Interoperability in a Time of Healthcare Crisis: A Q&A with Paul Wilder of CommonWell Health Alliance: Part 1
Since 2013, CommonWell Health Alliance has been connecting healthcare organizations and other members of the healthcare industry through the shared cause of promoting interoperability. With the emergence of the COVID-19 pandemic and the finalizing of the 21st Century Cures Act, the need for improved interoperability has become even more evident.
In our continual journey to improve interoperability and as member of CommonWell, we constantly look to them for advice, direction, and collaboration. The Executive Director of CommonWell Health Alliance, Paul Wilder, shared with us his experiences with integrated delivery networks (IDNs) and offered his view on some current interoperability issues.
In part one of our Q&A, Wilder touches on how issues like COVID-19 factor into the formation of a national healthcare data network. He also covers parts of interoperability that show progress as well as areas for improvement.
MEDHOST: Tell us a little bit about yourself and your vision for the future of interoperability.
Paul Wilder: I’ve been at CommonWell for about six months and it’s been eye-opening in a positive way. I have worked in HIE (healthcare information exchanges) for about 10 years and came to CommonWell because there are a lot of problems in healthcare. We’ve all experienced the inability for records to transfer from one place to another.
My first brush with interoperability, or lack thereof, was when my daughter was born. She was born in New York City and we lived in Hoboken, NJ – about four miles away from the hospital. She had some issues in her first few days of life and when she saw her local pediatrician in New Jersey we had to go back to the hospital.
We went to the nearest hospital in New Jersey. None of her data could get transferred from the hospital where she was born in NYC – which was four miles away. I said, “This can’t be right – you can’t have a healthcare system with all these fancy tools and technology and not be able to transfer records from four miles away.”
At that point I started working in HIE and records management with the New York eHealth Collaborative and I eventually made my way to CommonWell. CommonWell allows me to work on improving interoperability at a much larger scale with a different focus on solving HIE practical interoperability problems from an EHR and vendor perspective.
MH: In your new role how has interoperability evolved from when you started and what is your vision for the future?
PW: When starting in a leadership role with an existing company, you begin looking at where you can and may need to tweak things to improve efficiency and productivity. What are the things that are important to the Alliance and are they there for a reason? Where are things not working? In my time here so far, I’ve learned where we needed to be and what we need to prioritize.
From a personal perspective, I would really like to see our patient access use case improve. We’ve had a patient access use case for a couple of years. It was a slow start and difficult to verify patients and match them across records. We’ve learned a lot and we’ve improved, but I think it’s time to start taking it to that next level without bending the security curve in the wrong direction. We have to be very careful about privacy and patient data, but I’m excited to be able to work on that.
There has also been a tremendous amount of other use cases. Especially recently with how to assist public health. With COVID-19 in the backdrop of everything in healthcare right now, I think there’s a lot more our services can do to help there.
Something like COVID-19 is a use case that’s not currently inside our national network, partly because a lot of public health is local and state governed. I’m talking to a lot of people about how we can help accelerate data access for public health – accelerate research. As a byproduct we can potentially get patients engaged with what their data is and how it’s useful.
MH: How do you think the COVID-19 highlights the need for greater interoperability and access to patient records?
PW: I think this pandemic is opening up a lot of eyes into what we have infrastructure-wise as well as what regulations we have concerning patient privacy and security. I also think this shows where we can bend things little bit when it becomes necessary.
You never touch the security we put around patient data partially because patients don’t understand the danger. That being said, it is difficult to really understand what’s going on without insight into data. There are a lot of people right now trying to use secondary data to identify patterns with COVID. I don’t think we have good research or background data on comorbidities in relation to this virus.
When it comes to opening the economy and all the data involved around that, I also think there’s a big epidemiology gap. We don’t yet know how to treat the disease because people don’t have mass aggregated data to make those insights. We have enough people infected now that are tested, but we don’t have their historical data to analyze and to find clinical patterns – who is most likely to recover on their own versus someone who will need more help.
I think access to at least deidentified COVID data sets would help – evidence-based research for clinicians to make better clinical pathway decisions.
MH: Is research and data collection around comorbidities something that should have already been in the works?
PW: There are intentional blockages around this kind of data because if it’s stolen, not just healthcare is impacted. A patient’s livelihood is dependent on their data being secured. It’s much easier to steal someone’s financial history and financial records if your health record is stolen. But there are ways to anonymize data and allow us to aggregate it so people can do research. The problem is it’s really hard to deidentify this data.
People forget that – while we think about EHRs being relatively new – some of our biggest academic healthcare institutions have been storing patient data decades on. Back 18 years ago, when you were doing clinical analysis and writing reports, all this stuff wasn’t done with the understanding that it would have to be anonymized later.
The challenge here is, the worst time to prepare for a disaster is during it, and I think that’s what we are seeing right now.
MH: Talk about the importance of interoperability in relation to emergency preparedness and disaster recovery.
PW: While you’re in the middle of something, you do what you have to do. You can’t help your neighbor if you yourself are struggling. It’s important that everyone does what they need to do public health wise, while also thinking about what to do next. What to do next is more connectivity and there should be more conversations about triaging data.
The moral of the story is it’s time to move towards interoperability if you haven’t and it’s time to become more interoperable if you already are.
As it comes to emergency preparedness, we would be more prepared if we were more connected. If we had a single patient identifier across the country, our job would be a heck of a lot easier. A lot of our time is spent on trying to match records across disparate systems. That’s a good question for the future – Is there something we can activate to get us better at patient matching when we really need it?
I did hear from members that there are more patients trying to get access to data right now. I think this is because of the pandemic’s economic impact. When filing for things like unemployment people need access to their clinical records. Increasing the ability for patients to access records securely is likely a big administrative burden for a healthcare facility. We need to think about better ways for patients to access records when they need them – securely, without it being difficult for the healthcare facility. We also need to think of interoperability as a means of supporting administrative workflows including patient access.
Check back here on our blog for part two where we talk more about the COVID-19 crisis and touch on some other key promoting interoperability topics.
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