Socioeconomic conditions are widely regarded as the top driver of inequality in healthcare.
In the health IT industry, it seems difficult to determine how best to help promote greater health equity, but the answer for many of us is to enhance interoperability of health information.
First, let’s be honest: the U.S. effort to fight broader health equity is a complex, decades-long cause that requires many long-term economic, social and political challenges. Interoperability is far from silver bullets to solve these historic social problems. Instead, interoperability acts as a enabler, with about tens of thousands of ways to reduce the gap in healthy equality.
In addition to the disclaimer, interoperability is the ability of the system to securely connect and exchange information, and does provide physicians and other providers with more comprehensive and accurate health information, providing effective needs for patients and their caregivers, as well as health care payers, and others in making routine and approved decisions, providing potential to improve the quality of care.
In-depth understanding of patient needs
According to an article in the magazine BMC Medical Informatics and Decision-making. Patient health information is often dispersed between multiple healthcare facilities and other data holders, making it inaccessible to providers outside the original institutions. As a result, unless the patient is conscious, willing and able to communicate, thus hindering fully wise decision-making, health care professionals may lack critical medical information.
To make informed decisions about appropriate prescriptions, procedures, and other interventions, healthcare professionals need access to patient information, which is typically distributed across multiple institutions. When the lack of such information leads to errors, solving the problem becomes more challenging, even if not feasible. Therefore, better interoperability is needed.
The article says that the lack of interoperability leads to “superfluous, confusing, disconnected and unacceptable medical information that may affect the quality of care provided to patients and the quality of waste financial resources”. Instead, improved interoperability can provide patients with better and safer care while enhancing public health and health services management.
As a practicing physician, I see the value of interoperability every day. A common situation involves maternal health. Pregnant women often receive prenatal care in a different health system than the place they are delivered. After birth, their babies may receive pediatric care in another system. Additionally, sometimes new mothers move to different parts of the country during perinatal period.
Interoperability allows us to access important data about mothers and children in different settings and institutions to ensure that clinicians have all the necessary data for completely wise decisions.
The latest federal program, known as TEFCA (Trustful Exchange Framework and Common Agreement), is designed to establish the technical standards needed to support and expand the interoperability of key healthcare stakeholders for multiple exchange purposes.
The Paradox of Interoperability: Too Much Is a Bad Thing
An often overlooked, paradoxical aspect of interoperability is that it leads to sharing specific patient information with providers with whom the patient is reluctant to share. According to Shift Cromporative, when this happens, the health IT system effectively forces patients to choose between care and privacy.
Shift highlights some thought-provoking use cases that illustrate why patients can seek to share some of their health information freely with some providers or institutions, such as Health Drivers (SDOH) data. For example, consider a situation where a woman with intimate partner violence or other social health problems wants to keep the information confidential. She is concerned that such information is visible in the patient portal, shared between health care systems or accessed by third-party applications that may not meet HIPAA privacy standards.
This is important because details about the patient's SDOH, such as education, housing, income, food insecurity or experience of violence, are essential to providing integrated care, but they can be very sensitive. When such information is shared through a system that lacks strong privacy protection, patients may face serious risks, including stigma, discrimination or threats to their personal safety.
Without fine-tuned privacy controls, SDOH and other highly sensitive data may be discussed or exposed, especially when shared with community organizations or mobile applications outside of traditional healthcare environments. This situation underscores the urgent need for consent perception systems that help protect patient autonomy and coordinated care. (A valuable work by another group to support the proper exchange of SDOH data is the Gravity Project, which is developing technical standards for sharing this often complex information.)
in conclusion
Improving the interoperability of health information has a meaningful commitment to promoting health equity by enabling health care providers and other stakeholders to have a more complete understanding of the patient’s medical history and other relevant information. It empowers patients and caregivers to enhance clinical decision-making, reduce redundancy, and support safer and more coordinated care – especially in complex situations such as pregnant women’s health, behavioral health, and a variety of chronic diseases. However, as we expand data sharing, we must also recognize the risks posed by exposing sensitive patient information without proper safeguards. Ensuring interoperability efforts are based on security, consent awareness, respect for privacy systems and are essential to protecting patient autonomy and promoting equitable care. Ultimately, thoughtful, secure interoperability could be a powerful catalyst for closing the healthcare equity gap.
Photo: Leowolfert, Getty Images
Dr. Steven Lane is the Chief Medical Officer of Health Gorillas and is a nationally recognized leader in interoperability of health data. As a practicing primary care physician, he brings profound clinical insights into his work promoting the exchange of health information across the country. From 2020 to 2024, Dr. Ryan served as chairman of the Nursing Steering Committee, helping guide one of the most influential interoperability frameworks in the United States. He has also served as a federal consulting body, such as the Health Information Technology Advisory Committee (HITAC) of ONC. In Health Gorilla, he bridges the gap between policy, technology and frontline care to ensure data exchange has real-world clinical impacts.
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