Talking HealthTech: 324 – Interoperability; feasible goal or holy grail? Spring Summit 2022 Feature Episode

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Interoperability is a word that is being used with increasing frequency. The reality is we have the technology to make it happen. There is no reason why technology can’t support it. 

So, why have we failed to achieve that goal so far?

We know it’s important to the future of patient-centred care. We know it underpins the full framework, but what does the ideal experience actually look like for patient-centred clinicians? What are we actually trying to achieve? 

In this episode, we look back at the Interoperability segment from Talking HealthTech’s Spring Summit. Danielle Bancroft from Best Practice Software chaired this session with a panel of Kate Ebrill from CSIRO, Alex Duong from Monash Health and Dr Brent Barker. In this episode, they look at the potential benefits of interoperability and answer the age-old question; is it a realistic and achievable goal or just a dream?

Supporting Caregivers 

Brent recently found himself in the midst of a pandemic, supporting his mother through a complex health journey and is now supporting his father, who is independently living at home and needing care. While providing care and support for his parents, Brent has experienced many complexities over the last few years. However, there are many changes that could be made to help him and others in similar situations.

Though the technology exists for optimising interoperability, it still requires someone to take the time, interpret the information and apply it. Regardless of his clinical background, one thing that could have helped Brent’s situation is support. Having someone like a case manager, a coach or an advocate to support the family and help with coordinating services or ensuring that patient information is linked to identify what resources are available makes so much difference. 

A lack of resources is also a major issue. Knowing what resources are available and where to access those resources would provide further support for Brent and other caregivers. There needs to be better information sharing and coordination of services. Additionally, improved transparency within the community can link providers to minimise repetition and better inform patients and caregivers of available services.

Is Having Interoperable Systems and more Data a High Priority?

The key point about interoperability is that it will allow our systems to talk to each other. But we still want the data to be accessible to everyone. When a patient visits the emergency room, for example, they expect their data from the GP or their specialist to be available. They don’t realise that our systems don’t talk, and even hospitals that are using the same technology also don’t communicate with each other. 

Not having that data is quite challenging for both patients and clinicians; plus, more often than not, they have to repeat tests, which is not ideal. As such, interoperable data would be the ideal gold standard- having all the relevant patient data in one place, up-to-date, accurate, easily accessible and secure. With all their patients’ data available in one source, a clinician’s life would be much easier. For hospital practitioners, that would be in the electronic medical record. 

Even as it stands today, for a patient who had tests or appointments in a network, the clinician has to look into three or four different systems, which means logging into three or more different programmes in a time-poor situation.

How to Support Data Transfer 

Not all systems speak the same language; therefore, how do we prevent data from getting lost in transfer?

All systems need to speak the same language, so clinicians know what kind of information is being exchanged between systems. They also need to know the type of vocabulary or terminology that is used underneath that information to facilitate transfer between systems. 

The problem is that a lot of what is done digitally is what was done in the paper world. They’ve just made it digital without actually thinking about the new models of care, the new pathways and what that experience looks like in the future. There is also little consideration for how sharing the data could enable new pathways and the future of healthcare in general. 

There is also the matter of standards, which are not useful unless they are fit for purpose, supporting the workflows. Interoperability standards around data should focus on enabling the clinician to do the right thing, which should be the easiest thing. Standards should not make the work harder. 

To achieve true data interoperability, we must look at:

• that roadmap and how to actually get progressively there

• how to start thinking about those new workflows

• how to bring the consumers and clinicians into that journey and ensure that what is being done in the standard space will actually improve health outcomes and consumer experience and make it easier for clinicians to do their jobs.

Creating the Pathway to Interoperability

To achieve interoperability, one must first be clear about the actual pathways, use cases or experiences they are trying to build toward. If you are not clear on your end goal, how can you break that up to start working on accomplishing it? You must be clear about the goal so you know what blocks need to be put in place to create a roadmap that the industry can follow. 

Innovators need to look at how to support the clinicians, the workforce, the practices and the healthcare organisations with the right tools and services. The technology is there, and the standards are well on their way; therefore, what is that underlying enabling infrastructure to put that in place? 

Providing Interoperability for Caregivers

The whole system relies heavily on the patient to be an essential source of information, but by definition, they are unwell or distressed and not necessarily the best person to give their clinical history. If somehow the patient had a window on their electronic medical record, allowing them to check and keep abreast without commandeering the information, that would significantly aid with improving their understanding of the issues and have a better understanding of what’s important and what’s not. 

Are Patients Concerned About Privacy?

There are two sides to the coin of sharing patient data. Data sharing is necessary in order to provide better patient care and have a better understanding of the full picture of the patient.

On the flip side, more data sharing means more data available for misuse. 

A lot of people have opted not to have a My Health Record and not share it because of their general concerns about privacy. However, they may not realise that this means their clinicians won’t have access to their data as well. There is a profound difference when clinicians can log in and see the results of tests that patients had previously done, and while the collaboration integration between Monash Health and the MyHR is not completely interoperable, it is a start. 

Furthermore, there are patients who didn’t even know that they had opted out of the MyHR, or some of them have chosen a password to protect their data, but they don’t even know what the password is, and they were more than happy to share their data at that point in time when they needed it to be shared. 

With that being said, patients do want their data to be shared by their clinicians, but they don’t want people who shouldn’t have access to their data to have it, and since the MyHR is not regulated enough, they fear that this might happen. 

Additionally, if the message comes from the clinicians instead of the government, people might be more trusting and responsive.

Collaboration in the Health Tech Sector

If health tech companies could cooperate to design and develop better solutions together, putting the patient at the centre would ensure they benefit. One way they can support each other and ensure the right standards are being used and that it results in the right use cases is by using FHIR. 

FHIR is driven by a community approach, stemming from the heavy involvement of industry and healthcare organisations coming together to look at use cases and develop them. For that reason, one of the best ways to collaborate is to ensure that they have really strong clinician-consumer industry co-design in these specifications. Then use those community processes to start to guarantee the development of those systems that join up interoperably.

Identifying and Providing Critical Data

It’s not about recording every single piece of data but more so about being able to adequately identify what data is most important and being able to present that data at those key times around different use cases. This means looking at the information that is most important to that clinician and for each patient. 

Having just the necessary data also facilitates a very informed conversation with the consumer as well. So questions like “why is my information being used? Who’s it being shared with for what purpose?” can be answered. This approach could promote a much more privacy-positive-focused conversation without overloading clinicians with too much information. 

Let’s all figure out what is the end goal that we’re trying to work towards and then work a roadmap towards it.

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