Observation Deck

The Interoperability Imperative

HME providers must implement bi-directional data communications with other healthcare providers -- now. Snooze and you’ll lose relevance.

• By Dave Cormack
• Sep 01, 2015

For the last 10-plus years, a major trend in our industry involved providers adopting technology solutions that allowed them to improve their operational efficiencies to counter the pressures of reduced reimbursements. More recently, competitive bidding has accelerated the normal levels of mergers and acquisitions activity as better-run providers (read: more efficient) acquired the providers that could not adapt to these lower reimbursement levels. These more efficient providers could win bids, take market share and acquire other providers to continue to grow and prosper.

While this trend toward more efficient operations will continue, a newer and frankly more exciting trend is emerging: interoperability. Organizations across the care continuum are already striving to communicate better and share information to improve patient outcomes and eliminate unnecessary costs, such as unplanned readmissions and extended lengths of stay in the hospital.

Interoperability is being driven by payors who, in order to improve outcomes and control ever-escalating healthcare costs, are moving from a fee-for-service to an outcomes- or performance-based reimbursement model. My prediction for HME providers is this: If you cannot share data bi-directionally with acute care and physician practice management systems in the next 12 to 24 months, including automating the referral and order process so that the payors can see data transparency across the care continuum, you will lose your referral sources.

Therefore, to be relevant HME providers must quickly adapt to this brave new world of interoperability. To date, acute care organizations and physician practices have invested much more in technology and data sharing solutions than post-acute care organizations, such as HME. Many hospitals and physicians have implemented electronic health record (EHR) systems that eliminate paper and enable the sharing of health data electronically across care settings. There is a growing expectation from these referral sources that HME providers also share data dynamically and electronically between systems.

As interoperability across the care continuum becomes reality, here are a few recommendations that providers should consider to successfully transition:

Look into Industry Initiatives

Realistically, the only way the broad healthcare industry can truly achieve interoperability is for their technology vendor community to work together. The primary industry collaboration that is focused on this is the CommonWell Health Alliance. This initiative was formed by the healthcare vendor community as a means to solve the challenge of matching patient identities across vendors and care settings. Healthcare providers that use CommonWell Health Alliance member systems can seamlessly retrieve clinical information on patients under their care. This Alliance has proven that its approach works and has attracted a “critical mass” of vendor support.

Providers should ask their current software vendors what their plans and timescales are to support the CommonWell Health Alliance and other interoperability initiatives. And be sure that your software vendor has a dedicated team of engineers focused 100 percent on these data sharing initiatives.

Share Information for Better Outcomes

Providers should embrace the idea that information sharing is vital to creating better patient outcomes. Being able to collect, view and exchange data securely across the care continuum can vastly improve a healthcare provider’s ability to continually evaluate patients and make better decisions about their care.

Consider sleep therapy compliance, for example. When a patient receives a sleep apnea diagnosis — either by a hospital or physician — he or she is matched with an HME provider that delivers a CPAP machine to the home. Typically with this “hand off”, the physician has no real-time visibility into a patient’s usage of the device and compliance with the treatment plan.

On the other hand, when HME providers can easily receive information on the patient’s level of compliance and exchange that information with their referral source, then both entities have a window into whether the patient’s needs are being met. The consistency in flow of information means that a physician can quickly verify a patient’s usage and compliance — and intervene when necessary. HME providers that can easily communicate this compliance data will be viewed as more valuable to referral sources and, therefore, referrals will be more plentiful!

Employ the Right Technology

Let’s face it, the days of paper-based communications and manual processes are numbered. Labor intensive efforts to stay in touch with referring partners — such as sending employees to wait and collect signed documentation, or making endless phone calls — require significant resources. With the rest of the healthcare industry shifting quickly towards electronic, real-time sharing of patient data, HME providers will have no choice but to shift as well.

Unfortunately, many providers and their software vendors lack the resources and infrastructure to achieve interoperability and connect with disparate systems used by their referral sources and payors. Accordingly, HME providers should look to move to solutions that provide an interoperability and data sharing framework in a cost-efficient — yet very effective — manner. Older generation client server-based technologies are very poorly suited to this ever-changing, more interconnected healthcare environment.

When it comes to interoperability, a modern, cloud-based, Software-as-a-Service (SaaS) solution has a tremendous technology/platform advantage. Simply put, a cloud-based platform will automatically manage 100 percent of the data interoperability ‘plumbing’ to hundreds of connections in the healthcare ecosystem on behalf of its provider customers. If however a provider is on a client-server software product, where the system is managed internally by the provider, then all of the data interoperability (plumbing to hundreds of potential healthcare connections) has to be managed and maintained internally by the provider’s individual client-server system. Therefore, a cloud-based platform is ideal to seamlessly meet these emerging interoperability challenges and position an HME provider as a more reliable and attractive referral partner.

Ultimately, by employing the right technology that operates seamlessly between systems, HME providers can share information faster and more accurately — leading to reduced costs, improved patient care and heightened marketability of their products and services.

Interoperability is the Future

By using innovative solutions that enable a high-level of interoperability, these providers can demonstrate they are strong, reliable referral partners that enable better care and mitigate risk.

As healthcare and technology continue to evolve, organizations that have the flexibility to adapt will thrive. I encourage you to take steps now to partner with a forward-thinking software vendor that can help you streamline your current operations and prepare for the critical, interconnected environment that’s coming very soon.

This article originally appeared in the September 2015 issue of HME Business.