AI, Semantic Interoperability Top Health IT Trends for Next Year

Leveraging Health IT to Deliver Better Care

Titus Schleyer, DMD, PhD, a research scientist at the Center for Biomedical Informatics of the Regenstrief Institute, expects the industry's focus on AI to continue into 2024.

"A big trend is artificial intelligence, large language models, and how we should construct healthcare to perform better given all this technological support and all these technological innovations we have," Schleyer told EHRIntelligence in an interview.

However, he emphasized that amidst the AI buzz, delivering better healthcare in simpler ways should always be top-of-mind.

"Lots of people in this country and elsewhere don't get the healthcare that clinical guidelines say," said Schleyer, who also serves as a biomedical informatics professor at Indiana University School of Medicine.

"They either don't have access to the care that they need or if they do, the clinical environment isn't such that it's very good about doing simple things that will help people stay healthy."

Schleyer pointed out that social determinants of health (SDOH), such as food security and transportation, play a significant role in care outcomes. Studies estimate that clinical care impacts just 20 percent of county-level variation in health outcomes, while SDOH can affect as much as 50 percent.

Focusing health IT innovations on ways to address these upstream factors of health, such as access to nutritious foods, could help the industry improve care outcomes while cutting down on burgeoning costs related to disease.

For instance, according to the American Diabetes Association, national healthcare costs attributable to diabetes have increased by $80 billion in the past decade, jumping from $227 billion in 2012 to $307 billion in 2022.

Schleyer noted that people who lack access to nutritious food have a high caloric intake and are more likely to be obese, which is a risk factor for diabetes.

"The causes for a lot of our health problems, we have to look for in much more upstream areas," he said. "I wish that we would focus our pursuit of technology to do those things because they are known to work. A person who exercises regularly and has access to decent food is much less likely to develop diabetes than the person who doesn't."

AI-Fueled Semantic Interoperability

According to Scott Stuewe, president and CEO of healthcare industry alliance DirectTrust, AI could help advance semantic interoperability across the care continuum in 2024.

Semantic interoperability "provides for common underlying models and codification of the data including the use of data elements with standardized definitions from publicly available value sets and coding vocabularies, providing shared understanding and meaning to the user," according to HIMMS.

Put simply, semantic interoperability means that two or more systems can exchange data accurately with a common format and meaning.

Stuewe noted that AI could go a long way in streamlining health information exchange. For instance, stakeholders are leveraging AI to create standardized clinical documentation from unstructured text.

"We're seeing this in the context of fax messages that organizations receive, and then they use AI to produce structure from the text," he said.

Basically, healthcare organizations are able to produce a Consolidated Clinical Document Architecture (C-CDA) formatted document from a fax message leveraging AI.

"We're going to need to really pay attention to AI because it may change the requirements for a lot of the standards that we have in place," Stuewe said. "It may make the need for data to be reliably coded less important, which I think would be, on the one hand, very disruptive. On the other hand, probably a pretty good thing."

Stuewe also mentioned that the recent launch of The Trusted Exchange Framework and Common Agreement (TEFCA) will be a "big feature of the interoperability story in 2024."

TEFCA aims to increase access to health data and improve interoperability between healthcare providers and payers through a network of networks approach.

Stuewe explained that while TEFCA could make it easier for healthcare providers to access patient health data, the framework doesn't solve the issue of data usability, which stands as a major challenge across the care continuum.

A recent Medical Group Management Association (MGMA) poll found that improving EHR usability is medical group leaders' top health IT priority. The most common usability goals mentioned by respondents for the next six to 12 months centered on improved interoperability.

"I'll be watching for improvements in usability," Stuewe said. "I think that's going to be really important."

Meaningful Enforcement of Information Blocking Provisions

Sean Sullivan, a healthcare regulatory and compliance attorney at Alston & Bird Law Firm's Atlanta office, expects the healthcare industry to continue its slow march toward interoperability.

Expected policy-driven improvements for interoperability in 2024 include a newly finalized HTI-1 rule from ONC that adds enhanced data exchange requirements for certified health IT.

Sullivan also noted that ONC has a proposed HTI-2 rule that will likely update health IT certification standards further.

"I think that the government is doing its part to push things along, but in my view, where the government is not really doing its part, is moving things along quickly enough and making sure that there is meaningful enforcement of information blocking," Sullivan said.

ONC's 2020 Cures Act Final Rule implemented key provisions of the 21st Century Cures Act, including the prohibition of information blocking, which refers to preventing or interfering with the access, exchange, or use of electronic health information (EHI).

There hasn't been a practical enforcement mechanism for the regulation until recently when the HHS Office of Inspector General (OIG) released a final rule with information blocking enforcement policies.

Effective September 1, 2023, OIG has the authority to investigate reports of information blocking across certified health IT developers, companies that resell certified health IT, health information networks, and health information exchanges (HIEs). Stakeholders could be subject to up to a $1 million penalty per instance of information blocking.

However, Sullivan noted that OIG has not begun enforcement of the information blocking provisions.

If OIG does not start investigating instances of information blocking a few months into 2024, Sullivan suggested the potential need for congressional oversight.

As the healthcare industry continues to navigate AI, semantic interoperability, and regulatory advancements, the overarching goal remains focused on leveraging health IT to bolster care outcomes.