Rob Mackay
Health and Wellbeing Leader
Seizing the moment: Putting interoperability into practice
Connected health systems underpin the long-term sustainability of our healthcare system and services, and interoperability is a key enabler. In the structural and consumer-driven shift from traditional hospital treatment to more cost effective out-of-hospital and in-home care settings, significant opportunities exist for acute care and primary care providers to automate data exchange to smooth coordination of care.
AUTHOR
ROB MACKAY
15 MINUTE READ
10 MAY, 2024
In brief:
- Exchange of data between healthcare providers delivers a raft of benefits to patients, providers, insurers, and governments. But for some stakeholders there is pain before gain.
- Calls to mandate “open” standards for health software vendors are getting louder, with a push to expand the open banking model to healthcare.
- Australia will struggle to transition to value-based models being adopted abroad, which reimburse providers for quality interventions as opposed to activity-based measures, without data interoperability standards and incentives.
- Powerful new tools are easing the interoperability journey for healthcare providers and third-party integrators (i.e Halo Connect).
Key advantages of interoperability
For Primary Care providers
- Streamlines the flow of data to and from acute healthcare providers and hospitals
- Increases visibility of data for patients, helping drive behaviour change and health outcomes
- Reduces administrative burden on GPs, allowing better patient interaction
- Increases the portability of patient data, easing administrative burdens on practices
For Hospitals
- Allows a data driven approach to preventative hospital readmissions
- Models patient journeys from different data sources to inform clinical care pathways
- Enables and enhances connected personalised care
- Increases financial sustainability via data that identifies and manages overspending
- Helps smooth the path to funding via patient outcomes rather than on an activity basis
For Private Health Insurers
- Increased availability and depth of health data drives more efficient business and commercial decisions
- Promotes efficiency and preventive care, decreasing costs to insurers
For State and Federal Governments
- Improved health outcomes for their citizens through patient data portability and accessibility
- More efficient allocation of health budgets through increased transparency and real-time data
- Ability to identify and target pinch-points in health care infrastructure
- Increased ROI on policy and research actions through quicker, more data-rich feedback loops and evaluation
- Faster and more accurate collection and interpretation of public health data enabling State and Federal agencies to answer pressing questions for both patients and providers
Few systems are more complicated than healthcare. It caters to an unending stream of patients with all manner of presentations. Infrastructure ranges from arcane to state-of-the-art. Organisations run from sole practitioner GPs and private hospitals to large health insurers and state and federal governments, each with their own perspective and remit. And ever-evolving treatments make it wickedly difficult to maintain clarity.
However, what is often lost in the crucial debate about connected health systems, is the fact that it has and will continue to deliver profound impact for patients and providers. The Royal Australian College of General Practitioners, for example, recently acknowledged the upside of interoperable clinical systems, noting that “clinical information systems (CISs) can improve individual patient and population health outcomes, enhance workflows and efficiency for clinicians, and benefit the research and evaluation of health initiatives and policy.”
”Data that can be utilised across the entire ecosystem will ultimately deliver more effective health outcomes for everyone.”
Continuity of care in a modern health landscape requires crucial health data to be securely and reliably transported between healthcare applications, regardless of whether it is a small regional single GP or a large network of privately-owned practices. Data that can be utilised across the entire ecosystem will ultimately deliver more effective health outcomes for everyone in the community.
Today, powerful horizontal infrastructure platforms that leverage open source standards such as FHIR – the Fast Healthcare Interoperability Resources standards that specify how electronic health care data can be exchanged – have been developed to solve the interoperability quandary. Despite these technological advances, there is still a lag in implementation, driven by often expensive and time-consuming investments in executing and scaling new systems, and, as noted by the RACGP, “the competing priorities of policy makers, software vendors, and end users”. This lack of interoperability creates data silos which block ready access to patient information and can compromise safety and delivery of quality care.
Problematic large-scale projects — such as the UK’s National Programme for IT (NPfIT), which failed at a cost of more than £10 billion — have also made governments nervous. This anxiety often trickles down to the grassroots of the medical profession. One in three British doctors working in general practice and hospitals say their software systems are “rarely” or “not at all” adequate, according to the British Medical Association. Three out of four cite “interoperability of systems” as a “significant barrier” to digital transformation.
