November 2, 2021


Massachusetts: Leading the Nation in Healthcare Interoperability

By Minal Patel, CEO of Abacus Insights

Patients may not realize it, but as of July 1, healthcare has changed forever. The Centers for Medicare & Medicaid Services’ (CMS) widely-anticipated Interoperability and Patient Access Rule finally arrived, improving how providers, electronic health records (EHRs), and insurers exchange health data for good — and, most importantly, placing unprecedented control of health data directly into the hands of patients.

Much of the rules about sharing healthcare data that are taking place today build upon the leading work in Massachusetts that has been underway for well over a decade. The exchange of health information across health systems, health plans, and patients in Massachusetts has produced a multitude of benefits, as better data has translated directly to reduced costs, better quality of care and improved patient experience.

Now, those benefits will soon be realized across the country. It may sound complicated, but the lack of interoperability in healthcare is something that has impacted all of us on some level. Ultimately, interoperability means getting the right data into the hands of both the patient and provider at the right time. How many families, for example, have had to take a child to a specialist, only to have to start from square one with their pediatrician for a follow-up appointment?

Interoperability allows patients to get an X-ray in the ER over the weekend without having to order another from their primary care provider Monday. Instead, their primary care provider will be able to see the results of that initial X-ray, saving the patient from having to undergo an unnecessary, redundant, and potentially harmful second scan. In the absence of interoperability, this type of situation happens regularly to people across the country.

Over the past year, states have been scrambling to create interoperability networks that allow valuable healthcare data to flow from one organization to another without friction, delays, HIPAA violations, or other transmission or privacy issues. Massachusetts is not one of those states.

Massachusetts, which ranks near the top (if not at the top) when healthcare quality is evaluated state-by-state, is home to some of the world’s top universities and has a well-deserved reputation in biotechnology innovation. Lesser known, the state has also been a long-time innovator in data interoperability and was early to grasp the idea that global or national connectivity for healthcare information begins with regional connectivity.

Massachusetts has a head start in many ways due to the Massachusetts eHealth Collaborative, a nonprofit that pioneered EHR adoption and interoperability. The eHealth Collaborative was led by then-CEO Micky Tripathi for over 15 years. Tripathi, who was tapped by the Biden Administration to lead the Office of the National Coordinator for Health Information Technology (ONC) this past January, was instrumental in helping Massachusetts build regional networks and healthcare connectivity long before “health IT” became buzzy and data interoperability became a federal mandate.

The Road to Interoperability

In 2004, the ONC was established to encourage the adoption of electronic health records, build a National Health Information Network and create local enablers of data exchange called regional health information organizations (RHIOs).

Tasked with managing the transfer of healthcare information electronically across organizations, RHIOs were among the most important pieces of the puzzle when it came to growing EHR adoption. When ONC issued its RHIO directive, Massachusetts was ready to hit the ground running. A decade before, the state had created Affiliated Health Networks of New England and Chief Information Officer Forum working groups, following it up two years later with the New England Healthcare Electronic Data Interchange Network. These stakeholders gave Massachusetts an early jump on creating local and connected pools of healthcare data, and they have proven to be the reliable infrastructure that is needed for the unfettered flow of information. Despite early progress, a significant hurdle still remained when it came to sharing data in 2004: A scant 15% of healthcare providers in the state were using EHRs, meaning most healthcare data was in rudimentary silos existing within independent healthcare organizations.

This was the case across the country. In fact, EHR adoption wasn’t widespread until the 2009 stimulus plan’s Meaningful Use initiative, which spurred electronic sharing of medical information from one facility to another through EHRs and health information exchange (HIE) networks.

Prior to the widespread adoption seen nationwide after 2009’s Meaningful Use initiative, EHR adoption jumped dramatically and quickly in Massachusetts early on, setting the stage for a connected, data-driven healthcare system across the state. When the Massachusetts Chapter of the American College of Physicians made promoting universal adoption of EHRs in physician offices in the state their highest priority in 2005, Blue Cross Blue Shield of Massachusetts pledged to invest $50 million to make fast adoption a reality. That investment spurred the establishment of the Massachusetts eHealth Collaborative and set the stage for what would become the most interconnected health ecosystem in any state across the country. But the journey to true interoperability is just now beginning.

Patients Benefit from Interoperability

Interoperability has clear advantages for health plans, healthcare providers, and EHRs. Empowered with the ability to capture and harness patient data as it flows across systems and applications, these healthcare organizations are better prepared to reduce diagnostic errors and clerical hiccups that too often negatively impact patient outcomes and experience.

What’s often lost when talking about interoperability is the impact it will have on everyday consumers of healthcare, especially when combined with data management platforms that enable advanced analytics. For patients, it translates as an improved experience when interfacing with the healthcare system — fewer forms to fill out before an appointment, more face time with providers, no more having to start from scratch with medical and medication history from one provider to the next, and the ability to take your health data and shop freely across the healthcare market without being anchored to a single healthcare entity — non-trivial desires we as patients have been wanting for decades.

Partnering with Abacus Insights

Recently, a health plan partnered with Abacus Insights to accelerate supporting their members and providers with all of the benefits of the CMS interoperability rule by powering and enabling their data transformation journey. The Abacus Insights interoperability solution standardizes, curates and enriches data from multiple sources leveraging industry standards such as Fast Healthcare Interoperability Resources (FHIR), a standard specified under the CMS rule to assist health plan’s efforts to share data between patients, providers’ offices, hospitals, pharmacies, labs and numerous digital health applications.

In addition, interoperability enables providers to spend more quality, productive time with patients by reducing some of the more redundant data entry obligations that have contributed to increased clinical burden and provider burnout over the past few decades.

Thanks to the accelerated data transformation strategies of forward-looking health plans and their partnership with Abacus Insights, consumers across the nation are increasingly benefiting from emerging patient-facing health applications, which offer greater control over personal healthcare data and make it easier to proactively manage their health.