, effectively and efficiently contribute, share and analyze data” “A learning health system is characterized by continuous learning cycles, which encourage the creation of new knowledge that can be consumed by a wide variety of electronic health information systems” “This knowledge can support effective decision-making and lead to improved health outcomes” Let’s look at the definition of a learning health system from the ONC’s Nationwide Interoperability Roadmap, which will be discussed later, and that is informed by concepts from the group called the Learning Health Community. “A learning health system is an ecosystem where all stakeholders can securely, effectively and efficiently contribute, share and analyze data and create new knowledge that can be consumed by a wide variety of electronic health information systems.” A learning health system is characterized by continuous learning cycles and this information is then used to support effective decision-making and lead to improved health outcomes.” Health IT Workforce Curriculum Version 4.0

The ultimate goal of interoperable health IT is to support a learning health system The ultimate goal of interoperable health IT is to support a learning health system. This diagram shows the health IT ecosystem as a learning health system. It shows the interoperability between a patient’s personal health record, an EHR, health information exchanges, and then with large scale analytics systems for the purpose of determining and sharing clinical guidelines, informing public health policy, and supporting clinical decisions. In a learning health system, information is securely shared across the ecosystem with the ultimate goal of supporting effective decision-making and improved health outcomes. 3.6 Figure (Office of the National Coordinator for Health Information Technology, 2015) Health IT Workforce Curriculum Version 4.0

The vision of interoperable health IT – imagine this… To briefly summarize the vision of interoperable health IT, it is to support fully coordinated, patient-centered care in a learning health system. 3.7 Figure (Lorenzi, V., 2016) Health IT Workforce Curriculum Version 4.0

Benefits of interoperability Available information supports improved care Better coordination among caregivers More complete data available sooner to aid clinician’s decisions Data available to more participants in the care process Patient and caregiver engagement Timely access to data Able to contribute data Able to communicate More efficient care, more value Smoother workflow, less delays Less redundant work Data available to improve population and public health You can see with interoperability, you can have available information that supports improved care with better coordination among caregivers, more complete data available sooner to aid clinician’s decisions, and data available to more participants in the care process. We have better patient and caregiver engagement because they would have timely access to data, they would be able to contribute their own data, and they would be able to communicate with their caregivers and their care clinical providers. We would have more effective care and more value. We would have smoother workflow, less delays, and less redundant work and that would save money. And in addition, we would have data available to improve population and public health. Health IT Workforce Curriculum Version 4.0

JASON Report: benefits of interoperable health IT Satisfy the growing demand of patients for flexible access to their own health information Offer faster, interoperable access to patient records by health care providers Reduce errors within individual records and across records Reduce redundant testing and diagnostic procedures Produce more complete health records and more accurate health data Promote better longitudinal tracking of patients and patient groups In April 2014, the JASON group published a report entitled “A Robust Health Data Infrastructure”. The JASON group is an independent group of scientists that advise the federal government. This report helped shape the ONC interoperability vision so it is useful to look at the benefits sited in this JASON report. The JASON report listed the following benefits of interoperable health IT. 1) Interoperable health IT can satisfy the growing demand of patients for flexible access to their own health information. 2) It can offer faster, interoperable access to patient records by health care providers. 3) It can reduce errors within individual records and across records. 4) It can reduce redundant testing and diagnostic procedures. And 5) It can produce more complete health records and more accurate health data and it could promote better longitudinal tracking of patients and patient groups. Health IT Workforce Curriculum Version 4.0

From the provider perspective, interoperability provides important capabilities: Data capture for use by clinician and others at point of care Technology to continuously analyze what is happening when and where (allows for optimization) Decision support with automatic alerts and notifications Seamless transfer of information between and within care settings Assistance for provider to follow their patients throughout their care Remote delivery of care Data analysis support for the benefit of the wider population (National Health Service of England, 2015) Now let’s look at interoperable business capabilities, which is another way of looking at benefits. A report entitled the Interoperability Handbook was published in September 2015 by the National Health Service in England. This report lists benefits from the provider perspective. For the provider, benefits of interoperable health IT would be the ability to actually have information electronically captured for the doctor and others at the point of care and the ability to receive automatic alerts and notifications to help them make the right decision. The provider would be able to seamlessly transfer patient information between and within care settings. They can use technology to provide care remotely – that is, perform telemedicine. They can take advantage of all the data shared to analyze effectively for the benefit of a wider population. And then they ultimately would be able to use technology to understand what is happening, where, and at all times. As you can see, there are many common themes in the benefits listed in the United Kingdom report and the United States report. Health IT Workforce Curriculum Version 4.0

Benefits of interoperability: patient perspective – “Steve’s Story” Steve is a 26-year-old male, who had a brain tumor removed as a child and is now suffering from frequent headaches He is referred to many different doctors and health care facilities for treatment Required to repeat registration information, medical history, allergies, medications, etc. Required to repeat tests and procedures due to a lack of comparison test results and scans Steve contracted an infection during a recent hospital visit and is concerned about ongoing and emergency care He has increasing levels of fear and frustration Making it more personal, I would like to share a special story with you about the benefits of interoperability, from a patient’s perspective. It’s Steve’s story. Steve is a fictional character, created by Robin Raiford. Robin was a well-known Health IT advocate. Robin Raiford invented the character, Steve, based on a real person. Steve is a 26-year old male, who had a brain tumor removed as a child, and is now suffering from frequent headaches. He is referred to many different doctors and health care facilities for treatment. He is required to repeat registration information, medical history, allergies, medications, etc. He is required to repeat this over and over again when he is referred. He is required again to repeat tests and procedures due to a lack of comparison test results and scans. He has brain scans repeated over and over. Recently, he contracted an infection during a recent hospital visit. He does not want to go back to a hospital and he is concerned about his ongoing and emergency care. He has increased levels of fear and frustration. Imagine this is how Steve felt without interoperability. Health IT Workforce Curriculum Version 4.0

