New Survey Highlights Future of Interoperability

By Matt Phillion

Interoperability comes up often in healthcare. With the increasing need for portability of patient data and technical advancements happening at a record pace, the healthcare industry is at a crossroads when it comes to health data exchange. Regulation agrees: The 21st Century Cures Act and the Trusted Exchange Framework and Common Agreement (TEFCA) both set the stage for significant increases in the sharing of health information between trusted parties. Federal mandates and incentives are helping to speed up this movement among healthcare stakeholders to enable secure, nationwide health information exchange.

Health Gorilla, a Health Information Network and interoperability provider, recently released its inaugural 2023 State of Interoperability report in collaboration with Flexpa and the Health Management Academy. This report collects insights from more than 130 executive decision-makers across the healthcare ecosystem, including health systems, EHRs, digital health organizations, and diagnostic labs. It addresses emerging trends and perspectives in the areas of data interoperability, quality, patient access, participation in national exchanges, regulations and federal initiatives, and more.

“The first thing that jumped out at me was that so many people responded to the survey from a bunch of different perspectives, and we got really interesting data from them,” says Steven Lane, MD, MPH, chief medical officer with Health Gorilla. “This is something nobody else has been able to do.”

Other surveys have targeted specific slices of the healthcare world, but this report sought to gain insight from various stakeholders across the ecosystem. And those respondents had a lot to say:

  • Health system executives said that only 2% of their data is perfect or near-perfect quality
  • Over 50% of health system CIOs plan to spend 5%–20% more on interoperability initiatives this year
  • Respondents want not just new data but new data types, with 80% stating they want complete clinical data from other EHRs to enrich their own data
  • 69% of digital health respondents said they had gaps in their data

The study also found that there is enthusiasm for TEFCA and what it will mean for the industry. The vast majority of health system CIOs responded that they support TEFCA, and 58% of CIOs support sharing health information for purposes beyond treatment—such as individual access services, payment and operations, and research.

TEFCA “constitutes the next iteration of interoperability,” says Lane. “A lot of work has been done with individual networks to build the initial framework and allow all networks to connect with each other; all those folks can now exchange under the Carequality interoperability framework. But that’s been driven by the market. With TEFCA, the government gets involved and can drive participation.”

The progress made so far hasn’t closed all the gaps, Lane explains, adding that while the industry has taken great steps since the 21st Century Cures Act came into existence, the report shows how much further there is to go.

“And the respondents are really positively oriented toward TEFCA. They not only see that it has technical standards and requirements, but what we’re seeing among health IT leaders is an awareness of changing standards and enthusiasm for the exchange of data,” he says.

The existing national framework came out of the marketplace, but TEFCA will involve government oversight, and as standards advance, those changes will be baked into TEFCA, Lane explains. TEFCA participation will be completely voluntary at first, with the initial use cases already identified to support treatment and individual access services.

“It’s not happening 100%—people do still send faxes, etc.—and there’s always an opportunity to bring people on board to get them to use the push messaging functionality. But with TEFCA, we’re starting with those two things, and very quickly it’s going to advance to support payment, healthcare operations, and other use cases,” he says. “What we heard from the folks surveyed is they’re already getting in line with these requirements.”

Getting labs on board

Although 68% of lab respondents share data into health information exchanges, the report also found that 76% of them contribute only to regional exchanges, 26% reported data sharing was not a priority, and 10% believed that data sharing mandates do not apply to labs.

“I’ve been promoting interoperability for 15 years as a clinician, and I know data exchange is critically important to providing high-quality and safe patient care,” says Lane. “Lab data exchange is one of those bugaboos in all this. Lab data is complicated and often isn’t apples to apples, with different labs using different methodologies, different machines. Not only do we need greater access to lab data, but also substantial analysis for it to be truly useful for recipients.”

While there is real excitement about the new information blocking prohibitions and advancement in the sharing of data, lab data remains hard to get to, Lane says. “Labs are specifically identified as providers under the information sharing requirements,” he says. “They must, by federal law, make their data available in the manner and method requested without requiring special effort on the part of the requestor.”

In reality, many labs haven’t gotten to this point. They may mistakenly believe they aren’t a provider—or perhaps they’re waiting to see what the penalties for noncompliance will be.

“It did jump out at me, this acknowledgment that lab data is still really hard to get. It’s easy to get that information from the providers once they have it, but we’ve not seen this clear movement toward a broad standard of interoperability between labs,” says Lane.

Discussion of EHR access

The report addresses several points regarding EHRs. Thirty-two percent of EHR executives are actively evaluating Qualified Health Information Networks (QHIN), and their choice will be influenced by factors such as existing integration/relationship (76%), technology capabilities (60%), and pricing (56%).

Meanwhile, 33% of digital health organizations rely on a third-party intermediary vendor to access patient data from other EHRs. There was interest among respondents in accessing additional data types, such as claims data (58%), PROs (42%), and pharmacy data (39%).

“The report did highlight the needs of digital health—a really interesting new part of the ecosystem with telehealth care management, retail health, etc.,” says Lane. “When you stand up a business like this, putting yourself out there to offer episodic healthcare, the idea is healthcare consumers have a lot of choices regarding where to go, but if those places have no idea who the consumer is, what medications they’re on, the quality of care is going to suffer. We don’t want to trade efficiency and choice against quality.”
It’s encouraging to see digital health organizations engaging through companies like Health Gorilla, says Lane. “They’re addressing not only their need to get data, but also to facilitate workflows,” he says. “I like the fact that these digital health executives are eager and excited and appreciate there are gaps in their data to improve. That’s great—let us help you find those gaps, manage your workflows, and improve.”

Naturally, obstacles will crop up on the way to improving interoperability, but Lane is encouraged by the “clarity and understanding on the part of the industry and the general willingness to jump in,” he says.

Providers and payers are very much on board, he says, though there are differing systems, views on use cases, and the like to consider. But adopting a common set of standards and enabling access to data across formats using a single on-ramp like TEFCA is the right direction to head in.

“Once you bring folks together—researchers, community-based organizations, all these participant groups who have not been included in the existing interoperability framework—I think we’ll see more data, more participants, and then these standards will be promulgated and we’ll see more use cases,” says Lane.

The voluntary nature of TEFCA will also need to be worked through. “There are always going to be early adopters, but then there’s the great middle who won’t come along until they’re required to,” he says. “But if we celebrate [our victories] and then incentivize enough people to start moving forward, then we’ll see progress.”

Matt Phillion is a freelance writer covering healthcare, cybersecurity, and more. He can be reached at