For so long in interoperability we’ve focused on the ability to move data, but now that information is flowing, it’s time to focus on data usability. The Sequoia Project, the recognized coordinating entity charged with bringing interoperability to healthcare IT systems through TEFCA, is tackling this issue head-on.

For instance, The Sequoia Project is looking beyond merely connecting IT systems to consider the relevance, quality, and usability of data. The association is partnering with the American Health Information Management Association (AHIMA) on the Data Usability Taking Root Movement to make electronic healthcare information more useful so that not only does data flow, but it’s actually used in care.

I was honored to represent DirectTrust among nearly four dozen implementers, sponsors, and Sequoia-member supporters, many who took part in the first daylong Summit  in Washington, D.C.. Several noted organizations have already pledged their support to the initiative, including DirectTrust members or Standards participants Civitas Networks for Health, Delaware Health Information Network, Epic, Kno2, MedAllies, NextGen, and the New York eHealth Collaborative.

The Summit included a half-day presentation of the V1.0 Data Usability Guide, followed by several breakout sessions where people swapped ideas and shared feedback, and a group exercise to identify future roundtable topics and where the initiative may go in the future.

Overall, the conversation centered on six broad data topics where The Sequoia Project has developed a high-level implementation guide:

  1. Data integrity, format, and trust
  2. Data tagging/searchability
  3. Data provenance and traceability of change
  4. Effective use of codes
  5. Reducing the impact of duplicates
  6. Effective use of narrative for usability

While every usability topic is important, in particular I see opportunity for DirectTrust to contribute to addressing data integrity and its effective tagging.

It’s important to note that the Data Usability Taking Root Movement isn’t developing new standards. Rather, it’s looking at different standards, organizations, government agencies, and regulations to reach consensus on a common way forward that promotes the flow of useful information across the healthcare landscape.  It’s the very best of the “Team Interop” movement – using our unique and individual strengths to advance our common goal of seamless interoperability that positively impacts patient care.

Data Integrity is Foundational to Establishing Trust

If data isn’t accurate or from a trusted source, it isn’t actionable. DirectTrust emphasizes the importance of data integrity through our Directory Improvement Initiative. The guide focuses on accurate patient matching, a foundation of successful interoperability.  The concepts can be extended though to identifying the correct providers for exchange of information.  This is why DirectTrust adopted Project US@’s guidance as part of the entry requirements for our Aggregated Directory. Data accuracy/quality and data usability are complementary in creating an accurate picture of the patient, and of other data points as well.

Didi Davis, recognized as a DirectTrust Interop Hero, serves as Vice President of Informatics, Conformance and Interoperability at Sequoia. The purpose of the initiative, she says, is to provide guidance to arrive at a common dataset that advances patient care. It’s not supposed to be descriptive but collaborative, as evidenced by the Summit and the wide range of attendees.

High-quality but unusable data doesn’t help clinicians or patients. A central challenge of interoperability at scale is determining whether the presented data is from the same patient. Accurate patient matching is a core aspect of data integrity and is critical for patient safety among people with the same name and/or similar identifying attributes. Similarly, DirectTrust hopes to contribute to future versions of the usability guide related to Directory entry best practices as well.

Data Tagging Can Cut Through the Information Clutter

Getting the right data to the right person is a critical success factor in interoperability. Recent work in DirectTrust has focused around “context” in push interoperability.  Essentially, context in Direct can be seen as tagging a message as a particular type: a referral, a 360x closed-loop referral, an admission notification, a discharge notification, etc. Data tagging can help practices and hospitals cut through information clutter and find what they need, including segregating messages based on content.

Let’s take a hospital discharge notification. The primary care provider (PCP) probably doesn’t need that notification but the scheduling staff does to set up a post-hospital PCP visit for the patient. Proper tagging can ensure the right message gets to the right person, reducing information overload and creating efficiencies for clinicians and staff.

Other Issues that Hamper Data Quality

Data provenance provides the foundation for usability: Where is the data coming from and why should providers trust it? One participant said something so compelling that I tweeted it, “Health information moves at the speed of trust, and trust starts with provenance.”

For a start, the Data Taking Root Movement is focusing on provenance metadata for allergies and intolerances, immunizations, medications, and problems to create a template that can guide addressing other data classes.

Effective code use details the differences among standardized code sets that can get lost in translation between sending IT system and receiving system. As the Fast Healthcare Interoperability Resources (FHIR) standard for data exchange continues to gain traction, establishing a common framework will allow clinicians to get at the pertinent, actionable data in a more straightforward manner.

Duplicative information is often the bane of data exchange. Multiple providers may have the same information, or a single provider may have recorded data multiple times. The initiative is focusing on problems, allergies, medications, and immunizations exchanged within clinical document architecture (CDA) documents. Not all duplicative information is unnecessary, however. Think about immunizations like shingles or COVID-19 where multiple doses may be indicated.

Effective use of narrative entails telling the “story” of the patient, which isn’t only contained in discrete data. A narrative discharge summary from the emergency department physician to a PCP, for example, can help explain the thinking behind the tests and the diagnoses the ED physician reached. Likewise, similar communication from provider to patient can include the clinical reasoning and thoughts of the provider.

Finding Consensus Advances Interoperability

It’s no secret I am Team Interop; I believe collectively we can do so much. I hope this is the first of many discussions on how various stakeholders across the interoperability spectrum can come together to collaborate, exchange ideas, find consensus, and discover commonalities that make accurate, actionable data available to everyone.

DirectTrust has a critical role to play as The Sequoia Project’s Data Usability Taking Root initiative comes into sharper focus, not only through informing our Standards work and other initiatives, but also by informing future iterations of the implementation guide as well.

If you’re interested in learning more or joining the Data Usability Taking Root Movement, visit The Sequoia Project’s website here.

Contributed by Kathryn Ayers Wickenhauser, Senior Director of Community Strategy, DirectTrust