Interoperability is a Rural Health Disparity

The following is a guest article by Jaime Bland, DNP, RN-BC, Chief Executive Officer at CyncHealth, the health data utility for the Midwest, and Kat McDavitt, Principal Advisor and Head of Public Affairs for Innsena and advises organizations including PointClickCare on external affairs.

The inability to share and access clinical data is a rural health disparity. This is an issue that rural communities understand acutely, with critical access hospitals often underfunded and surrounding ambulatory providers lacking the resources to coordinate through technology platforms.

The COVID-19 pandemic has magnified this historic technology divide and interoperability gaps at a time where the need to streamline the transfer of clinical information is more important than ever. To manage the post-pandemic world and build a better infrastructure, health equity planning must include the access and implementation of technology infrastructure.

Congress acknowledges the needs of rural communities and has made access to broadband, quality improvement programs and telehealth resources available to providers in these regions. But the foundational technical ability for providers in remote regions to share information, and in real-time, as patients access the healthcare system has not yet been realized.

Addressing the Disparity

According to the Centers for Disease Control and Prevention (CDC), 46 million Americans live in rural regions. Those regions have unique challenges related to many public health issues, including the COVID-19 pandemic. The CDC advises public health professionals focused on rural regions to review data to understand disease burden in a particular area. But these regions are impacted by a true health disparity—lack of interoperability and thus, lack of accurate and complete data by which to make decisions.

Support to rural health providers has focused on adoption and use of EHRs. But while foundational, EHR adoption is not analogous to interoperability, much less to healthcare infrastructure. It is wholly insufficient. Access to broadband, a massively critical need to realize the promise of interoperability, is also insufficient without funding and aligned incentives to facilitate true care coordination with insights to make better decisions—both at the provider and state levels. According to a 2017 brief from the Office of the National Coordinator for Health IT (ONC), rural hospitals were about 50 percent less likely to share health records than larger urban facilities.

The components of building a public health infrastructure that will inform the long recovery from the COVID-19 pandemic and build a modern public health foundation must be informed by known gaps in the current state of rural interoperability, as well as issues that include the economic recovery of rural and frontier geographies.

Rural communities need infrastructure to create interconnectedness that collects pertinent data to manage multiple use cases can proactively optimize patient outcomes and alleviate stress on systems driven by the overutilization of acute care. This includes social determinants of health (SDOH) infrastructure to ensure that economic recovery is addressing the social aspects of health. Community infrastructure that connects all healthcare stakeholders such as the hospital, pharmacy, skilled nursing facility and clinics is part of the economic recovery.

The health data utility model as an infrastructure for the public good

Leveraging and expanding access to the health data utility model will let providers in rural communities to catch up to those in urban centers. With lessons learned from the successes and failures of health information exchanges built post-ARRA, the health data utility model can be a multi-state public resource tailored to the unique needs of the region. It provides a single and trusted source of robust clinical and non-clinical data allowing diverse healthcare stakeholders to achieve their shared goal of healthier communities.

While some of the functions inherent to the HIE model are a part of a health data utility, the utility acts as a secure, consistent and neutral data hub for state governments, public health workers and the healthcare community at large. It ensures universal connectivity for all providers within a region—from hospitals to skilled nursing facilities to urgent care locations. The health data utility can also support newer use cases for underserved and vulnerable populations by facilitating the exchange of social determinants of health data. Often considered applicable only in dense urban regions, food and housing insecurity are just as critical to rural populations.

States can mandate that health data utilities act to fill critical public health infrastructure needs, such as mass vaccination programs, testing for pandemic response and cancer registries, as examples. They can also support public health departments and governors’ offices with critical data and insights to make decisions about directing resources to regions in need. But the value of a health data utility goes well beyond the pandemic response. Maternal and infant health, the ongoing and worsening opioid epidemic and rising cases of behavioral health issues can all be mitigated in large part by the insights provided by a health data utility.

The catch is that building a health data utility is not free, and many states are not in a position to fund a program given the current public health emergency.

As Congress considers the new infrastructure package as a way to get America on a path to recovery, it should consider heavily the lack of investments in public health across the country. Rural states and regions, in particular, need support from Congress to ensure that lack of technical healthcare interoperability is addressed for what it is—a health disparity.

