Q&A on Interoperability

August 08, 2017

Category: News

Last week, CTO Nathan Apter was quoted in an article about the state of interoperability in the post-acute space. Here is his full set of answers, edited for clarity. 

As healthcare in general looks to better connect care providers so that they work in concert, share data, etc., what is the state of post-acute software and information technology interoperability? Please discuss the HME industry progress as it relates to the interoperability of post-acute software and information technology. How far has it come?

There have been big strides in education and awareness, which is a huge first step. ‘Interoperability’ is moving from being a trendy buzz word to being part of the everyday lexicon of providers. For years, Medforce been working openly with other software and information technology companies such as Mediware, QS/1, TeamDME, and FleetTraks to share data and allow post-acute providers to choose their own best-of-breed technology setups. The idea of software integration is not new. But things are changing in two big ways: One is that the baseline level of expectation from post-acute providers about how their data comes into and moves throughout their organization has risen. Providers are better informed, and this pushes software developers to keep up and continue to create tools that are flexible and can adapt to meet evolving needs. The second way is that talks of interoperability have expanded to be about data transfer and secure sharing of information across healthcare sectors and across players. It is no longer just about sharing of data between two software applications, it’s about creating an entire ecosystem of secure data transfer that is streamlined, automated, and improving the productivity of every entity involved. This includes acute to post-acute, provider to payer, payer to provider – everyone.

Interoperability in healthcare in general is further ahead than it is in HME. The biggest strides in general are being made in patient transfer, the ability to move an entire patient record from one healthcare provider to another so they can effectively service the patient. HME has additional unique needs. We need documentation to be electronically signed for compliance and reimbursement. A unidirectional pull of a patient record is not enough, HME providers need to request additional information or send documentation to be filled out.

That said, we are at the beginning stages of bringing interoperability out of the strategy phase and into reality. There are multiple pilot programs and taskforces working to translate these big ideas into everyday action.

Why is post-acute software and IT interoperability important for businesses and for patients? What are the biggest benefits for providers and patients when software and information technology have interoperability with referral partners, etc.? What segments of post-acute will interoperability help the most? Please give examples.

The value proposition of interoperability is fairly clear for providers. Referrals and new orders will come in digitally, centrally, and ideally with complete information. It will reduce the back and forth, streamline processes and enable faster, more efficient patient care. It will speed up prior authorization and, in theory, reduce denials on the back end. This clearly will benefit patients who need life sustaining equipment or treatments such as oxygen and infusion the most. But all patients will be better served when the patient transfer process is smoother.

The benefit to the provider is having more complete information upfront that enables faster delivery of care and cleaner claims. Payers want to change all claims to a prior authorization/preclaim review model. This will allow them to eliminate post-pay audits, which are a huge drain on everyone’s resources, and reduce improper payments. However, before they can implement that providers need to be able to quickly get all the information they need at the time of referral so they can immediately service their patients.

The challenges remain that there is not yet a “no brainer” to the referral partners. Even if the transaction is happening under a value-based payment model, the referral partners’ incentive is not so large that they are jumping at the chance to pilot these new interoperability programs. Many are in a “wait and see” mode, sitting tight until the technology providers have worked it out the issues. As with all new ventures, the beta phase is extremely important to modify and refine the information architecture to be sure everyone’s needs are being addressed and the net result is positive. With post-acute providers already so strapped for resources just to run their everyday businesses and with referral partners less incentivized than other players, it is a challenge to get these pilot programs off the ground and, in turn, a refined product to deliver to the industry at large.  

Are you a member of the CommonWell Health Alliance? If so, what has been your experience being a member of that group? What has been the progress?

We are not currently a member, although we have been looking more closely at joining. CommonWell focuses specifically on patient transfer. That is, they are developing standards and channels to allow patient clinical records to transfer safely between provider entities. It empowers a better continuum of clinical care for patients. There are some obvious subsectors of post-acute where this makes a lot of sense, such as home health. 

But the transfer of patient clinical information is just one piece of the interoperability puzzle. There are everyday communications that need to go back and forth between healthcare providers and HME suppliers and payers. For example: orders, prior authorization paperwork, documentation for signature, and post-claim documentation.

At Medforce, our philosophy is guided by the idea that post-acute provider care is just as vital as patient care. You can’t deliver outstanding patient care if you are forced out of business. We operate under the assumption that if we enable providers to be more successful and more profitable, they will deliver even better patient care. Our goal is to help providers be as streamlined and efficient as possible because that has a ripple effect to patients and even payers.

Some things CommonWell does not do at the moment is enable document transfer or the bidirectional communication needed for information requests. They also are not focused on inter-provider interoperability - the ability for two software systems used by the same provider for patient care to transfer data without a specific one-to-one integration.

In general, there is a lot of talk out there but not as much action. One of the best ways to evaluate whether an interoperability initiative is one to watch is to make sure that providers are at the center, and the technology is built to improve their health and viability.

Talk specifically about the interoperability of your software solution. What can it do? What are the plans for future interoperability? Feel free to talk about how some of your HME provider customers are benefiting from interoperability.

Medforce follows an open architecture philosophy. We believe providers should choose the mix of software systems they use within their internal health organizations and ensure efficient communication with third parties, including referral partners and payers. We can import and export many datatypes and work with HL7, X12, and CONNECT document submission. We were one of the original CMS certified Health Information Handlers (HIH) and have our own esMD program that allows for electronic transfer of documentation to CMS RACs for ADRs and Prior Auth requests.

We are involved in several interoperability initiatives including an initiative with CMS called EMDI: HealthIT.gov EMDI - Medforce and The Innovation Messaging Group Taskforce which will be working with DIRECT messaging to share data between HME providers, payers, and healthcare providers as well as provide digital signing of documentation.

What are some of the challenges of the interoperability of HME software and information technology? How are you working to remedy these challenges?

Like I said, the biggest challenge is adoption among referring providers of any solutions. Large healthcare systems are slow to adopt new technology and they don’t want to use different technology for every provider they refer patients to. Integration of the solutions into the referring providers EMRs will be key. Finding the healthcare and post-acute providers who are willing to devote precious resources to beta these programs is equally important.

How does interoperability affect the future of post-acute product development?

Interoperability will be a big part of all post-acute development budgets in the coming years. Expect a much bigger push once the referring providers EMRs are ready to implement a solution that solves the unique issues of interoperability among post-acute providers. Software developers can start now by maintaining a philosophy of interoperability - including open standards for communication and allowing providers to connect any other open software system for bi-directional data transfer of patient and order data, whether in-house or at another provider.

What is the future of post-acute provider software and IT interoperability? How do you see it over the next five or 10 years?

I think it’s a really exciting time for technology in the post-acute sector. It’s going to be a race to the top with better, more robust features and functionality. More choice for providers. More opportunity to create. In times of great struggle, there are often great breakthroughs. I think software and technology can be the underpinning of a great revolution in productivity and efficiency within the post-acute sector.

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