Interoperability: The key to unlocking a health care system that works for all

Today’s complex, fragmented health care system doesn’t always meet individual care needs. It can also be burdensome for providers and often costs more than it should.

The building blocks to create a better health care system are present, but they’re not connected in ways that maximize their use. For example, providers don’t always have ready access to a patient’s full medical history during a visit, which can unintentionally create blind spots. Providers also may not have the latest evidence-based clinical guidelines at their fingertips when they’re trying to make in-the-moment care decisions.

The existence of information is not the challenge. In fact, about 30% of the world’s data is created by the health care industry.  And within that abundance of information lies tremendous opportunities to deliver care that’s higher quality, better coordinated, and more efficient. But only if we’re able to put it to use. To translate data into meaningful information at the point of care, it must be unified and have the right analytics and modeling applied—and that requires interoperability.

What is interoperability?

Interoperability is the ability of different information systems, devices, and applications to exchange and appropriately use shared data. It’s critical in health care because having full access to all patient information, as well as relevant support tools and coverage requirements, allows for advanced data analytics and better clinical decisions that improve outcomes.

To enable interoperability, we need universal standards to ensure a common language and a common set of expectations across the health care system. If stakeholders use different languages and terminology in their systems, it makes it more difficult to ensure patients get affordable care in the right place at the right time. Interoperability standards ensure that patients, clinicians, payers, labs, hospitals, and pharmacies can share data no matter what application they’re using or what system they’re part of.

Application programming interfaces (APIs) play an important role in interoperability. They provide a protocol that helps software programs communicate. In health care, using APIs as part of electronic health record (EHR) systems makes it easier for patients, providers and payers to receive and share health information.

The EviCore by Evernorth focus on interoperability

As the market leader in automating artificial intelligence (AI) and establishing electronic prior authorization (ePA) connections, EviCore by Evernorth® along with Evernorth Health Services are focused on interoperability. It’s critical to ensuring patients get all the care they need and none they don’t. It also helps reduce the administrative burden for providers by helping them get to “yes” faster when they have prior authorization requests. For example, intelliPath is an internal cloud-based solution from EviCore that seamlessly connects to data in EHRs to automate prior authorization case creation and submission. Used by over 180 provider organizations nationally, this solution streamlines a process that can otherwise be cumbersome.

The Evernorth Digital Health Formulary® is a clinically based platform of verified, credible health apps designed to help patients better manage their sleep issues, anxiety, alcohol and opioid use disorders, and inflammatory conditions. It gives patients access to new and affordable options to improve and maintain their health while making it easier and cost-effective for payers to include these solutions in their benefit plans.

These initiatives are delivering on the promise of interoperability today as they enable the sharing of data and delivery of tools that lead to better patient outcomes at lower costs with less frustration for providers.

Partnering with CodeX to drive more-seamless connectivity at scale

Evernorth is also partnering with CodeX™ to ensure that we’re helping to inform and advance industry interoperability standards to drive more-seamless connectivity at scale across the health care ecosystem.

CodeX’s goal is to accelerate adoption of the HL7® (Health Level Seven International) FHIR® (Fast Health Interoperability Resources) standard. FHIR is an API-focused standard that allows for the exchange of EHR data between different computer systems.

CodeX is leveraging the work of the Da Vinci Implementation Guides, which we are supporting and developing. These implementation guides are sets of rules describing how to use HL7 FHIR resources, and they’re designed to help integrate FHIR into health care practices.

The Da Vinci prior authorization project involves three industry-standard APIs that will be provider/payer/EHR agnostic:

• Patient Eligibility – This API processes patient data to identify whether an individual is eligible for a requested service. If so, it determines whether prior authorization is needed and how to get it.
• Documentation, Template, Rules – This API works within the provider’s workflow to inform providers of the documentation and rules that need to be fulfilled to meet prior authorization requirements in a much more standardized way. 
• Submission of the Prior Authorization Request – This API allows for the EHR submission of prior authorization data and the receipt of responses from the payor via FHIR standards.

EviCore is working with CodeX to pilot this approach with oncology, but we see opportunities to expand to other solutions as well. In fact, many APIs are being developed beyond the Da Vinci project that focus on general interoperability, and we will continue to work to inform and leverage those efforts.

Through initiatives including intelliPath, the Digital Health Formulary, and CodeX, we are at the forefront of delivering interoperability not only to the people we serve directly but to the entire health care ecosystem. It’s the key that unlocks a better health care system for all.