Medical and Social Data Interoperability in Community Care Coordination

January 2, 2020

After decades of intent, discussion, debate, analysis, and resistance, CMS is moving ahead with healthcare data interoperability standards in several federal healthcare programs. Providers participating in the Medicare Advantage, Medicaid, and Children’s Health Insurance Program, as well as the and Affordable Care Act, will most likely have until next year – 2020 – to get up to speed with new information-sharing standards.

Earlier this year, a proposal outlining the rule change was published by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC). The intent is to improve the ability to share electronic medical information among different providers, caregivers, and patients. Interoperability has long been an elusive goal in healthcare. Current information sharing standards still heavily rely on patients carrying their medical records from provider to provider, including social service providers.

“Health data standardization is not so unlike trying to achieve world peace,” said Dr. Shaun Grannis, director of the Regenstrief Institute’s Center for Biomedical Informatics in a 2018 interview with Modern Healthcare. “Everyone wants it, but no one is sure how to get there.”

Change is clearly on the agenda, however. A recent Deloitte industry survey of 70 healthcare leaders in health systems and insurance plans more than half of the combined group plan to use the stated compliance requirements as part of their broader interoperability strategy. And more than half said they plan to go beyond the standards being offered through current vendor solutions.

Social Agencies Will Realize SDoH Benefit in a Data Platform

So, what does this emerging CMS mandate mean for social agencies? Social service providers are keenly focused on Social Determinates of Health (SDoH). After all, only 20 percent of health outcomes are directly related to clinical care. The remaining 80 percent is determined by non-clinical factors influenced by geography and socio-economic conditions.

It takes a longitudinal view of all aspects of a patients’ life to organize and provide whole-person care. It is critical to deploy analytical tools to use medical and social data to achieve interoperability and patient matching. By tracking a common patient identifier using medical and social management data, better outcomes and lower readmission can be realized. This, of course, reduces costs and achieve better patient satisfaction.

For example, a 2017 report titled Beyond the Boundaries of Health Care: Addressing Social Issues cites programs in New York, Washington, Colorado, California, and Connecticut, among other states, have used State Innovation Model (SIM) grants to focus attention on addressing data-driven SDOH outcomes. The SIM demonstrations provide links across different types and settings of care and incorporate concepts relevant to addressing SDOH, including housing, employment, and food security. The report also cited the University of Pittsburgh Medical Center (UPMC) innovative program to address housing needs where participants gained an annual health savings of $6,384.

Feds Moving Forward with Interoperability Standards

ONC is moving forward with developing the technical standards for new interoperability standards. This month, ONC announced it had tapped The Sequoia Project, a healthcare interoperability nonprofit to help the agency implement components of an interoperability framework. CMS, which has closed its comment period for the adoption of interoperability, also published a wide range of specific standards, ranging from technical certification to patient and provider standards.

These recent and rising efforts by CMS are intended to overcome longstanding barriers to medical and social interoperability. According to an ONC report earlier this year, these include

Technical barriers.“These limit interoperability through – for example – a lack of standards development, data quality, and patient and healthcare provider data matching.”
Financial barriers. “These relate to the costs of developing, implementing, and optimizing health IT to meet frequently changing requirements of healthcare programs.” This includes a lack of incentives for sharing information and the need for business models for secondary uses of data.
Trust barriers. “Legal and business incentives to keep data from moving present challenges. Health information networks and their participants often treat individuals’ electronic health information as an asset that can be restricted to obtain or maintain a competitive advantage.”
Administrative requirements.“Federal documentation and administrative requirements (including billing requirements) contribute to health IT burden due to outdated guidelines for evaluation and management codes that unnecessarily link payment to documentation.”
Reporting requirements.“Federal reporting requirements in some cases add burden to healthcare providers by requiring them to report on quality measures that are not relevant or meaningful.”
IT usability. “Health IT system design and usability barriers identified by stakeholders include … variations in the design [of user-interfaces] that make day-to-day use complicated when a healthcare provider uses multiple systems and the lack of developer engagement with end-users of health IT regarding design needs.”

Social Services and Medical Providers Will Benefit from Data Interoperability

There is a growing awareness that SDoH and whole-person care are linked at the hip in the social services and medical sectors. Data interoperability is emerging as the common language to reduce costs and improve outcomes.

“We’ll still focus on helping people when they’re in a car accident, have a heart attack, or get cancer,” said Marc Harrison, MD, CEO, Intermountain Healthcare, a 24-hospital system in Utah. “But we have the opportunity to do that in conjunction with a ‘keep people well’ system…won’t it be terrific if we can actually keep people out of (the hospital)? And have them stay as close to home as possible in the least restrictive environment?”