So why is interoperability in healthcare such a nightmare to deliver?
First, the good news: over the last 10 years there has been broad adoption of electronic health records among health providers, professionals and health consumers. Over 90% of Australians have a My Health Record as of January 2024. People are far more comfortable moving data around an ecosystem with high-level privacy and confidentiality components. Australian government incentives to digitise analogue records has significantly increased the medical data available within public health systems. The Health Record is the brain of an interoperable health system, however the brain needs a nervous system to transmit messages between all the constituent parts.
That is where the current challenge lies. Channels to move these messages are ill defined in most of the Western world. Message formats are not standardised – FHIR is the commonly agreed format but it’s early days. In short, we need uniformity in the messages and better ways to move them around.
Who is responsible for overcoming these barriers?
There are a number of examples across the globe where private enterprise and governments have stepped in to drive the shift towards interoperability. Two large-scale examples are the CommonWell Health Alliance in the United States and the National Electronic Health Record in Singapore (see below). While differing in approach, both of the programs effectively mandate health software vendors comply with a set of interoperability standards and open up their applications to share critical health data across the ecosystem.
Recent developments in both the US and Singapore also highlight a policy shift from voluntary standards to more regulated outcomes. The RACGP noted that some jurisdictions have moved to make it illegal for software vendors to restrict health information exchange as well as calling for standards and an accreditation process for software products “ideally underpinned by a legislative framework and managed by an independent body”.
Achieving the right balance in this ‘carrot-stick’ framework will keep Australia in step with healthcare systems in other developed economies. Governments and private practice sense a similar sentiment in the Australian healthcare context which creates an opportunity to accelerate the interoperability agenda rather than just talking about it.
Interoperability plays a pivotal role in transitioning care from traditional hospital settings to more cost effective, out-of-hospital environments. Not only does interoperability facilitate a smoother coordination of care, it allows primary care providers to communicate treatment outcomes back to hospitals.
This, in turn, can help future-proof Australian hospitals, insurers and primary care organisations should healthcare funding shift, as it has overseas, towards a value-based model which reimburses providers for delivering quality care and interventions as opposed to activity-based measures.
How Mantel Group can help
As commercial, medical, and regulatory drivers converge, investing in interoperability has become a compelling strategic differentiator for Australian healthcare operators. The Australian Digital Health Agency (ADHA), through the National Healthcare Interoperability Plan 2023-2028, has set some good direction for what is needed to evolve to a more connected Australian healthcare system. The recently established Australian FHIR Coordination Committee has also been established to oversee the integrity and transparency of the development and implementation of FHIR standards in Australia.
Halo Connect – the healthcare interoperability platform
While these are positive Government-led steps, industry has been hard at work taking this guidance and direction and translating that into practical and accessible solutions for providers to consume today. Mantel Group, through its ventures business, is an investor and co-creator of Halo Connect, a leading cloud-based API that plugs into on-premise and cloud-based practice management systems, facilitating the crucial exchange of patient data among healthcare providers and third party integrators. Our partnership with Halo Connect has given us a deep understanding of health data exchange, including FHIR based engineering.
Coupled with our team’s extensive experience and understanding of the healthcare ecosystem, we offer bespoke support and customisation for healthcare clients in their journey towards interoperability. We know what works because we’ve not only supported the design, development and launch of Halo Connect, we’ve also interacted with pretty much every healthcare application available in Australia and New Zealand.
Our partnership with Halo Connect can help healthcare providers stop talking about interoperability as the core pillar for a more connected Australian healthcare system and start taking practical steps towards actually executing on this vision.
Platforms such as HALO Connect can promote efficiency and preventive care, offering clear commercial value to clients.
For health insurers, interoperability can help reduce the frequency of expensive hospital visits, lowering costs to providers.
These reductions are balanced against the necessary investment in technology and support systems.
How global organisations are embracing interoperability
When a small group of competing health technology companies said out loud in 2013 that they were forming an alliance because “working together was the way towards better interoperability for the United States”, the reaction from the health conference’s audience was one of shock. But a decade later, the CommonWell Health Alliance has proved a resounding success. Today, the network includes 70 member companies in every US state, representing 34,000 provider sites with 226 million individuals and over 3.5 billion patient documents thanks to mandated technology platforms that enable sharing of health information between the Alliance’s members.
