Issue link: https://beckershealthcare.uberflip.com/i/1479669
60 INNOVATION Health informatics chief Dr. Peter Winkelstein says EHR, patient data exchange could work like smartphone apps By Giles Bruce T he seamless sharing of patient data has long been a goal of many in healthcare. Just ask Peter Winkelstein, MD. He has led the health informatics program at the University of Buffalo for 25 years. He is also chief medical information officer for Kaleida Health and UBMD Physicians' Group, both based in Buffalo, N.Y. So he's certainly qualified to answer the question: Why aren't we there yet? As part of a series on healthcare data-sharing, (parts one and two are here), Becker's recently discussed the topic with Dr. Winkelstein, executive director of the University at Buffalo's Institute for Healthcare Informatics. Note: e interview has been condensed and edited for clarity. Q: Why do you think interoperability hasn't happened yet? What might it take to get there? A: Well, the short answer is: It's hard. It's easy to say let's move data freely among electronic health records and other sorts of platforms. But it actually is really hard to do, and that's why it's not been done yet. However, I think over the past 10 years, or an even shorter period of time, we've made significant progress. And that's happened for several reasons. One is that there's industry interest in providing interoperability, and so there are now industry platforms for interoperability. And that's very powerful because the industry is relatively consolidated. And so they're in a position to be able to set interoperability standards pretty well. e other is, of course, the government has been pressing for this. e goal is pretty straightforward. A patient clearly wants their data to be able to travel with them, so that when they go from one provider or doctor to another, or one health organization to another, when they arrive the appropriate data is with them. And they want that done in a secure fashion. is all strikes me as extremely reasonable and something we should be striving to achieve. And there's not much debate about that. I don't know anybody who says we should not do health interoperability. Everyone agrees that the data should be able to flow. But as I said, the fundamental problem is that it's hard. It's hard because the data is complicated. And it's hard because the data is scattered over so many different places, because patients typically go to many different offices, and many different healthcare facilities oen each have their own EHR, and even if it's the same vendor, it may be their own implementation of the EHR. Also the insurance companies have their own systems. One possible advancement in technology is the development of relatively easy-to-access API's, or application programming interfaces, so third- party apps, non-EHR vendor apps, can access your health data in a secure fashion with your permission and can begin to provide some ability to aggregate it and transport it from the patient standpoint. So there are a number of examples of that. Probably the one that readers would know the most is Apple Health. It's a little app that comes with your phone. If you go into Apple Health, you'll discover there are a lot of different health organizations that have already opened up their EHRs so that you can connect to them with the Apple Health app. I can connect two or three different EHRs where I have personal medical data into the Apple Health app, and then that allows it to aggregate in one place. Q: Can you quantify where the healthcare system is at now in terms of interoperability, and what will it take to get to 100 percent? A: I don't quite know how to quantify it. I would say most, if not all EHRs, offer patient portals, so a patient can access their data by signing up for the patient portal and going and looking at the data in the EHR. Patients can at least see some of their data, and now with the information-blocking laws, the amount of data that patients will be able to see is going to be greater and greater and greater. And then, as part of the same regulations, they'll be able to transport that data into these third-party apps. Patient access to their own data has improved dramatically, is close to 100 percent and will be at 100 percent or more with the current information- blocking regulations and the APIs. How many patients are taking advantage of that access? I don't really know. How much do they really want to use portals? How much do they really want to look at their data? I don't know. Moving the data from one system to another — that's more complicated. at requires a higher level of technology. And there are a couple of different routes for that. One is using health information exchanges. So you send the data to a central place, and then you bring it down from there to your computer as you need it. And now there's direct messaging, which is essentially a secure form of email that's designed for health information. at's in the early days of penetration, but I think it will increase dramatically. And that is designed for provider-to- provider, EHR-to-EHR type communication. So when you think about interoperability and flow of data, sometimes you need to think about who it's flowing to. Flowing it to the patient is one thing. Flowing it between electronic health records is another thing. Some of this has nothing to do with the technology. ings like patient portals — are you encouraging your patients to use the portal? So every time a patient comes in, you say, 'Hey, sign up for the portal area. If you're not, we recommend it.' at's not a technology question. at becomes a question of how does the office want to connect with their patients. When I hear medical organizations talk about patient portals, their concern usually falls into one or two different categories. One category is they're worried, I think legitimately, about making sure that patients don't get bad news before they've had a chance to call the patient. ey want to deliver bad news themselves. ey don't want the patient to find out bad news by looking it up on the computer. e other related concern is that sometimes it's difficult, depending on how the information goes to the portal, for patients to interpret the significance of abnormal results. And then there's sometimes they're worried about, 'Boy, you know, we have trouble handling all the phone calls we get as it is. Now in addition to that, we add messaging from the patient portal, then we're worried about being able to handle the volume of calls plus portal requests.' Despite