Segment 6: Interoperability Can Add Value to Care Coordination

Data interoperability is still a challenge among practicing physicians and health plans, mainly because each system operates on its own standards and vocabulary, explained Jason C. Goldwater, MA, MPA, senior director, National Quality Forum. In a panel discussion with Linda Bosserman, MD, assistant clinical professor and staff physician, City of Hope, and Jennifer Malin, MD, staff vice president, Clinical Strategy, Anthem, the speakers agreed that more needs to be done to bridge the gaps between various systems.

Mr Goldwater explained that diverse systems operate on various data standards and coding sets because there is no mandate that requires a unification of measures. Though there are certain codes and vocabulary that are used universally among clinicians in the oncology field, the lack of interoperability remains.

“Why it’s been difficult to take data from different systems is because you have to ensure that the data stays structured. But, you also have to ensure that the data is semantically correct, that it’s giving the appropriate information,” Mr Goldwater said. “And, when you have these differing vocabularies and different ways of exchanging information,” things gets complicated, he said.

Mr Goldwater believes that one of the reasons for this lack of effective data exchange across systems is that physicians and health plans are still trying to figure out ways of uniquely identifying each patient. He explained that not everyone is assigned to a patient identifier using a patient master index or coding scheme, so referencing a patient and locating their data records remains a challenge.

Dr Bosserman added that developing electronic systems that bridge the gap between systems is an ongoing project. However, a part of the reason for this lack of interoperability is a focus on the wrong data measures when inputting patient information. Dr Bosserman explained that measures such as diagnosis, treatment decisions, complexity, toxicities, and medications should be the key focus points for physicians when it comes to these data sets. She added that this data is far more valuable than any compliance for billing and collection information, and recommended that providers and health plans should move away from volume-controlled measures and toward value-based compliance.

“All of those elements go in to the actual measures but more importantly, it’s going to give us the real outcome data on how did this patient do. Did they live well? Did they have side effects? Did we ultimately improve their survival, their disease free survival, and their quality of life?” Dr Bosserman said.