Clinician Expert: Enhanced Interoperability Needed to Improve Maternal Healthcare
A clinician expert, writing in the Health Affairs Forefront section online, argues that interoperability must be enhanced in U.S. healthcare in order to address the nationwide maternal mortality crisis. Rebekah Dailey, DNP, R.N., a biodesign health policy fellow at the Stanford University School of Medicine, on Nov. 20 published an article entitled “Addressing The Maternal Mortality Crisis By Improving Interoperability.”
Dailey notes that “Despite a presidential declaration of a crisis and continued bipartisan support for increased funding and research, maternal mortality persists as a devastating issue, claiming the lives of hundreds of women per year in the United States. Nearly 80 percent of maternal deaths are preventable, and maternal mortality disproportionately affects Black women, who are three times more likely to die during pregnancy or in the year thereafter than their White counterparts. A number of contributing factors have surfaced in research—advanced maternal age, chronic illness, mental health conditions, and racism or bias”—but she adds that there is a somewhat hidden element that must be looked at—the interoperability, or lack thereof—among patient care organizations and providers.
“In 2021, 41 percent of deliveries were paid for by Medicaid, with one-half of Black non-Hispanic and Hispanic women using Medicaid,” Dailey notes. “This suggests that state Medicaid programs and federally qualified health centers (FQHCs) that serviced more than 15 million Medicaid patients in 2022 are ideal approaches to combating the maternal health crisis and health disparities. Maternal health care models for FQHCs vary and can include hybrid services, such as referral to other clinics if prenatal services are not offered, or delivery management by an FQHC provider, independent provider, or hospital system.”
Significantly, however, “With fewer than 50 percent of hospitals and office-based physicians engaging in interoperable standards, it is standard practice for clinics to print medical records as the patient nears delivery, expecting patients to retain and present them at the hospital,” Dailey writes, adding that “Each transition of care and interdisciplinary collaboration” among the dozen-plus that are typical in a full episode of care for a patient, “increases the potential for errors among FQHCs, ancillary or specialty providers, and birthing hospitals. For example, if a patient has abnormal vital signs or laboratory results from an encounter outside of the birthing hospital and the information is not available upon delivery, the potential for care delays leading to negative outcomes or preventable pregnancy-related deaths increases.”
Importantly, Dailey notes, “Enhanced communication and coordination amongst interdisciplinary care teams is the core of patient-centered care. This suggests the root cause of many preventable maternal deaths lies in the delivery of care and care coordination. Perr that, she writes that “Improving interoperability will require providers to do more than simply use an EHR or get involved in a health information exchange. A goal of the White House Blueprint for Addressing the Maternal Health Crisis is to advance data collection and standardization and eliminate siloed data systems through improved transparency. Increased focus on health centers servicing vulnerable and rural populations will be key to the success of the blueprint, as they are often encumbered with limited financial and other resources.”
Indeed, she is hoping that TEFCA—the federal Trusted Exchange Framework and Common Agreement initiative—“will be able to bridge the interoperability gap, expanding data-sharing capabilities and establishing accountability for stakeholders to enhance their data exchange capabilities.” In the end, she writes, “The exchange of health information plays a vital role in delivery of care and health outcomes for pregnant and postpartum woman. Action is needed to identify the gaps and opportunities for health information exchange to improve maternal mortality rates.”