A path forward for rural communities

There are multiple avenues to support states in building out a health data utility infrastructure, but a path forward that considers the financial constraints on states and remote regions is an augmentation of the Healthcare Connect Fund administered by the Federal Communications Commission (FCC) under 47 CFR Subpart G. This fund, currently focused on rural broadband, can be increased annually by $900 million allowing for ongoing and well-equipped public health infrastructure throughout the country.

To ensure these funds are used effectively and efficiently and avoid some of the pitfalls associated with early HIE models, any funds allocated to the development of health data utilities and other public health infrastructure should be administered and distributed annually by the ONC.

The ONC and state Medicaid agencies have more than a decade of experience administering large scale health IT programs.  ONC’s oversight over funding administration and program efficacy will ensure health data utilities, and other health information exchanging entities, demonstrate the ability to realize cost savings to the Department of Health and Human Services and state governments.

Existing and successful health information exchanges with demonstrated impact to clinical and financial outcomes, are moving toward the health data utility model. Funding under the modified FCC Health Care Connect fund should be prioritized by modalities presented for coordinating care for telehealth programs, rural health programs, care coordination for long term care and post-acute care, care coordination for substance abuse treatment providers and behavioral health providers, care coordination efforts innovating public health preventions and treatments, care coordination connecting social services, and a particular emphasis on entities which have prioritized providing patients access to their information.

Adoption of the health data utility model, and aligning incentives for rural health, regulatory oversight, and funding opportunities from Federal agencies will ensure that this new public health infrastructure is efficient and effective, and builds on lessons from the past. Lawmakers need to act now to ensure rural communities are not left behind and vulnerable to future public health emergencies as American rebuilds.

About the author

Guest Author

5 Comments

  • Must strongly disagree with both the analysis and conclusions presented here.

    1) Interoperability is as big a problem in urban areas as in rural areas. NO ONE in either area can access ALL their records from ALL their providers.
    2) The solution is NOT to create another expensive bureaucratic entity. A better, more effective and inexpensive solution is to give patients control of their records which they can share with their doctors anytime, anywhere they require care, and they can use to better manage their own care. Our MedKaz® portable personal health record does just that.

  • @ Merle Bushkin, the MedKaz website did not really offer any meaningful information about your technology. From what I could gather, it is a usb stick with text scanning software that converts EHR documents to PDFs? This is not the solution to the interoperability challenge, and I would be hesitant to even label that feature ‘interoperability’.

    Can you provide any other information about the product, would be interesting to see what you actually have.

  • The beauty of MedKaz is that its technology IS simple but its scope and functionality are sweeping!
    A patient’s complete medical record from all his/her providers, plus the patented app to manage them, are aggregated on the patient’s MedKaz mini drive. The patient gives it to his/her provider when requiring care. In turn, the provider can search for and read specific records! That IS interoperability!
    The system also enables a patient to share his/her records with anyone he/she chooses. That, too, IS interoperability!
    Happy to discuss it further with you. Call me at 802 484-0249.

  • So a pull/push API and PDF storage? That would have been ‘interoperability’ 10 years ago, at best. Any plans to incorporate open data formats or integrations, in order to provide semantic properties to the data you aggregate?

    If an EMR you are pulling data from uses SNOMED (or any other open-ish standard to populate data sets), the additional information would be lost during conversion to PDF, no?

  • Not sure whether your objective is to provide interoperability or merely to massage data in as many ways as you can!

    Ours is to ensure our doctors can deliver top quality low-cost care by being able to easily access their patients’ COMPLETE record from ALL their providers at the point of care — and that’s what MedKaz does. It also is a communication platform that allows patients to share their records in a timely way with all their doctors, loved ones, care givers, researchers, et al.

    MedKaz does both, TODAY! Trying to connect provider silos on the fly hasn’t worked for 17 years (since ONC was created) and I don’t know anyone who honestly thinks it will ever work!

    To your last point, we preserve structured data and provide it to whomever needs it and is equipped to manage it.

Click here to post a comment
   

Categories