Facts and Fallacies about Interoperability for Long-term Care

By Billy Waldrop, MBA, VorroHealth

Health IT interoperability is becoming increasingly important as a result of new government incentives as well as competitive pressures.
The Protecting Access to Medicare Act of 2014 includes a provision for a new Centers for Medicare and Medicaid Services (CMS) reimbursement plan that could provide a bonus payment beginning in October 2018 to skilled nursing facilities with reduced hospital readmissions. Increasing interoperability between hospitals and long-term care (LTC) will definitely help secure those additional payments as well as improve reimbursement overall.
Competitive pressures come from hospitals that are focused on reducing their readmission rates in order to avoid financial penalties from the Centers for Medicare and Medicaid Services (CMS). They are more likely to refer patients to LTCs that can help them accomplish that goal, and the ability to exchange data discretely between hospitals and LTCs definitely helps.
The roadmap proposal released in early February by the Office of the National Coordinator for Health IT (ONC) takes a harder look at what interoperability means — including specific parameters by which providers and EHR vendors will be measured.
But what, exactly, is interoperability? HIMSS defines it as “…the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged. Data exchange schema and standards should permit data to be shared across clinicians, lab, hospital, pharmacy, and patient regardless of the application or application vendor.”
Still, there seems to be a lot of uncertainty about interoperability within the LTC community, and getting it wrong means missed opportunities. To help you make better decisions, following are some of the fallacies (and facts) around interoperability.
Fallacy: Achieving interoperability is too difficult or expensive for LTCs.
Fact: This fallacy has been perpetuated primarily by the electronic health records (EHR) vendors that offer expensive systems not designed specifically for long-term care. While there is a cost associated with interoperability, that cost is generally outweighed by the value of being able to see more information about a resident’s care throughout the continuum in order to create better outcomes. For example, if a physician in the emergency department can see in the EHR that an LTC resident has been on a particular physical therapy regimen, that information is invaluable in guiding treatment. As healthcare reform continues and initiatives such as bundled payments and accountable care organizations grow, the reality is it will be too costly for LTCs not to have some form of interoperability. With the pressures they are facing, providers will only want to work with LTCs who can deliver the information they need directly to their EHRs.
Fallacy: You need an EHR to achieve interoperability.
Fact: While having an EHR does simplify matters it is not a necessity. As you know, in order to be reimbursed by CMS an LTC must submit the Minimum Data Set (MDS) and a home health agency must submit the Outcome and Assessment Information Set (OASIS) electronically. This same data can be transformed into a Continuity of Care Document (CCD) that can be easily integrated into an EHR or health information exchange (HIE). While the CCD may not contain the complete health record, it does give physicians and nurses the most critical information about the resident’s prior care.
Fallacy: There are no standards for interoperability.
Fact: Many LTPACs often use a perceived lack of standards as an excuse for not working toward interoperability. But the reality is standards do exist today. As we have seen, MDS and OASIS provide ready-made standards that LTPACs are already using; it is a small leap to convert that information into CCDs, especially with readily accessible and cost-effective tools such as KeyHIE Transform, which was developed through the Keystone Beacon Community. CCDs themselves have become a de facto standard for data exchange when no EHR is available.
Fallacy: Exchanging PDFs, lab results or other documents between providers is interoperability.
Fact: Actually, that is merely file sharing. Not only does the data have to be available to clinicians (i.e., stored in the system somewhere) it also has to be consumable. Look again at the HIMSS definition – clinicians have to be able to use the data that has been exchanged. Which means the hospital must be able to access the data on a discrete level and integrate it into the EHR. It must be transactional, meaning a lab result must be viewable as a lab result rather than as part of a larger document, or have the capability to be fed into and used in an analytics application. Essentially, the data should look the same in both the LTPAC’s and hospital’s or physician’s system.
Fallacy: Direct messaging is interoperability.
Fact: Secure direct messaging between providers is valuable in certain instances, such as patient transfers between care settings, because it allows providers on one end to email or otherwise send information to clinicians on the other end. It also helps hospitals and physicians attest to Meaningful Use Stage 2 and Stage 3. But again, unless that information can be consumed and shared discretely the messages are not interoperable. They are merely sharing files.
Fallacy: Giving hospital physicians log-in privileges to the LTPAC’s system is interoperability.
Fact: This is how some LTPACs attempt to check the interoperability box. But if physicians have to log in to a completely different system to obtain the information they need it may be better than nothing – but it is not interoperability. If the data is not in the physician’s own EHR it is simply another form of file sharing.
While it may not have seemed urgent 12 months ago, true interoperability is becoming increasingly important to LTPACs as healthcare reform continues to accelerate. Which makes the ability to discern fact vs. fallacy more critical than ever.
Interoperability is where the industry is headed. How are you planning to get there?

About the author
Billy Waldrop, MBA, is the Vice President of Operations for VorroHealth. Billy specializes in managing and developing complex healthcare systems. He spent nearly 10 years at the Mayo Clinic where he directed teams responsible for the development of critical Patient Financial Services systems. He was also responsible for the design and implementation of a Citrix deployment to enable the delivery of Mayo Clinic’s Electronic Medical Records applications. He can be reached at bwaldrop@vorrohealth.com.