President of Bamboo Health. 20+ years of healthcare/tech experience with leadership roles at McKinsey and Company, Anthem, and Healthways.
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Quality healthcare relies on the ability of providers to share patient data and coordinate care. A patient may visit their primary care physician at the beginning of a care episode and then be referred to a specialist, who may send the patient to an imaging lab for an ultrasound. But although patient data is generated and recorded in all three cases, that data is of little clinical value if it remains siloed and inaccessible to other providers treating the patient.
Care coordination requires interoperability among the electronic health records (EHRs) of primary care practices, specialists, hospitals, labs and payers. As we continue moving toward value-based care (VBC), it will become increasingly important that other relevant stakeholders, such as community-based organizations (CBOs), are able to share data with providers. Coordinated care not only results in better patient outcomes but also helps lower overall healthcare costs by preventing needless duplicative tests and procedures.
Healthcare historically has lagged behind other industries in its ability to share data across networks. The good news is that deep interoperability in healthcare is progressing. The results of a survey by the College of Healthcare Information Management Executives (CHIME) and KLAS Research show that 67% of the provider organizations that participated in the study indicated they "often" or "nearly always" had electronic access to patient records in 2020. This shows a dramatic rise from 2017 when only 28% indicated they had the needed access.
Yet, interoperability challenges remain for many providers. Nearly half (49%) of the providers surveyed by KLAS-CHIME said their EMR vendor makes interoperability harder, at least sometimes. Further, healthcare data today is being generated by personal and medical devices that must be securely integrated across multiple systems.
Driving Forces
What are the fundamental drivers of this trend toward healthcare interoperability? There are three broad factors at work.
Number one is regulatory pressure. The 21st Century Cures Act’s interoperability rule finalized in March 2020 requires providers to securely share data electronically and prohibits information blocking. The interoperability rule went into effect in April 2021 and puts pressure on technology vendors to meet the standards for data exchange set by the Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health Information Technology (ONC).
The second driver is funding. Healthcare interoperability startups are attracting investors. Companies such as Health Gorilla and Particle Health have raised millions of dollars to develop and roll out interoperability tools such as API platforms that allow developers to build applications that facilitate data sharing across disparate systems.
Indeed, the global healthcare interoperability solutions market is projected to reach $7.9 billion by 2029, up from $2.7 billion in 2019. As long as investors see the potential for market growth and profits, money should continue to flow into solutions addressing healthcare interoperability.
The third driver behind healthcare interoperability is the growth of the overall digital health market, which is massive. An analysis by Allied Market Research indicates that the global digital health market will reach $768 billion in 2030 from $146 billion in 2020 — a CAGR of 17.9%. This market includes health information technology, telehealth and telemedicine, mobile health, wearable devices, connected at-home devices, implants and personalized medicine.
Startups in the digital health market are addressing solutions that enable VBC, which relies on data sharing and, by extension, interoperability. The combination of regulatory imperatives, market demand and the ongoing need to integrate new and innovative digital health devices and services into healthcare systems will continue to make interoperability startups an attractive option for investors.
Barriers To Interoperability
Despite the money and momentum, there remain hurdles to full healthcare interoperability. One of the biggest hurdles is the long tail of providers who lack digital data in any form. As a digital health provider of behavioral health services, we at Bamboo Health see this all the time.
Another hurdle is market fragmentation. Although EHR giants Epic and Cerner have a combined market share of 56%, this leaves 44% of the EHR systems market to other vendors.
Even if a provider is digitized and using an EHR that's connected, there's the challenge of connecting patient identifiers and patient information across an entire digital ecosystem beyond the EHR. In June 2021, the ONC released for public comment the draft technical specification for Project US@, which was launched last year to develop “a unified, cross-standards, healthcare industry-wide specification for representing patient addresses to improve patient matching.”
Then there's the formidable issue of data quality, which can be highly variable — and that's a huge barrier to care coordination. Incomplete forms, conflicting information, incorrect formatting and other data flaws can impair the ability of clinicians to make evidence-based decisions or even to definitively match patients to their records.
The job of interoperability in healthcare is to create enough consistency and liquidity of data in a way that allows it to be utilized by organizations downstream to create value. To provider organizations, this value primarily is defined in terms of better patient outcomes and cost control — neither of which are possible without care coordination. And effective care coordination requires the ability of clinical stakeholders, payers and patients to share quality data.
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