Bidirectional Exchange: Another Major Step Toward Healthcare Interoperability

Interoperability

Imagine this scenario. While visiting his daughter and grandchild out of state, a man experiences shortness of breath and chest pains. His daughter rushes him to an urgent care. Thanks to their patient query technology, the medical staff is able to quickly locate important data from the man’s primary care physician before treating him. Score one for healthcare data interoperability.

But there’s something important missing from this scenario, which could bring us much closer to full healthcare interoperability: the ability for the urgent care to easily update the patient’s PCP about the incident and the care they’ve delivered. In other words, bidirectional health data exchange.

What is bidirectional exchange?

Querying patient records is typically a unidirectional method of healthcare data exchange. A provider or healthcare organization asks for patient records and pulls those records in from one or more sources. But if the recipient of that data—say, a hospital—uses it to treat the patient or prescribe medicine, that new information probably won’t make it back to its source.

Over time, this means that a growing number of providers involved in a patient’s continuum of care will have their data become increasingly incomplete and out of date.

This is where bidirectional exchange becomes invaluable and represents something much closer to true healthcare interoperability. When a provider receives patient records and other information at the point of care, both healthcare parties—the sender and recipient of those records—stay updated as to the patient’s current treatment.

A real-world example of bidirectional healthcare data exchange.

Consider a government-operated immunization database. When doctors’ practices, clinics, pharmacies, and other entities administer an immunization, they can send that record through their EHR to the government database.

Now, if an individual were to change primary care physicians, and the government’s system were unidirectional only, the new doctor would have to ask the patient directly if they’d received the immunization. Not a very efficient or reliable process.

But with bidirectional exchange, the government’s system would maintain an up-to-date list of immunized patients—and make those records available to other participating physician practices accessing the database. Under this preferable scenario, that new doctor would be able to query the government’s system and receive any available records of the new patient’s immunization history.

Why is so much of healthcare data exchange unidirectional?

There are several reasons that healthcare data exchange has remained largely a one-way flow of information. The first reason is technological: Many electronic health records (EHR) systems were designed for only unidirectional data flow.

Moreover, most EHRs are designed with their own proprietary methods of identifying, classifying, and organizing data. This means that even if an EHR did enable a recipient of patient information to send back updates to the source, the digital system on both ends would likely speak the same “language.”

These technological obstacles have made it difficult and time consuming for healthcare providers who wanted to send important patient updates back to the organizations that sent them records in the first place. Which leads us to the second reason: inertia. Because most digital healthcare systems do not enable fast and easy bidirectional data flow, few healthcare professionals have developed a system for doing so themselves.

The good news: bidirectional exchange is becoming more prevalent

As more healthcare professionals and organizations experience the benefits of bidirectional exchange—to improve operational efficiencies, reduce healthcare costs, and deliver better patient care—we’re seeing more of the industry moving in this direction.

EHR providers are increasingly building bidirectional exchange capabilities into their platforms. Data standards, particularly HL7’s Fast Healthcare Interoperability Resources (FHIR), are gaining traction with healthcare technology providers specifically as a way to facilitate bidirectional data flow. And in early 2020, the VA and DoD announced their own bidirectional data-sharing capability—which the agencies said will enable them “to more quickly and securely exchange health records with other providers in the wider community.” All of this is great news because it means the healthcare industry is making real progress toward its goal of achieving true healthcare interoperability.

Jeff Solis