Healthcare interoperability: Myth or reality?

The healthcare system needs to make patients empowered, knowledgeable, and confident to manage their health and participate in shared decision-making. Since patients reside at the center of healthcare activity, health services need to focus on the outcomes that matter to members/patients. Under this scenario, interoperability plays an integral role in:

Providing information when and where required
Reducing waste by cutting out repeated work
Accelerating accurate decision-making
Improving safety with fewer errors

With the industry adopting digital transformation, meaningful interoperability is required. Meaningful interoperability involves communication and processes–communication between systems, how receiving systems process data, and how all that data is made available for human use. Meaningful interoperability paves the path for data interoperability in healthcare which has tremendous potential to fulfill patients’ needs. It can define and maintain wellness for healthy individuals while also addressing the needs of patients with complex chronic conditions. The growth is mainly driven by the increasing need to control:

Rising healthcare costs
Deteriorating patient care and safety
Lack of agility in the care delivery model
Lack of funding for healthcare interoperability

According to Markets and Markets research, the global healthcare interoperability solutions market is projected to reach USD 4.2 billion by 2024 from USD 2.3 billion in 2019, at a CAGR of 12.6%.

Understanding the challenges in the healthcare interoperability

It is not uncommon to find stringent federal regulations across diverse industry segments. Healthcare business outcomes are the effect of heterogeneous technology transformation and disparate regulations. The problem with healthcare standards is the lack of incentivization. An alternative view is that the standards available have been overly complex and expensive to implement and maintain. This view has led to the development of Fast Healthcare Interoperability Resources (FHIR).

As complete patient data becomes untraceable for the payers and providers, they cannot make informed healthcare decisions. The asymmetrical patient data impacts the customer experience, requiring payers to have a comprehensive solution that promotes claims and clinical data interoperability in a cost-effective and timely manner. When members and providers dispute the organization’s determination, they need a solution that redresses the member request with transparency, detailed explanation, and compliance.

Interoperability will continue to spark innovation

The global healthcare industry faces significant contradictions like rising costs. The shift to value-based care addresses this challenge by redefining success with healthcare outcomes. In this scenario, FHIR empowers organizations to collaborate, foster innovation, and help co-create solutions to assist patients accessing their longitudinal records. The record compiles payers' and provider-generated health, wellness, financial, and social data.

FHIR, an organized concept of “resources,” defines the many types of resources that describe the healthcare space. It is an open license and a formal maturity process linked to implementation outcomes. Consisting of two main parts – content model (resources) and exchange specification— it contains both normative and standard for trial use (STU) resources.

FHIR makes it easy for implementers by using already familiar tools and an understandable format with an API style. From the interoperability perspective, it is a fixed set of resources offering several advantages such as standardization of APIs, content, and communication protocols like XML, JSON, REST, and OAuth.Payers, providers, and HealthTechs pioneers in Open APIs can provide patient records, support electronic data exchange for care transitions, and enable the integration of patients’ claims, clinical, pharmacy, financial, and social data. Open APIs powered by API marketplace offer payers and providers a powerful mechanism by which they can:

Add new revenue streams
Offer value-added services
Form partnerships with the HealthTechs, pharmaceutical, and medical device companies

FHIR interoperability drives a seamless care journey for members who choose the right plan. It gives them the abilities such as being able to view digital ID cards and find the nearest in-network care provider for a specialized disease. Therefore, to enable seamless data sharing and service through an online marketplace via APIs, healthcare organizations need to make significant changes to their information infrastructures. While the online API and solution marketplace will be paramount for healthcare innovation, information security will be at the platform’s heart. Payers, providers, life sciences, and medical device companies should ensure significant risk and quality-control mechanisms to enable secure transmission consumption of data. Consent management will be an essential consideration, along with data privacy frameworks, such as the General Data Protection Regulation (GDPR), to ensure that individuals have given consent for third-party providers and HealthTechs to access and use their data.

Once data interoperability becomes the new normal, the next big step should be to take an AI-first approach and leverage Machine Learning (ML) and Natural Language Processing (NLP) to build actionable insights to guide business priorities and ensure the quality of care. Predictive data analytics will lead to more robust patient risk identification and clinical pathway development.

Concept of an Open Innovation Platform in Healthcare

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