Marilee Benson is President of Zen Healthcare IT, a technology provider focused on simplifying interoperability with a flexible health data exchange platform and experts in on-demand data exchange. Zen’s Gemini Integration Platform addresses the breadth of healthcare interoperability needs, including easy API access to more than 600,000 providers via national data exchange networks.
Benson, with more than three decades of experience in health IT, is an expert in the interoperability needs and challenges facing hospitals and health systems of all sizes. She is passionate about leveraging technology to improve patient outcomes and is a recognized leader in the healthcare interoperability community, currently serving on the advisory board of Carequality.
Healthcare IT News spoke with Benson about the impact of interoperability on hospitals and health systems, strategies for overcoming common challenges in healthcare data exchange, the role of technology and interoperability in improving patient outcomes, and the future of interoperability in healthcare.
Q. What does interoperability offer for hospitals and healthcare systems?
A. The most important impacts of interoperability on hospitals and health systems are those that directly improve the patient experience. I recently read an article that said improving the patient experience was a top priority for hospital and health system leadership.
That makes sense, because we’re entering a phase where patients have more and more options for where they seek care, including many more virtual options. To compete in this more complex healthcare ecosystem, hospitals and providers need to ensure they’re delivering a great patient experience.
On the other hand, patients and caregivers continue to be frustrated by the difficulty of navigating different care environments and having their important information follow them throughout their care journey. Hospitals and health systems that want to prioritize the patient experience are already focusing on this aspect or will soon have to do so.
And it’s not enough to just be “on Epic.” The Silver Tsunami we’ve all heard about means that a given patient will be in and out of a wide variety of care settings more often, dealing with multiple conditions.
And even if you’re not silver yet, you probably have aging parents. Focusing on ensuring a seamless flow of data between all the different healthcare institutions via Attention to interoperability in healthcare is a core requirement for improving the patient experience.
When I talk about improving the patient experience, I also mean improving patient outcomes. Healthcare systems are investing in promising technology to improve patient outcomes, particularly purpose-built AI technology that finally appears to be delivering on the promise of improving health outcomes. Granted, it’s early days, but I don’t see the AI trend in healthcare slowing down in the next five years.
These promising AI tools won’t work without data, which brings us back to the critical need for better interoperability between different systems.
Q. What are some strategies to overcome common challenges in healthcare data sharing?
A. The biggest trends today to address healthcare data sharing challenges are strategies to replace a do-it-yourself approach with a managed platform/outsourced interoperability expertise approach.
We see this strategy being deployed for both traditional direct data sharing – what I call the “bread and butter” use cases for healthcare data sharing – as well as for broader community-based sharing via old-fashioned IHE-style connections, which have enabled nationwide data sharing for treatment-focused data sharing for years.
FHIR is no exception. FHIR shares many of the same issues as other healthcare data standards. For example, there are multiple versions and implementation guides, and more importantly, FHIR must be able to coexist with older standards.
Examples of traditional interfaces include lab orders/results interface, radiology orders and results, or data feeds that send admission/discharge data to your local health information exchange. A managed platform approach can allow a single EHR data connection to be routed to multiple other systems that need the same data, saving time and money – and reducing the number of point-to-point connections that need to be managed in the long run.
And as healthcare systems increasingly look to outsource core IT functions to reduce costs and become more efficient, a platform-plus-expertise approach starts to make sense. How expensive is it to retain a team of interface/interoperability engineers in the long term? And for smaller organizations, how costly and disruptive is it when their one interoperability expert leaves?
For broader data sharing with the healthcare community, we are seeing providers and health systems looking for ways to improve the provider experience, which in turn improves the patient experience. Providers are looking for better ways to receive and process data from outside their practice or institution to better support referrals and care transitions.
