The ability to easily send and receive data can be critical to advancing the fight against COVID-19. The second strategic action of the HIMSS COVID-19 Global Policy Call to Action Report highlights this issue by addressing the need for policy promoting data sharing and interoperability within the health field. Interoperability is the key to improving various facets of the healthcare spectrum.
Patient care can be improved in clinical settings by connecting patients with multiple practitioners. While in medical research, collaboration can expedite the understanding and response to the studied material. As underscored by the following examples, research and clinical improvements are just some of the benefits from policies promoting interoperability.
Two divisions of the Department of Health and Human Services (HHS)—CMS and the Office of the National Coordinator of Health Information Technology (ONC)—released regulations regarding the advancement of healthcare interoperability in the United States. As problems with this type of collaboration are diverse, these “final rules” aimed to target the issue from various angles. The purpose of the CMS rules is to increase data sharing between health providers by requiring those participating in Medicare and Medicaid to share the data of a particular patient with each other in the event they interact with multiple providers. Doing so allows a provider to have a clearer picture of a patient’s history, translating to better service and care.
Another facet of the CMS rule increases the frequency by which providers must send data of enrollees of both Medicare and Medicaid to CMS from a monthly to a daily basis. Continual data sharing allows CMS to maintain better up-to-date information, granting the opportunity to provide appropriate care to enrollees for their respective conditions. Furthermore, it may reduce the administrative costs associated with billing.
Typically, when one thinks of healthcare interoperability, they consider the data sharing potential only between healthcare facilities and organizations. However, it is important to remember that patients are also a member of the healthcare ecosystem and therefore deserve the right to participate in data sharing. The ONC rules empower patients by reducing impediments to their ability to access and share their data, primarily through the strengthening of APIs. APIs are computer applications used to transfer data between different sources.
The ONC rule sets security and administrative standards for health IT developers who want their API product to be featured in the healthcare ecosystem. Beyond ensuring the privacy of transferred data, APIs must maintain a level of transparency so that the user interface is more accessible. API developers also face restrictions on the fees they can charge for their product. Together, these aspects of the ONC rule promote greater access to technologies promoting interoperability while keeping them relatively inexpensive for providers and patients to use.
Along with the regulation of APIs, the ONC rule also addresses the act of information blocking, where information is made inaccessible to certain parties. The rule sets provisions against information blocking, though it does provide some exceptions.
While not directly released as a response to the pandemic, the CMS and ONC legislations are vital to the public health offensive response to the virus. Overall, their implementation allows health-related data to be easily shared between healthcare organizations, hospitals and government agencies. Data sharing is necessary to form a clear picture of the movement of COVID-19 throughout the country. Moreover, the relationships made between organizations can lead to a strong collective attack on the virus.
Beyond the federal government, legislation at the U.S. state level has highlighted the importance of healthcare interoperability during the pandemic. Indiana Governor Holcomb signed Executive Order 20-27, allowing governmental COVID-19 data from the Indiana Network for Patient Care Database to be shared with the Indiana Health Information Exchange (IHIE), the largest inter-organization health information exchange repository in the United States. As a repository it acts as a center of interoperability in the Indiana health field, connecting patients, physicians, and providers through ease of data sharing.
The flexibility granted by Executive Order 20-27 allowed IHIE and the Indiana State Department of Health to work in concert to construct two COVID-19 dashboards—a private dashboard intended for public health agencies who required detailed information, and a public dashboard that displays border metrics. Centralizing data this way proved vital to Indiana as they helped quickly recognize outbreaks of the virus in various counties. Such a response would not be possible if health data was not readily shared between hospitals, IHIE and government organizations.
The importance of healthcare interoperability during the pandemic has been recognized internationally. New Zealand in particular has received wide admiration for their swift response to the COVID-19 virus within their borders. The New Zealand Ministry of Health published an Interoperability Roadmap that outlined the acceleration of the advancement of healthcare connectivity within the nation as a partial response to COVID-19.
The goals listed in their roadmap mirror the objectives of the ONC and CMS rules. For instance, in order to ease inter-organizational connectivity, they aim to leave closed-loop networks in lieu of secure APIs and maintain a standardized means of communication. Furthermore, they intend to maintain a standard for all participating APIs that promotes the unblocking of information, benefiting both healthcare organizations and patients.
Another instance of international interoperability is seen in the European Union. The European Commission released their ERAvsCORONA Action Plan, a document listing 10 short-term goals concerning research development in the fight against the pandemic. Though each goal was distinct in its own respect, together the document reflected a desire to expedite progress through international collaboration.
Their ninth goal specifically called for a platform to easily allow research data sharing between organizations, manifesting as the European COVID-19 Data Portal. This collaboration between the European Commission, the European Bioinformatics Institute, and member states of the European Union, among others, resulted in the development of a cloud-based platform which allowed for the simple and secure collection and sharing of data sets pertaining to a spectrum of studies related to the virus, ranging from pre-clinical studies and clinical trials to epidemiological research.
The data portal proved to be an extremely successful project; over the past year, the portal boasts 4.4 million web requests, 180,000 users, and 1.5 million accessed records. The European data portal has also inspired the development of data platforms in Japan, Spain, and Turkey, to name a few. As such, the project has been successful in its mission of connecting international researchers and their work.
HIMSS calls on government, businesses, civil society leaders and elected officials to recognize the important role and value of health information and technology during a health emergency and to work across industries to leverage sound health data, tools of informatics and innovative solutions outlined in our Global Policy Call to Action.