by Tom Hurd

How CareSource IT is addressing data interoperability challenges in healthcare

Jul 03, 20237 mins
CIO 100Data ManagementHealthcare Industry

Investments CareSource has made in providing increased visibility into patient data and access across disparate clinical systems has paid off in improved overall ratings. But there is a long road ahead toward the interoperability that the healthcare industry needs.

Nurse working on PC in modern private clinic with glass walls where patients are brought in wheelchair from an elevator and other persons are going through hallway. Team of doctors researching
Credit: DC Studio / Shutterstock

One key challenge facing the healthcare industry today is the inability to easily access and share electronic medical information between healthcare providers, clinicians, and patients. This is a significant problem because sharing data between clinical systems and providing patients with easy access to their information enables them to make better-informed decisions and, subsequently, supports improving the quality and timeliness of care.

While there are efforts to establish interoperability rules and regulations at both national and regional levels, existing IT systems do not effectively communicate and interact with one another and, as a result, have created scattered siloes, notes the Healthcare Information and Management Systems Society (HIMSS,) a nonprofit dedicated to improving healthcare quality and safety, as well as eliminating barriers to data sharing and access.

Years ago, the Centers for Medicare and Medicaid Services (CMS) established a series of rules and federal regulations outlining the necessary requirements to support Interoperability. CMS also defined the minimum standard requirements for patient access, ensuring patients have improved visibility to their health information through technology and across the healthcare system.

Other standards are also in place, such as Fast Healthcare Interoperability Resources (FHIR), that provide a set of flexible and adaptable rules and specifications for exchanging electronic healthcare data and make it easier to connect strategic electronic medical record (EMR) systems and providers to enable real-time data exchange and care notifications for patients and care teams.

We at Dayton, Ohio-based healthcare company CareSource have made interoperability investments an integral component of our IT strategy in order to drive quality healthcare outcomes for our members. Interoperability within CareSource is achieved through a variety of ways: Health Information Exchange (HIE), direct connections to provider EHR systems, and partnerships with multiple companies to deliver critical information in the areas of clinical, claims, social determinant, and formulary data to our patients through secure means.

But work remains to be done in leveraging innovative technologies to support seamless data sharing to drive greater transparency and efficiency, better data quality, and more complete patient records.

Our challenge in improving interoperability at CareSource, and in moving beyond just the mandates, was to achieve the following goals: Eliminate inefficiencies internally and externally by streamlining processes and the sharing of electronic medical records (EMR) and other healthcare data; provide ease of access to information; improve care and the patient journey; and ensure transition of patient care among providers, hospitals, and clinical systems. Our work to aggregate and standardize data across many sources into a unified data structure enables us to accurately measure the efficiency and effectiveness of our programs and initiatives on member health outcomes.

Improving interoperability and eliminating roadblocks, however, is not an easy task. There are several inherent challenges such as inconsistencies with patient identification, conflicting information exchange standards, disparate systems among health plans, providers, hospitals, and clinics, and an inability to consistently measure and analyze the effectiveness and quality of patient history and care across different local, regional, and national systems.

There are also hurdles in ensuring better than adequate privacy and security controls are in place and measures taken to consistently monitor the effectiveness of these safeguards. These are impediments to the widespread adoption, implementation, and standardization of interoperability tactics across the healthcare industry.

Power in partnerships

One of the first steps we took in moving the needle to improve interoperability and eliminate healthcare information barriers was to take advantage of our connections and partnerships within the health information community at the local, state, and national levels. CareSource also participates in many interoperability workgroups that help define the industry standards for how our systems, policies, and procedures will comply with regulations. These workgroups help identify and define new methodologies and strategic initiatives and collaborate and share knowledge with industry partners and players.

CareSource also serves as a representative on data sharing committees focused on the development of innovative methods for reporting Healthcare Effectiveness Data and Information Set (HEDIS) measures using data from electronic clinical data systems. These include the Indiana Network for Patient Care (INPC) Management Committee, Ohio’s Health Care Coverage and Quality Council Health Information Technology Task Force, and the American Health Insurance Plan’s Health Information and Technology and Interoperability Workgroup.

Minding the gap

From an adoption perspective, gaps remain with implementing interoperability solutions from all industry constituents. We continue to drive proactive partnerships with hospitals, providers, and EMR solution providers bringing innovative and quality solutions. The adoption gap is being reduced by actions taken by the federal Office of the National Coordinator for Health Information (ONC) and its Cures Act Final Rule that is structured to give patients and their healthcare providers secure access to health information.

Technology solutions are available that can eliminate interoperability barriers and provide multiple channels for provider and member interaction and support automatic and bidirectional data exchange to arm providers with the latest information they need to design and communicate the right care plan for members. These include data aggregators like i2i and Azara that can be used to connect with Federally Qualified Health Centers (FQHCs) to enable tracking and monitoring outcomes produced from real-time EMR data with actionable insights. These gateway solutions enable real-time sharing of information among state partners, providers, community-based organizations (CBOs), and care team members.

CareSource also designed its interoperability technology ecosystem to scale and adapt as the industry evolves by managing internal APIs that fully integrate our CareCore MIS solution components as well as external APIs. In addition, we are implementing the EPIC Payer Platform enabling immediate ability to share data with other providers using that solution.

While making use of technology tools and other collaborative solutions is a strong step in the right direction, interoperability continues to be a complex challenge for healthcare and other industries. The key objective is to align your technology strategies with your overall mission goal, which for CareSource is to drive strategies associated with growth, improve the quality and relevancy of data, and expand standardization. The following are some key areas in healthcare that might be top of mind in any interoperability journey:

  1. Policy and advocacy: Utilize technical abilities and analytics to build a market influencer network that drives opportunities which better position the company to meet the needs of providers and patients.
  2. Data and technology: Innovate in each area of company to further create a member-centric “closed loop.” This includes dynamic planning, hooked and unhooked technology/data, workforce planning, and legal and risk competency.
  3. Growth: Develop the expertise, process discipline, and flexibility to easily assimilate other technologies, systems, or business area. In healthcare that might be health plan and special population acquisitions.
  4. Agility: Become expert in utilizing an integrated, closed loop data that might be outside your network to drive improved outcomes, results, and quality.

CareSource has made significant advances through our experience in implementing interoperability capabilities, although the journey for many has just begun. There is a long road ahead in healthcare, made shorter is the industry continues to drive adoption, usage, and efficiencies to improve the patient experience.

by Tom Hurd

Tom Hurd is Vice President for IT Core Systems at CareSource, a nonprofit managed healthcare provider with more than 2.3 million members. It is headquartered in Dayton, Ohio, and administers one of the largest Medicaid managed care plans in the US.