Steve‘s story in the future The future: health care in an interoperable world With Steve’s consent, health care information will be seamlessly and securely exchanged between and among diverse systems across the United States Adapted from Healthcare Information Technology Standards Panel 2008 webinar But imagine a nation where we have true health care interoperability, what would Steve’s future look like? With Steve’s consent, health care information will be seamlessly and securely exchanged between and among diverse systems across the United States. Health IT Workforce Curriculum Version 4.0

Steve‘s story in the future (Cont’d) His care providers will have instant access to key data from other providers and care settings, including: Active and past medication list Allergies Current and previous problems and diagnoses Discharge and visit summaries Lab results and other test results, including images Registration and insurance information Steve can also record his own findings and share them electronically with his doctors His care providers will have instant access to key data from other providers in care settings, including active and past medication lists, his allergies, his current and previous problems and diagnoses, all his discharge and visit summaries, all of his results, including those images from those scans, and all of his registration and insurance information. And Steve himself could record his own findings and share them electronically with his providers. Imagine how much better Steve would feel in this future world, knowing that he and his doctor’s had the right information at the right time to optimize his care. Health IT Workforce Curriculum Version 4.0

Unit 3: Overview of Interoperable Health IT, Summary – Lecture a, Benefits of health care interoperability The national vision of interoperable health IT is to build an interoperable health IT ecosystem that supports a learning health system The Office of the National Coordinator of Health Information Technology and the Health Information Management Systems Society have definitions for interoperability This concludes lecture a of Overview of Interoperable Health IT. To summarize, the national vision of interoperable health IT is to build an interoperable health IT ecosystem that supports a learning health system. There are definitions of interoperability from the Office of the National Coordinator of Health Information Technology and the Health Information Management Systems Society.

Unit 3: Overview of Interoperable Health IT, Summary – Lecture a, Benefits of health care interoperability (Cont’d – 1) A learning health system is an ecosystem where all stakeholders can securely, effectively, and efficiently contribute, share and analyze data and create new knowledge that can be consumed by a wide variety of electronic health information systems to support effective decision-making and lead to improved health outcomes There are many benefits from interoperability, including: having information available to support improved care and to improve population and public health, engaging patients and caregivers, and having more efficient and value-added care We also talked about what a learning health system is, which is an ecosystem where all stakeholders can securely, effectively, and efficiently contribute, share, and analyze data and create new knowledge that can be consumed by a wide variety of electronic health information systems to support effective decision-making and lead to improved health outcomes. Finally, there are many benefits from interoperability, such as having information available to support improved care and to improve population and public health, engaging patients and caregivers, and having more efficient, value-added care.

Unit 3: Overview of Interoperable Health IT References – Lecture a Agency for Healthcare Research and Quality. (2013). A robust health data infrastructure. Available at Office of the National Coordinator of Health Information Technology. DeSalvo, K.B. (2014). Press release: A robust health data infrastructure. Available at Office of the National Coordinator of Health Information Technology. Healthcare Information Technology Standards Panel. (2008). Steve’s story. Available at HITSP 2008 webinar archives. Health Information Management Systems Society. Definition of interoperability. Available at HIMSS. Institute of Electrical and Electronics Engineers. Definition of interoperability. Available at Institute of Electrical and Electronics Engineers website. NHS England, HSCIC, South, Central, and West Commissioning Support Unit. (2015). Interoperability Handbook. Version 1.0. Office of the National Coordinator for Health Information Technology. (2015). Connecting health and care for the nation: a 10-year vision to achieve an interoperable health IT infrastructure. No audio.

Unit 3: Overview of Interoperable Health IT References – Lecture a (Cont’d – 1) Office of the National Coordinator for Health Information Technology. (2015). Connecting health and care for the nation: a shared nationwide interoperability roadmap. Final version 1.0. Raiford, R. ONC Health Information Technology Standards Panel Webinar Series. No audio.

Unit 3: Overview of Interoperable Health IT References – Lecture a (Cont’d – 2) Charts, Figures, Tables 3.1 Figure: Lorenzi, V. (2016). Interoperability within an organization. Used with permission. 3.2 Figure: Lorenzi, V. (2016). Interoperability between organizations. Used with permission. 3.3 Figure: Lorenzi, V. (2016). Vision of interoperability and care coordination. Used with permission. 3.4 Figure: Lorenzi, V. (2016). Vision of interoperability and patient-centered care. Used with permission. 3.5 Figure: Lorenzi, V. (2016). Vision of interoperability and learning health system. Used with permission. 3.6 Figure: Office of the National Coordinator for Health Information Technology. (2015). Health IT ecosystem. 3.7 Figure: Lorenzi, V. (2016). Vision of interoperable health IT. Used with permission. No audio. Health IT Workforce Curriculum Version 4.0

Unit 3: Overview of Interoperable Health IT, Lecture a – Benefits of Interoperable Health IT This material was developed by Columbia University, funded by the Department of Health and Human Services, Office of the National Coordinator for Health Information Technology under Award Number 90WT0004. No audio.