|7 Sep 2022|
A future vision of interoperability in healthcare delivery
By Todd Haebich, General Manager Altera Digital Health Australia and New Zealand
A recent trip to the United States afforded me the opportunity to interact with some of Altera Digital Health’s futurists and thought leaders on the hot topic of interoperability and what it means for the future of healthcare technology, and ultimately, patient outcomes.
Altera Digital Health (previously the Allscripts Hospitals and Large Physician Practices business segment) has maintained an EHR-agnostic open architecture and culture since 2007 that has positioned the company as an industry leader in the space. Below, I share some of my colleagues’ ideas and reflect on where Australia and New Zealand are on the interoperability journey.
It’s clear that interoperability is evolving at a rapid pace, driven by a variety of technological advances over the past two decades, and that we can expect to see a continuation of data transmission and consumption, as well as greater adoption of these standards through 2030 and beyond. Because of enhanced interoperability capabilities required of different EHR systems, the consensus among my colleagues is that patient data will no longer be confined to the four walls of any one provider organisation because of system incompatibility.
Advanced interoperability will smoothly enable connections between health information networks, ensuring providers can tap into patients’ data wherever they receive care. And as patient data flows more freely within the broader healthcare system, progress with data provenance standards will instil user trust in the information before them.
We are getting a glimpse of the future through initiatives such as the Victorian Centre for Data Insight’s “Syndromic Surveillance” of patient records from the Gippsland Health Alliance (GHA). Altera Digital Health provides GHA a Cloud-based (Microsoft Azure) EHR platform, and in this instance, Syndromic Surveillance involves the acquisition and evaluation of data from GHA hospital emergency departments to provide early warning of possible public health risks. The process detects key words relating to symptoms in the triage notes entered when a patient first presents, to identify trends or patterns of illness that have a greater public implication. These might include fevers and rashes in patients who’ve recently travelled overseas, gastro-intestinal illness potentially linked to contaminated food or water, or even the prediction of thunderstorm-related asthma to help the community prepare for the grass pollen season and improve asthma and hay fever management.
By the next decade, interoperability will give healthcare professionals the efficiency they desire today. Transferring information from one EHR to another will also no longer be a headache. Data will be mapped and made usable automatically with artificial intelligence, saving valuable time and resources. For example, better data mapping will remove burdens associated with patient matching and identification in information exchange—a win for patient safety.
Another example of the future of interoperability can be seen in South Western Sydney Primary Health Network’s (SWSPHN) innovative Integrated Real-time Active Data (iRAD) interoperability project, which has enabled healthcare organisations to share patient-consented health records across the continuum of care. SWSPHN serves a population of 1.1M people and is spread across seven local government areas of Bankstown, Fairfield, Liverpool, Camden, Campbelltown, Wollondilly and Wingecarribee. One of the biggest challenges facing healthcare delivery is the sharing of clinical datasets from multiple services and disparate systems. It is broadly accepted that easy and timely access to patient information across different sites, for example, the patient records of a general practice and a hospital situated in the same community, enables clinicians to be better informed, leading to improved patient management.
In 2017, SWSPHN partnered with Altera Digital Health to develop Project iRAD, which is now pioneering open, connected health communities in Australia—a flagship project committed to achieving better patient outcomes and which reflects the enthusiastic willingness of a diverse range of health service providers to deliver their services as part of a connected community in Australia.
iRAD was established to enhance the sharing of patient information, typically, when the patient is accessing services in more than one setting. These incorporate general practices, outpatient services, antenatal shared care sites, after-hours clinics, residential aged-care and palliative-care services. iRAD shares a host of patient and clinical information datasets, including demographics, diagnoses, medications, allergies, pathology and radiology. The project now comprises more than 60 general practices and a large local hospital emergency department. For clinicians, the benefits of iRAD includes access to reliable health information through a simple and intuitive system that aids informed clinical decision-making.
Altera’s role in iRAD is in the delivery of its cloud-based interoperability platform, the dbMotion™ Solution, which is available to the Australian market via Microsoft Azure. iRAD is the first implementation of dbMotion in the Asia-Pacific region and is also the first implementation globally on the Microsoft Azure platform.
iRAD reduces the administrative burden by saving time and limiting duplication and is well received by patients who no longer have to explain their health issues to multiple clinicians or have duplicate tests undertaken unnecessarily.
We see a bright future in which people can focus on higher value tasks rather than the mundane, where more time is spent with patients, not technology.
In addition to more efficiency, we will see greater connectivity across healthcare as information exchange volumes continue to increase. Adoption of application programming interface (API) standards will enable EHRs to interoperate with apps and connected devices. Care delivery will shift from the hospital to patients’ homes and alert their teams in real time when necessary. Virtual and augmented reality technology will transform care delivery as we know it, raising telehealth to new heights. Bringing acute-level care to patients through technology will enable them to comfortably recover from procedures at home, as well as age in place.
The COVID-19 pandemic has made the idea of in-home care more acceptable to patients and providers alike. Interoperability will expedite this.
Improved interoperability will not only support the use of technology, but also will accelerate the pace of clinical research through extraction of real-world data in EHRs. This interoperable data will give research teams an inclusive, representative view of patients contributing to a more equitable care experience for all. As therapeutics and devices go to market, FHIR-based clinical decision support (CDS) hooks will point clinicians in the EHR to newly determined best practices, much of it based on real-world data derived from EHRs. And as just one example, the COVID-19 vaccine has shown us just how critical time can be with respect to research and development.
As interoperability progresses domestically, data exchange between different countries will also improve. Standards adoption across international borders will increase data liquidity, enabling better transport of public health data for the good of patients around the world. The pandemic has shown us that while healthcare is local in many regards, it is also extremely global and we must never forget that.
The future of interoperability we envision is aspirational yet attainable.