3 Key Pieces to the Interoperability Puzzle: #3 Query-Based Exchange + Directed Exchange

While advancements in interoperability are currently enabling pockets of health data exchange, more work is necessary to ensure that information sharing technologies support efficient and effective clinical workflows. 

In the third installment of our series focused on the elements of an effective interoperability strategy, we focus on the importance of combining query-based and directed exchange technologies to enable clinicians to provide appropriate care and improve care coordination with other providers and organizations.

Query-based and directed exchange are chiefly responsible for meeting the healthcare industry's growing demand for information sharing. 

Query-based exchange is vital for both episodic and longitudinal care. In urgent care or emergency facilities, clinicians often encounter patients for the first time. As the Massachusetts eHealth Institute notes, “clinicians often struggle to locate and access relevant patient information when they provide unplanned care,” so the ability to query, select, and retrieve existing patient information allows for informed clinical decision-making.

But query-based exchange also has benefits for planned care. For example, a specialist will want a patient’s complete medical picture and cannot rely on the referring provider alone for this information. “If the transition of care record received from a referring provider appears to be missing key elements,” query-based can be used “to obtain additional data from other sources,” adds MeHI.

For directed exchange, three common examples include a primary care provider sending an electronic care summary to a specialist for a patient referral, a specialist sending a summary of care document back to the referring PCP after seeing the patient, and a provider sending immunization information to a public health agency to fulfill regulatory requirements.

The healthcare industry is making considerable strides to advance data access and information sharing between disparate systems through the use of both query-based and directed exchange. Research shows that providers rely on both capabilities to ascertain the most pertinent information about their patients. While query-based and directed exchange are necessary for making the most informed clinical decisions, they often require different tools, which can prove disruptive to providers. 

“Where we stand today with interoperability depends on whom you ask,” says Bevey Miner, Chief Strategy Officer, Consensus Cloud Solutions. “If you talk to IT staff, they typically speak positively about how well the system is doing with interoperability. That differs from the perspective of clinicians who use data in their work with patients and view today’s system as disruptive and not aligned with the goal of having the right information, for the right patient, at the right time.”

Addressing this disconnect is essential. The disruption experienced by clinicians is likely the result of how directed and query-based exchange have evolved over the years. Instead of a simplified means for accessing both capabilities, clinical users must use multiple tools that create a disjointed experience. 

“There are many different ways to communicate with one another based on the kind of communication we want,” Miner explains. “Like any other industry, we have different networks. The original notion was to have one way of health information exchange to be guided by the government. But as the private sector takes on more of a role — which is to our benefit — there are very few examples of one way that works in our democratized society.” 

While these modes of health data exchange emerged to serve a particular purpose, they need to be made available to providers in a streamlined way. From a clinician’s perspective, the usefulness of any technology comes down to its ability to improve the patient experience and health outcomes. Clinicians must be able to communicate and share information easily with other providers to deliver high-quality care to their patients. 

To deliver a meaningful experience to clinicians on the front lines, healthcare organizations must work to eliminate disruption to clinical and operational workflows to ensure that their interoperability strategy meets with success.

“Optimizing clinical and operational workflows must first be addressed before we can advance the interoperability discussion to help improve care coordination and regulatory compliance,” Miner maintains. Managing unstructured data and integrating data from multiple EHRs are two areas where healthcare organizations can and should direct their focus, she adds.

The further development and use of health IT standards and application programming interfaces, especially HL7’s Fast Healthcare Interoperability Resources Release 4 (FHIR R4), will help toward empowering clinicians to make data-driven decisions that improve both patient experience and health outcomes. 

“History shows that organizations don't always aggregate around a common standard,” says Miner. "The support for common standards and use of APIs means that clinical users may be able to have access to information from disparate systems within their system of record.”

Access to information, however, is only the first step. Healthcare organizations must work to ensure that clinical users can act on this information in a meaningful way. Having to use separate systems to view information creates fragmentation and works against deeper adoption of these capabilities, which is essential to advancing interoperability.

“As organizations gain confidence and become more accustomed to data sharing, they will use the data more frequently,” Miner maintains. “In turn, more and more organizations will build relationships based on a commitment to high-quality care and comprehensive access to information, further increasing trust and willingness to share data.”

Gaining this confidence requires addressing gaps in health data exchange and implementing technology that leads to efficient and effective clinical workflows. Solutions that combine both query-based and directed exchange capabilities in user-friendly fashion will build support for interoperability from the bottom up.

Just as a rising tide raises all ships, combining query-based and directed exchange will lead to an overall improvement in patient care by removing data access as an obstacle to effective clinical decision-making. By ensuring that health data exchange tools are integrated smoothly into clinical workflows, healthcare organizations can realize the benefits of having the right information available to the right people at the right time.

While query-based and directed exchange are important pieces of the interoperability puzzle, faxing remains the most widely used form of health data exchange and raises a multitude of concerns if not secured and optimized. But a new type of electronic faxing is readily available that could prove beneficial immediately, which we will explore in a forthcoming special installment.

See the other articles in this series, 3 Key Pieces to the Interoperability Puzzle:

3 Key Pieces to the Interoperability Puzzle: #1 Query Based Exchange

3 Key Pieces to the Interoperability Puzzle: #2 Directed Exchange

Key Piece to Today’s Interoperability Puzzle: Cloud Fax