The Alliance was recently designated one of the US Government’s Qualified Health Information Networks, making it a founding member of the Trusted Exchange Framework and Common Agreement, also known as TEFCA. A voluntary scheme, TEFCA is the US Government’s policy of encouraging common standards for the nationwide exchange of electronic health information. Over time, the Government hopes to link up the QHINs, forming an interoperable network of providers across the country.
TEFCA will not only give patients a secure, streamlined overview of their healthcare data, the access providers have to test results, images and diagnostics will, according to the American Health Information Management Association, reduce the need for redundant tests, enhance patient convenience and lower costs, while helping facilitate the provision of care across the health ecosystem.
For more than 15 years, Singapore’s Integrated Health Information Systems (IHIS), an internal Ministry of Health agency, has been tasked with improving the flow of health data throughout Singapore’s public and private healthcare systems. One key initiative, the National Electronic Health Record (NHER), was launched in 2011, creating a single national portal for a patient’s health data. It set out “data requirements for contribution to the NEHR, with backend system-to-system integration of the source IT systems”.
While the NHER is mandatory for public providers, broader uptake has been stymied by voluntary sign up for private health providers. After dangling the carrot, the Singapore Government is now proposing to wield the stick. In late 2023, it proposed a Health Information Bill that mandates all private providers integrate their health data into the national system. Responses to the bill are currently being considered.
Interoperability sits at the heart of the IHIS’ recent rebrand to Synapxe and five strategic priorities: (i) national repository for patients’ medical records; (ii) system for remote healthcare; (iii) national billing system; (iv) strong cyber and data security; and (v) looking into the future and exploring possibilities, such as generative artificial intelligence. As in all jurisdictions, data security remains a high priority, especially in light of a large data breach in June-July 2018 by a suspected state-sponsored hacker group in which over 1.5 patient million records were stolen.
How interoperability works for you
Interoperability has the potential to deliver significant benefits to all parts of the healthcare ecosystem. Here’s what’s possible for patients, providers, insurers and Governments when you achieve interoperability:
Improved Patients Outcomes
With connected systems, healthcare providers will have access to more of a patient’s data in one place. This means:
- Less risk of missing something important that may have been updated in one system but not in another
- Potentially better diagnoses and treatments
- Less time on manually updating data and more time on patient interactions
- Fewer opportunities for fatigue and repetition-related clerical errors
- Reduced likelihood of missing significant symptoms and important information
Positive Patient Experiences
More time and higher levels of interaction with clinicians can go a long way to boosting a patient’s perception of the quality of care being delivered by healthcare providers. If a clinician has more time to converse with patients and their broader care team, explaining diagnoses, treatment options and procedure details, patient confidence is likely to be higher and their adherence to their overall care plan is likely to be elevated.
In addition to greater access to clinicians, interoperability also opens the door for patients to access and interact with their own health records and communicate with providers more easily. This facilitates more of a balance of power in the clinician-patient relationship and enables the emergence of patient-led and peer-to-peer healthcare.
Better Population Health
Interoperability encourages faster and more accurate collection and interpretation of public health data. This can help organisations answer pressing questions for both patients and providers, and support public health leaders to identify health trends and emerging patterns on a population level.
Increased Efficiency
Healthcare providers willingly spend countless hours poring over patient documents in the interest of providing high-quality care. But the inefficiency of these manual efforts can weigh heavily on workers and lead to fatigue, errors, and low job satisfaction.
Combining all systems into one convenient interface — especially if the system is then automated from that point — cuts down on the massive amount of paperwork usually required to deliver high quality care. This means healthcare providers won’t have to waste time entering data manually, copying information from one system to another, double-checking to make sure all systems contain the most recent updates, or performing other tedious tasks.
Increased Financial Sustainability
Because interoperability leads to such huge improvements in efficiency, it can directly and indirectly save healthcare providers a significant amount of money. Simply reducing the administrative burden on clinical and non-clinical staff can result in potentially huge savings.
In addition, interoperability has the potential to prevent clinical errors that arise from incongruence between separate programs, which potentially reduces malpractice risk and costs and the need for duplicate testing or repeat procedures.
