As hospice and palliative care providers turn more towards telehealth and remote patient monitoring during the COVID-19 pandemic, a rising number are directing their attention towards the question of interoperability: How can the multiple electronics systems communicate with each other and interface with the providers electronic medical records system?
A step beyond linking their own systems, many hospices are seeking opportunities to allow their systems to interface with those of their referral partners.
“We can use interoperability to get technology systems to speak to one another on behalf of the patient. We’re not just exchanging documents. We’re actually able to exchange discrete data and use the information that has been exchanged,” Nick Knowlton, vice president of business development for Brightree, said in Home Health Care News/Hospice News webinar. “When we think about setting up these telehealth and remote patient monitoring programs in a COVID world, speed really matters. You don’t have to wait to custom design something to take care of your patient population. You need to be able to move forward, and modern scalable architectures play a big role in that.”
Hospices may find other financial and regulatory incentives to pursue improved interoperability. Government stakeholders such as the U.S. Centers for Medicare & Medicaid Services (CMS) and the Office of the National Coordinator for Health Information (ONC) have been working to promote interoperability.
Existing and forthcoming value-based payment models from CMS increasingly require participating providers to use certified EHR systems. Additionally, as post-acute care moves closer to value-based payment models, improving efficiency will be a priority for many hospices.
“When you think about the type of systems that you need to put in place so that a remote patient monitoring program can speak with a core [electronic health record (EHR)] and your agency, it’s really important to know that interoperability isn’t just about the technology specifications, it’s also about patient consent,” Knowlton said. “It’s about security, it’s about privacy. It’s about managing patient identity in the light during the COVID world, the technology and architectures and the specifications being used. The actual interfaces become very important.”
Nearly 60% of clinicians and organizations that refer patients to hospice would put increased electronic health record (EHR) interoperability on their wish list —particularly the hospice’s ability to receive referrals electronically, according to a 2019 report from Brightree.
Definitions of interoperability can vary. For the survey, the term “interoperability” referred to the ability of different IT systems and software applications to communicate, exchange data and use the information that has been exchanged.
About 675 home health and hospices providers as well as 440 referral sources responded to a Brightree-sponsored survey conducted by Porter Research. Among the respondents, 70% of hospice and home health providers said they had seen an increase in the number of referring organizations requesting to send referrals electronically during the past two years.
More than 60% of surveyed referral sources indicated that they would be willing to switch to a different post-acute care provider if that organization were able to accept electronic referrals, though only 4% of hospice and home health companies said they were prepared to accept referrals from an interoperable EHR system.
“A lot of organizations have created some very innovative programs that really help their organization achieve quadruple aims: improving their outcomes, improving the efficiency of their staff, serving as many patients as possible, and improving patient satisfaction,” said Nolan Santosa, vice president for client success at Health Recovery Solutions, in the webinar. “Telehealth is one half of the coin. The other half is how do we create that interoperability where organizations can be efficient and deliver those high quality outcomes.”
Two final rules released earlier by the U.S. Department of Health and Human Services (HHS) are designed to improve information technology interoperability among health care providers, including hospices, as well as provide patients with greater access to their own health data. The two regulations will be administered by the ONC and CMS.
The agencies developed the rules pursuant to provisions of the 21st Century Cures Act, passed by Congress in 2016. These rules require public and private organizations to share health information between patients and other parties while ensuring the privacy and security of those data.
Among other provisions, the ONC final rule establishes new rules to prevent information blocking by health care providers, developers of certified health IT, health information exchanges, and health information networks as required by the Cures Act. Currently, many EHR contracts contain provisions that either prevent users from sharing information related to the EHRs in use, such as screen shots or video.
The ONC final rule updates certification requirements for health IT developers and establishes new provisions to ensure that providers using certified health IT have the ability to communicate about health IT usability, user experience, interoperability, and security including (with limitations) screenshots and video.
The CMS Interoperability and Patient Access final rule requires health plans in Medicare Advantage, Medicaid, CHIP, and through the federal exchanges to share claims data electronically with patients.
“The importance of interoperability is huge — the ability for vital signs to be viewable within the EMR, the ability for clinical documentation to be viewable within the EMR, the ability to have a seamless and quick enrollment process between those two systems,” Santosa said. “Those [systems] have to be talking to each other for this program to work quickly and at scale.”