It's time for HIMSS Stage 8
To reach new heights, it's helpful to have a ladder. Each step brings steady progress towards the destination, though the last couple of rungs are the hardest to scale and require ample patience and balance. And if what you seek remains out of reach, you'll wish that ladder was just a bit longer.
We use ladders in health IT—figurative ones at least. Top of mind for me are the maturity models developed and administered by HIMSS. These frameworks offer healthcare providers stepping stones for greater adoption of digital tools and processes; best-known and most popular are the EMRAM and O-EMRAM, which respectively define roadmaps for maximizing EMR use in hospitals and outpatient clinics. It's a laudatory achievement to attain the pinnacle of Stage 7, and providers who do so benefit from digitized workflows and (hopefully) increased patient and clinician satisfaction.
As important as the goal of maximal EMR utilization is, however, it's increasingly insufficient. The burning priority for healthcare IT isn't the ability to punch orders into a computer but rather to exchange data beyond your four walls. Interoperability has become a key focus for practically every stakeholder, including patients and regulators, and it deserves a more prominent role within the EMRAM and O-EMRAM. We need a new HIMSS Stage 8 to guide providers in their interoperability journeys and to help the most integrated ones stand above the rest.
A little short
In fairness to HIMSS, it has baked a hint of interoperability into its offerings already. The Continuity of Care Maturity Model (CCMM) calls for "multiple entity clinical data integration" at Stage 3, e-prescribing at Stage 4, and a rather vague benchmark of "mobile tech engages patients" at Stage 5. Unfortunately, it seems that the CCMM hasn't caught on, as not a single health system has reached at least Stage 6 after nine years of existence.
Within the EMRAM and O-EMRAM, there are guidelines for participating in an HIE, exchanging discrete and unstructured data, and taking in lab results electronically. This is a decent baseline but doesn't push providers to adopt the latest and greatest. There's no mention of using APIs to release clinical information to payers and patient-authorized digital health apps. There's no declaration that providers should have a governance body overseeing implementation and auditing of integrations with third-parties. These gaps leave providers to figure out best practices on their own and slow down the adoption of new innovations.
A necessary step?
You may be questioning whether it makes sense to add interoperability to two tried-and-true maturity models. Wouldn't this be moving the finish line after the runners completed the race? And isn't it enough that the ONC is issuing regulations around info blocking and certified HIT that already promote interoperability? Fair points, but allow me to counter.
First, the ONC's approach has favored sticks over carrots. For an organization empowered to define the rules of the road, this isn't unexpected, but it would be valuable to have rewards as well. Incorporating interoperability more strongly within the EMRAM and O-EMRAM would incentivize providers who seek to be best-of-breed without introducing mandates on hospitals and practices with limited people or resources. Second, most of the recent ONC regulations for interoperability have been targeted at health IT developers, not healthcare providers. It's the developers, for instance, who must ensure their products integrate with immunization registries and support bulk FHIR API requests. Instead, what I'm proposing addresses the provider side of the equation.
I also wouldn't think of this as an exercise in moving the goalposts. The achievements of a Stage 7 organization would not go away; Stage 7 would still be a gold standard for the effective use of information technology in healthcare. We all recognize, though, that technology evolves and advances, and how we measure our progress with technology should evolve and advance as well. We have an opportunity here for continuous improvement, something that can take organizations from the gold level to platinum.
Building a better ladder
Okay, that's the why behind a new Stage 8, but what should be the specific criteria within it? Given the numerous possibilities, that warrants a separate post to discuss. Look for my thoughts and examples in the next edition of Nonstop Interop.
Photo by Armand Khoury on Unsplash