ATA Panelists Discuss Challenges, Promise of Telehealth Interoperability

A panel of telehealth experts convened by the American Telemedicine Association says telemedicine will only flourish if providers, patients and payers can come together to promote interoperability.

That was the main takeaway from an American Telemedicine Association webinar this week, the opening salvo in a long-term campaign by the organization to promote scalability and sustainability by getting all parties in the connected care ecosystem to work together.

But while healthcare providers envision a telehealth system that allows real-time access to data across all platforms, the panel of experts convened by the ATA noted that interoperability includes getting patients, providers and payers onto that platform.

“In many ways it’s the future of telemedicine,” said Andrew Watson, MD, MLitt, FACS, UPMC’s Vice President of Clinical Information Technology Transformation and the ATA’s president.

And as of now, that isn’t happening.

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Described by ATA CEO Ann Mond Johnson as “a barrier to adoption,” telehealth interoperability is currently mired in competing interests – between pay-for-service and pay-for-value, consumers and providers, and clinical interests and business cases. It’s siloed in departments and programs that have proven telehealth’s value but haven’t been scaled out to the enterprise or embraced by the entire health system. And it’s been stymied by parties who see value in data but not in sharing it.

“Interoperability is also a challenge from a business process standpoint and a business standpoint,” noted Robert Wah, MD, a former president of the American Medical Association who now serves as the Global Chief Medical Officer of DXC Technology.

From that standpoint, he said, patients are seen as a source of revenue, so their health information is valuable and should be seen as proprietary. But from the healthcare provider’s standpoint, that data needs to be shared so that everyone can collaborate to improve clinical outcomes.

From a clinical standpoint, the key to interoperability is the electronic medical record platform. Karen Rheuban, MD, a former ATA president who’s now a Professor of Pediatrics and Senior Associate Dean for Continuing Medical Education and External Affairs at the University of Virginia Health System and co-founder and director of the Karen S. Rheuban Center for Telehealth, sees the EMR as the central point around which healthcare and health data is unified, coordinated and documented.

“I don’t want my clinicians to have to log in to different systems” depending on who and where they are and what service they’re performing, she said. “That’s not acceptable.”

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Rheuban says interoperability is necessary to pull together successful smaller telehealth and telemedicine programs into the enterprise, where it can be standardized and scaled out to the rest of the health system. Once that is done, providers can track performance metrics through the EMR and pull in other parties – social services, health and wellness counselors, rehab centers, nutritionists, even transportation providers – to create a robust care management platform.

But interoperability also includes the consumer. And Don Rucker, MD, the Health and Humans Services Department’s National Coordinator for Health Information Technology (ONC), says the key to engaging consumers is “getting it on the smartphone.”

Rucker see the mHealth ecosystem as the key to interoperability, and says open APIs and robust standards for data sharing will create a platform that enables everyone to participate.

“Once you have an open API, it’s just absolutely fascinating” what kind of services could be included on that platform, he said. “We’re going to see all kinds of amazing things (with) telemedicine.”

Perhaps the last piece of the interoperability puzzle is the payer market, which has traditionally stayed on its side of the sandbox and let providers and patients do their thing. But Watson, who’s part of an integrated payer-provider network at UPMC, says payers and providers have to come together on this connected care platform.

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“We have to have the same view of the same patient,” he said, through real-time access to data. That would enable providers to target clinical care and outcomes while payers focus on health and wellness tools that improve long-term health management and care coordination.

That idea isn’t lost on the nation’s largest payer, the Centers for Medicare & Medicare Services. Rucker said CMS is building interoperability requirements into all of its payment streams, and is even looking at how telemedicine could be incentivized, much like the push for EMR adoption.

“CMS is extremely interested in incentivizing interoperability as a payer,” he said.

The interoperability issue will likely be front and center in many telemedicine discussions going forward. The ATA plans on continuing the discussion in a Twitter forum on Wednesday, Jan. 30, and will also be tackling the topic at its annual meeting, scheduled for April 14-16 in New Orleans.


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