Interoperability has long been a goal of the healthcare industry. Policymakers, IT professionals, and entrepreneurs have been working to make it a reality since the 1980s; from HIEs in the ‘90s to EMRs and federal legislation in the 2000s, the industry has taken strides, but the data-sharing puzzle has yet to be fully solved with seamless and responsive data exchanges.
But the healthcare IT environment looks different these days: We have now reached a critical mass of digitized processes and data sets along with established standards for data management—a situation primed to enable interoperability on a previously unattainable scale.
Looking ahead even just a few years from this vantage point, we see patients being empowered to take greater control over their healthcare information and choose care options that work for them, all enabled by an app economy that drives innovation across the ecosystem. The ONC Cures Act Final Rule published on May 1, 2020, represents a mighty step toward making that picture a reality.
Clearly, though, there is still substantial work to be done. A host of criteria must be met, beginning in late 2020 and then in mid-2021 with the requirement for having HL7 FHIR-based API capabilities in place for patient access and provider directory connectivity, and finally extending into early 2022 with due dates for payer-to-payer data exchange and the increased frequency of Federal-State data exchanges. Health payer organizations cannot afford to delay in moving to meet this changing healthcare IT landscape.
As preparations continue, we see three critical areas that organizations should focus on in order to not only meet CMS’s deadlines but also take advantage of the opportunities that these requirements present.
Interoperability is not simply an IT impact. Traditional payer focus areas—clinical, operational, service, product design, etc.—will be affected by new interoperability standards and will be called upon to provide greater levels of transparency into their underlying data. These standards will also accelerate partnerships across health payer and health system boundaries as organizations look to establish integrated processes designed to deliver personalized care plans and reduce administrative burdens and costs.
Access to timely and accurate data is the key to maximizing the benefits of interoperability at any scale. Health payers must define an operating model that breaks down traditional silos and sector boundaries through a user-centered approach that supports an end-to-end view of the organization and holistic view of impacted users. Such an approach will foster collaboration both across the enterprise and ecosystem.
The success of that user-centered approach will be determined by the quality of the experiences created for those users. Since there are multiple users in the interoperability equation—providers, members, claims administrators at other payer organizations, various care delivery professionals, and so on—it is critical to identify how each user group will access and interact with the data that’s made available, understand what their needs are, and design user experiences accordingly.
Knowing that these interactions and needs do not exist in a vacuum, the user experience design should reflect the operating model and end-to-end view we discussed in the previous section. This further underscores the need for collaboration—health payers and health systems must work together to develop personas and journey maps that define the user touchpoints needed to create seamless, holistic experiences.
It’s no secret that custom data models and legacy core applications plague the industry, resulting in a brittle and fragile integration environment at large. As interoperability standards are rolled out in the coming years, enabling adaptable integration patterns through a strong technology strategy will be a core competency that is vital to the growth and success of both health payer and provider organizations.
Cloud-based technologies such as Mulesoft, Redox, and Kafka have changed the approach to tech strategy by bringing previously unattainable scalability right out of the box. While there has yet to be a wholesale, industry-wide migration to the cloud, these technologies, in coordination with core processing adjustments, can present tremendous opportunities to seize competitive advantage in the interoperability landscape.
Whatever particular solutions are explored, a well-defined, outcome-focused architecture strategy and road map will be needed to guide an organization’s investments and migrations during this transition. Uncoordinated, nearsighted tech strategies, on the other hand, will increase both the complexity and costs of integration, limiting the organization’s ability to respond to evolving market conditions and demonstrate (and maintain) compliance.
The road to interoperability has been a long one, but it appears the industry is on the cusp of making significant progress—especially if the opportunities presented by the current technology landscape and upcoming interoperability standards are seized.
A health payer organization’s technology road map must be built into a reimagined operating model that is organized around user experience.
Integrating these three critical areas—operating model, user experience, and tech strategy—in this way will be vital to enabling adoption, meeting the Cures Act’s interoperability standards, and setting the stage for long-term success.