Interoperability & Provider Privileging: Part I | symplr

This is the first in a two-part series on healthcare interoperability. Part I examines the reasons why there is such a pervasive lack of interoperability as it relates to provider privileging, while Part II will dive deeper into why interoperability is so important to the provider privileging process - which ultimately affects patient safety.

Improving Provider Privileging 

There's no question that today's healthcare organizations rely on technology to handle all aspects of patient care delivery. The adoption of healthcare electronic medical records is growing exponentially, and the Centers for Medicare & Medicaid Services estimates that over 95% of eligible hospitals have now "demonstrated meaningful use of certified health IT."


An ever-increasing number of platforms are being used to handle everything from medical records and insurance claims to risk, quality, and provider management. And while there's no doubt these systems have led to improved care delivery, the growing lack of interoperability between them is an ongoing concern to organizations’ ability to prevent privileging errors.


What Do We Mean by Interoperability?

The Healthcare Information and Management Systems Society (HIMSS) offers this definition of interoperability:

“In healthcare, interoperability is the ability of different information technology systems and software applications to communicate, exchange data, and use the information that has been exchanged.”

Simply put, the different systems a typical healthcare facility uses need to be able to communicate with each other for optimal results. It means having the ability to maintain your data in one  place and to have that data be reflected in any number of other places.

It’s been an ongoing issue for the sector at large for years, which you can learn more about in this in-depth healthcare interoperability analysis. But it’s also a critical issue for privileging specifically.

Provider/ Physician Privileging

Provider privileging - the process of determining a doctor's qualifications to perform certain clinical procedures and the granting of permission to do so - depends on the healthcare facility's ability to compile and analyze a great deal of information. Factors such as education, experience, certification, licensure,  specialty, and more need to be collected, verified and examined to determine which procedures a physician can safely be permitted to practice.

Before we dive into the specific problems arising from interoperability issues, let’s look at why - from a privileging standpoint - the industry is struggling to improve data exchange and transparency. 


Reasons For Ongoing Privileging-Specific Interoperability Issues

It's a drastic oversimplification to line up the healthcare industry with other sectors and compare its success in achieving interoperability relative to others. The fact is, healthcare faces a dizzying number of regulatory challenges that other sectors don't.



With an eye toward improving healthcare interoperability, the U.S. Federal Government passed the Health Information Technology for Economic and Clinical Health Act (HITECH) which established the Office of the National Coordinator for Health Information Technology (ONC).

The ONC's mandate is to act as "the principal federal entity charged with coordination of nationwide efforts to implement and use the most advanced health information technology and the electronic exchange of health information.” And although the ONC is steadily moving the interoperability needle forward, several obstacles remain.  

Here are some of the obstacles to interoperability that have significant impacts on provider privileging.


1. Lack of Modern Standards

Each industry faces unique business conditions. When a new technology emerges, the dominant industry player effectively establishes the standards, which in turn allows laws and regulations to adapt to the technology.

However, healthcare has to take an inverse course. With so many pre-existing regulations in place, healthcare technology has to adapt itself to those conditions. Because the industry has had to bend itself to accommodate existing regulatory frameworks, it frequently leads to inefficient means of data exchange.

Despite the ONC's goal of creating a healthcare interoperability framework, the fact remains that a lack of a consistent set of interoperability standards to bridge the gap means that new technology has to contend with archaic accreditation regulations, slowing the process.


2. Lack of Specialized Resources

For most providers, resource availability comes at a premium. Many simply don't have what they need to implement new technology structures that maximize healthcare interoperability.

This lack of resources can take the form of:

  • Skilled and qualified personnel
  • Relevant knowledge base
  • Financial capabilities

Boosting interoperability within a health organization usually requires highly technical personnel, including I.T. developers, software developers, and I.T. experts specializing in infrastructure, architecture, and business analysis.

Also, these IT specialists have to understand the regulatory requirements specific to healthcare. HIPAA regulations, for example, must be fully complied with, and integrated systems have to be designed with this in mind. BSo bridging the gap between the business side and the technology side requires a level of specialized knowledge that can be difficult to come by - and costly.


3. Regulations Favor Legacy Technology

Ever-changing technology is another problem placing healthcare organizations.

Blockchain-based technology, for example, promises improved levels of data efficiency and security. However, blockchain's strength – its improved ability to disseminate sensitive information over distributed networks –naturally conflicts with pre-existing rules around accreditation. And since these archaic regulations favor older legacy technology, organizations simply can't take advantage of necessary upgrades.


The Next Steps Toward Interoperability

Ultimately, it will fall upon the business units of healthcare organizations to try and sort out the difficulties of upgrading to and integrating with newer-generation systems. How quickly they get there depends on a combination of ONC incentives, interoperability-focused changes to regulations, and a willingness to expend the proper resources to bring about change that reduces privileging errors and improves patient safety.


In Part II , we'll examine some of the problems a lack of interoperability brings to the provider privileging process.

symplr covers all the angles – from the credentialing, enrollment, and privileging of providers to tracking provider and practice quality to managing vendor and visitor activity in your facility – with advanced solutions, services, and support. Schedule a demo of our credentialing & privileging software solutions to learn more.

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