Healthcare Interoperability Can’t Wait For Another Pandemic
Joerg Schwarz

During the height of the lockdown in 2020 many hospitals were overwhelmed with the care for critically ill COVID patients and ran out of supplies, from ventilator equipment to PPE. County, State, and Federal public health authorities required weekly reports on supply levels to gauge over- and undersupplies and steer inventory according to actual and projected demand. Creating these reports was an additional administrative burden for stressed providers and highlighted a lack of transparency in hospital supplies. The disconnect between clinical and administrative systems created even more upheaval.  It’s critical that industry professionals understand the importance of linking clinical data, supply chain and financial systems together, not only to mitigate the type of disruption we saw in 2020 but also to ensure a seamless exchange of data when and where providers need it the most.

Unfortunately, many in the healthcare industry don’t have a system in place to provide necessary data integration. In a recent survey nearly one out of five of respondents stated data integration between ERPs and EHRs isn’t necessary and nearly one third of respondents disclosed they are looking for a solution.  Considering the lack of data integration brought unprecedented focus on supply chain issues and provider burnout, it’s surprising professionals had this lukewarm response to the question of data integration, especially two years into the COVID pandemic.

One of the basic functions of linking data from the EMR (Electronic Medical Record) and ERP (Enterprise Resource Planning) is to avoid provider burden and error proneness of dual data entry. Instead of documenting supplies required for care delivery in the EMR (for care documentation and billing) and in the ERP (for supply replenishment), linked systems can automatically determine supply depletion based on the clinical documentation. Furthermore, based on preference cards linked to providers and procedures, supply utilization can be predicted based on scheduled procedures and hospital admissions. This allows proactive planning and ordering – which is essential not only during the pandemic, but also post-pandemic to avoid waste on one side and supply shortages on the other.

Another important aspect of linking financial- and HR- systems with clinical systems is determining the exact cost of care delivery for specific patients or service lines. Today, many hospitals have a hard time determining their actual costs because costs are usually assessed by cost center, not by service line. In the past, knowing the exact costs by service line was not critical, because each hospital could determine their pricing independently.  With the shift towards value-based care and price transparency, however, it will become more and more important for hospital leadership to understand what their exact costs are, so they can contract for bundled payments knowing their margins. Knowing the exact costs versus industry benchmarks also helps an organization to identify wasteful practices, identify areas of improvement, and streamline their supply chain – cost reduction and eliminating waste is after all the fastest way to improve the bottom line, which has never been more important than during the pandemic, when many margin-rich elective procedures had to be postponed.

But the need for improved interoperability goes well beyond linking clinical systems and administrative systems. Many organizations discovered during the pandemic that they must modernize their patient interactions. A majority of CIOs are considering a Digital Front Door strategy, and most of them understand that a digital front door strategy requires multiple custom integrations; only a small group of Healthcare IT professionals and analysts believe a Digital Front Door can be handled by either of the EHR Megasuites alone. The Patient Portal of the Meaningful Use era, which mainly provided access to medical records, shouldn’t be confused with a Digital Front Door, which allows much more active patient engagement than the portals of old. The most requested features of a Digital Front Door strategy are online appointment scheduling and tele-consultations, which requires providing a common front end to scheduling procedures, not only in the main EMR, but also in ancillary systems such as labs, radiology, vaccination clinics, etc. Tele Visits must not only be scheduled, they also must be documented, for example by recording and transcribing the interaction utilizing modern AI based cloud services. Both the clinical documentation and billing require modern interoperability to yield optimal results without increasing provider burden and burnout.

While healthcare interoperability has long been stuck in standards originally developed in the early 1990s, in recent years HL7 FHIR, a modern interoperability standard based on web services, has gained momentum. HL7 FHIR is much better suited for web-based data exchange in a world of APIs and data analytics. A lot of interoperability innovation that allows better patient engagement, such as the Digital Front Door concept, relies on orchestrated API workflows with the highest levels of data protection and security. Appointment scheduling across multiple applications, for example, can be orchestrated by exposing available resources through an API, allowing a patient to find suitable appointment options without the need for a call (thus lightening the load on call centers). However, since most transactions are currently (and in the foreseeable future) still occurring in HL7 v2, it is necessary to bridge between the old world of HL7 v2 and the new API enabled world of HL7 FHIR with a real time translation layer. Only about a fourth of healthcare organizations have this translation layer already in place, whereas many provider organizations are looking for a solution – which are readily available in the market.

It took a pandemic to remind many health care executives of the strategic importance of interoperability – be that for the sake of connecting clinical data with the ERP to prevent dual data entry or supply shortages, accurate cost attribution, or be that for modern patient engagement with an interactive Digital Front Door strategy. It is now time to act on this wake-up call to prepare for the next wave of the COVID pandemic, the next pandemic, and the transformation of healthcare business models.

Joerg Schwarz is Director of Strategy and Solutions for Healthcare Interoperability at Infor