Host Jay Anders, MD welcomes John Blair, MD, CEO of interoperability communications company MedAllies and an expert on moving medical information for a discussion about interoperability and how it is slowly starting to take hold throughout healthcare.

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Dr. Anders begins with an anecdote from his days working as a physician in a large multi-specialty group practice. Although the practice had a unified medical record, with a big staff, 28 specialties, and a high volume of medical records, it was tough to get records moved from one place to another––even within the same facility. The practice had a solution that would track records, but they also tracked them independently so the staff would know in which office any chart was located.

One ENT surgeon tended to ignore rules and stored charts in the trunk of his car, so the chart management system included a location of “Trunk.” The practice routinely had vans shuttling between clinics transporting charts, and the apex of “interoperability” at the time was the ability to fax all or portions of a chart. The problem was, the person on the receiving end of one, two, or even 50 pages had to read the whole things and decipher what was sent.

TEFCA and QHINs––Changing the Status Quo

Dr. Blair, who worked in an academic setting before moving into private practice, notes that although much has changed in the world of medical records management and interoperability, many of these scenarios remain. Dr. Anders then asks about the new Quality Health Information Network (QHIN) and certification.

As the former president of a 5,000-physician organization spread over eight counties in New York, Dr. Blair has been examining the issue of interoperability and seeking solutions for over 22 years. The quest to solve the communications dilemma between providers led to the advent of direct messaging and one of the largest national Direct networks in the industry, which has been operating for a decade.

Around 2016, the federal government started showing interest in interoperability, which led to the Trusted Exchange Framework and Common Agreement (TEFCA). Despite some early doubts about TEFCA’s viability, Dr. Blair now believes the project’s leadership is strong enough to push it over the goal line.

In late spring of this year,  The Sequoia Project, which the ONC selected to support TEFCA’s implementation, announced the process and requirements for becoming a QHIN. So far, half a dozen or so companies have announced that they intend to apply––as does MedAllies. Companies that pass the rigorous qualifying will essentially earn a “Good Housekeeping seal of approval on interoperability,” according to Dr. Blair, which should go a long way toward corralling what has been “a bit of a wild west on interoperability.”

Interoperability in Practice

Dr. Anders asks about MedAllies and its work in interoperability. Dr. Blair notes that the company started in 2001 in response to work being done in his large physician organization around quality and cost. In addition to digitizing physician practices, the company did a lot of EHR work, which led to digitizing practices and establishing interoperability. Starting with a traditional health information exchange on a regional level, they integrated hospitals to create a longitudinal health record.

Moving into the next decade, MedAllies focused on transitional care and primary care practices referring to specialists, hospitals discharging patients, and consults coming back from specialists to primary care before pivoting to national Direct networks. Since the announcement of TEFCA, the company has focused heavily on QHINs and the Carequality query-based approach to networks, realizing that the push model is not enough to cover all use cases in healthcare.

Dr. Anders asks about the repository structure of QHINs, and Dr. Blair explains that it will connect ubiquitously (not just locally or regionally) across the healthcare ecosystem, with data residing locally at endpoints––EHRs, payer platforms, and other locations. And with the two-way query/response model, the requesting entity will receive information that is closer to what they expect, as opposed to receiving 100 documents that must be reviewed and filtered.

As for what’s next, Dr. Blair believes the next frontier is curation, de-duplication and presentation of that information.

Dr. Anders brings up the fact that smaller and rural providers remain disconnected, and wonders who will be connected to this network. Dr. Blair points out that that most hospitals are connected or capable of being connected but are not using the technology. Whether this is due to improper configuration or lack of training remains to be determined. So the issue is more about investing in setup and training, and less about basic connectivity.

So what is level of involvement for patients? Dr. Blair believes it is time that patients were involved and compliments the government and the industry for making strides. Although technical and security questions remain, there is good work being done to address these. And by mid-2023, he believes that patients will be able to query and receive responses from 75% of network participants.

Dr. Anders circles back to the issue of the query/push model, noting that when someone makes a query and receives 65 pages of information, the request has been fulfilled with the receipt of the medical record, but sorting and finding the required information is a challenge. Dr. Blair notes that there are summary documents available today, but that QHIN will require a summary Clinical Document Architecture (CDA) that is searchable.

Push is very succinct, while query can bring in much more information. But each has different use cases. For example, EHR providers want query so they can find the needles in the haystack, while a specialist receiving a referral doesn’t want that volume of data. So there is work to do on the query side to make it serve up meaningful, succinct data.

If there were one thing you could change…

Dr. Anders closes the podcast with his signature question, “If there were one thing in healthcare or healthcare IT you could change, what would it be?”

“I don’t think it’s a question for healthcare IT, but for our healthcare system,” says Dr. Blair. “If we could change the reimbursement system and pay for value––that is, higher quality and lower cost. We talked about connectivity, but then there’s not the funding to configure and train providers and their staff. So if you sprinkle a little funding on these problems and try to address them, it’s not the IT side of it, but the adoption and usage side which I think gets back to reimbursement. If you are reimbursing for transitions of care and care coordination, we wouldn’t be talking about this anymore.”

Tune in here to hear more.