Managed platforms built specifically for this type of broad-based data sharing are beginning to demonstrate the ability to optimize these referral/chart review processes as more avenues for connecting to regional or national data sharing networks become available. These platforms can function as pure middleware, using automated processes to retrieve and route data to an EHR, or provide an optimized, purpose-built user interface to visualize incoming data from external sources much more effectively than the typical EHR system.
The emergence of these non-EHR-based types of systems that are optimized for data queries has led to a new use case for national data exchange. Under the familiar Carequality exchange framework, this is called an “on behalf of” use case.
The idea is that a different technology is used to initiate a query on the national network than the EHR, which acts as the responding entity, as that is the source of truth about the patient’s entire medical record. This same concept is also applied at TEFCA, only under a different name.
Q. What is the role of technology in improving patient outcomes? And how does interoperability play a role in this?
A. Since the possibilities of technology to improve patient outcomes seem limitless to me, I will limit myself to one very important use case: individual access to our health data.
The vast majority of people today rely on technology to organize almost every aspect of our lives. I rely on my phone’s calendar to know what meeting is coming up next. I rely on my travel app to store and access my travel-related information.
The same goes for our health. I use an app to remind me to take my medication and even an app to test my hearing. I use patient portals regularly and like many people I find it annoying to have to log in to multiple patient portals.
I have a family member in the hospital right now. It’s incredibly frustrating that I don’t have access to their medical records because the hospital doctors are asking me questions that I can’t answer. If we can’t answer those medical history questions in an emergency, the care for our loved one suffers. Technology can solve that problem for us – we just have to look beyond EHR-connected patient portals. And this is where interoperability comes in.
Individual access – also known as patient access – to our health data is one of the most difficult interoperability problems to solve. And frustratingly, it is not a technology problem. The national networks such as Carequality, eHealth Exchange and Commonwell Alliance has developed implementation guides and conducted pilots related to patient access.
The problem was adoption – the willingness of hospitals, health systems, and providers to embrace electronic patient access as a required use case for data sharing. But two important things have changed, and that leads us to what I think is the biggest next step in making interoperability have an even greater positive impact on health outcomes.
This brings us to the future of interoperability in healthcare.
Q. What does the future of interoperability in healthcare look like?
A. TEFCA, the government’s trusted data sharing framework, is going to be a huge driver of the future of interoperability in healthcare. While private national networks have been hugely successful in treatment-based sharing (Carequality members share just under 1 billion clinical documents per month), that still leaves a huge gap, the most important of which is individual access, as I mentioned earlier.
However, TEFCA has succeeded in making individual access a mandatory exchange objective for healthcare institutions asking about treatments.
Add to this great change the recent Epic announces that they are asking all of their customers to migrate to TEFCA-based exchanges by the end of 2025 – via Epic Nexus, a Qualified Health Information Network, or QHIN, under TEFCA. Now you have all the ingredients for individual access to gain widespread adoption.
Epic represents a large number of hospitals and healthcare providers. This move will serve as a catalyst for other EHRs, HIEs, and health technology vendors to transition their healthcare providers to the TEFCA-based exchange.
This means that by some time towards the end of 2025, we should all be able to use a TEFCA-qualified health app to access the TEFCA data exchange framework – and be able to make a single query to get all of our important medical history into one app of our choice. This will help us all better manage our own health information, which I believe is the key missing piece to truly enabling technology to improve health outcomes.
Ultimately, the decisions we as humans make every day have the greatest impact on our long-term health.
To step back and look at healthcare data exchange in general, I don’t believe that TEFCA will eliminate the need for other types of interoperability, such as direct point-to-point interfaces. There will always be a need for many different types of direct interfaces, using different healthcare data standards, because those standards and use cases are not going away.
But if we all have our own complete health records at our fingertips, we have a whole new opportunity for our caregivers to access our data at crucial moments in our health journey, rather than relying on what we or our family members can communicate or remember.
Personally, I remain committed to making all use cases for healthcare interoperability simpler, safer, and easier. However, I am most excited about the positive health impacts of making individual access a routine part of healthcare data exchange.
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